New hepatitis category coming to your prior authorization program

#453

PDF Version

If you have Sun Life’s prior authorization (PA) program on your Pay Direct Drug plan, the new hepatitis category will be added to your program, effective July 4, 2014.

Why is there a new category?

Prior authorization aims to manage drug plan costs while providing your plan members with coverage for the right treatment for them.  From 2009 to 2012 the drug spend on hepatitis medicines increased by 98%, while the number of claimants only increased by 2%. With the introduction of Sovaldi and Galexos earlier this year we expect to see another dramatic increase in Hepatitis spend.

Recognizing these factors and how they may affect drug plans, TELUS Health has created this new hepatitis category of PA drugs and Sun Life is adding it to our PA program.  For a list of the drugs to be included in the new category, visit mysunlife.ca/priorauthorization after July 4, 2014, or speak to your Sun Life group benefits representative.

Grandfathering

When this category is added to your plan, we will “grandfather” any plan members already taking any of these drugs.  What that means is that if a plan member has already been reimbursed for any of these drugs in the 120 days before July 4, 2014, they will not need to apply for prior authorization approval for their prescription.

Easier way to navigate prior authorization online

You may have noticed that sunlife.ca and mysunlife.ca have both been updated with a new look in the past few months.  At the same time, we have created an easy and permanent way for you and your and plan members to navigate to the prior authorization page online. Now you can simply go to mysunlife.ca/priorauthorization to find the list of PA drugs and forms that is relevant to your PA program.

Sharing the news

We have attached a plan member communication for you to share this information with your plan members. This communication will also let them know about the new URL they can use to access PA information about your plan.

Questions?

Please contact your Client Service Administrator at 1-877-786-7227.