Expanding integration with provincial cancer drug programs

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As we communicated in December 2010, directing drug claims to specialty drug programs will help plan sponsors manage the increases in the overall drug claims experience and enable plan members and their dependants to receive as much coverage as possible. 

We’ve continued to monitor these types of specialty programs to identify additional integration opportunities.  We are pleased to announce effective June 1, 2011, eligible plan members in the provinces of British Columbia, Alberta, Saskatchewan, Ontario, Manitoba and Prince Edward Island, who claim for any of the identified cancer drugs, will be directed to apply to applicable provincial programs.

What this means for plan sponsors

Sun Life has processes and controls in place to integrate with basic provincial drug plans.In January 2011, we expanded this integration for specialty drug programs to ensure plan members accessed additional coverage opportunities through the province before their benefits plan. 

How coverage will be integrated

If the province provides full coverage, the claimant will not be eligible for reimbursement through their group benefits plan.

  • If the province provides partial coverage, Sun Life will pay the remaining portion of the drug cost, according to the terms of the group benefits plan.
  • If the province does not provide any coverage, Sun Life will continue to cover the drug according to the terms of the group benefits plan.

Questions?

Please contact your Sun Life Financial group benefits representative.