Originally from our sister publication, smallbizadvisor.ca
On May 1, 2013 Medavie Blue Cross is adopting mandatory generic substitution on all of their existing insured small group business clients with 50 or fewer employees. Medavie Blue Cross joins Great-West Life and Sun Life in making generic substitution mandatory for plans.
Mandatory generic substitution applies similar principles as generic substitution, which is when the plan will pay for the generic equivalent of a drug (when its available), unless a doctor insists on a name-brand drug. The key difference is that even if the member submits a prescription with “no substitution” indicated at the pharmacy, the plan will reimburse only up to the cost of the generic drug even if a brand name drug is dispensed.
Read: Price set for 6 widely used generic drugs
Medavie has developed an exception process for those instances when a prescriber indicates there is a medically substantive need for the member to remain on the brand name drug. Claimants or prescribers can provide a copy of the Canada Vigilance Adverse Reaction Reporting Form submitted to Health Canada on the claimant’s behalf, as well as the applicable Medavie Blue Cross request form for coverage consideration.
Applicable forms can be found on the forms section of medavie.bluecross.ca.
While providers move to make mandatory generic substitution the default in drug plan design, it still may be possible to keep the previous design. Advisors with clients who do not want mandatory generic substitution should contact their providers to ask how to avoid being moved to this new plan design as well as the costs associated with staying with the previous set up.