Prescription drug coverage: what's  included?

Prescription drug coverage can vary from one plan to another. Whether you're self-employed, topping up your workplace coverage, or between jobs, it helps to know how prescription benefits work.   

This article explains what drug coverage includes under Sun Life's Personal Health Insurance (PHI) plans, how it works, and what to check before you fill a prescription. It also highlights common coverage limits, so you know what to expect.

What's usually included in prescription drug coverage?   

Sun Life PHI prescription drug coverage may help pay for eligible medications that a licensed health-care provider prescribes for you. Depending on which plan you choose;  Basic,  Standard, or Enhanced, your coverage may include brand-name or generic drugs, and a portion of certain pharmacy fees.   

Some medications may need prior authorization, and coverage can vary by province or territory. 

What to keep in mind:   

• Coverage applies only to drugs your provider prescribes   
• Some medications may need prior authorization before they're covered   
• Your plan may include limits and annual maximums   
• A pay-direct drug card may be available (except in Quebec)   

It also helps to check your plan details to understand reimbursement tiers. Sun Life plans reimburse at different rates depending on your plan, which can affect how much coverage you receive.

At a glance: Sun Life PHI plans drug coverage

How do I check if a prescription drug is covered?   

The easiest way is to review your plan booklet, online benefits account or use Sun Life's online tools.

Here's a simple way to narrow it down:   

• Look up the drug name in your plan materials or online   
• Check whether the drug is covered in full or if prior authorization is needed   
• Confirm whether there are limits on quantity, timing, or reimbursement based on your plan's annual maximum   

Have the exact medication name and dosage on hand. Small details can make a difference, two drugs with similar names may have different coverage rules.

What drugs are excluded across all Sun Life PHI plans?  

• The following drugs aren’t covered in any of Sun Life’s PHI plans:  
• Contraceptives (except oral contraceptives in the Enhanced plan)   
• Fertility drugs   
• Dietary supplements and vitamins   
• Over-the-counter medications (even if prescribed by a physician or nurse practitioner)   
• Drugs to treat obesity (Ozempic, Wegovy, etc.

Brand name or generic: What's the difference?  

Brand-name and generic drugs often contain the same active ingredient, but they're not always treated the same way under a plan. A generic drug is usually sold under its chemical name once the brand-name version is no longer protected by patent rules. A brand-name drug is the original product sold by the manufacturer.    

Some health plans encourage the use of a generic option when one is available. Not every medication has a generic version, and some people may need the brand-name drug for medical reasons. If that's your situation, your provider may be able to explain why and whether an exception could be considered.

Which drugs need prior authorization?   

Prior authorization means Sun Life needs more information before deciding whether a drug may be covered. This is common for some medications, especially higher-risk drugs, newer treatments, or drugs that have alternatives on the plan's drug list.   

Your provider may need to send:   

• the drug name and dosage   
• the reason it's needed   
• any past treatment history   
• details showing why another medication may not be suitable   

Prior authorization exists to make sure the drug fits your plan's coverage rules. If a drug needs this review, it's a good idea to start the process before you run out of medication. 

How can I make better use of my Sun Life prescription drug coverage?   

How can I make better use of my Sun Life prescription drug coverage?   

A little preparation can go a long way. Keep your plan information handy, check your drug list before you start a new medication, and ask questions early if something's unclear.   

A few simple habits can help:   

• Keep an updated list of your medications   
• Save your Sun Life plan booklet or online login details in one place   
• Check coverage ahead of time if you're starting a new prescription   
• Ask about options if a medication is no longer covered   

Prescription drug coverage is one part of your complete health picture. Sun Life Personal Health Insurance can also help cover dental care, vision care, physiotherapy, emergency travel medical, and more, depending on which plan you choose. Looking at the full picture may help you see where your coverage is strong and where there may be gaps.

Ready to learn more?   

Visit our personal health insurance page to learn more about our different plan tiers and choose the one that best fits your drug coverage needs.

When you’re ready, get a quote and easily apply for personal health insurance online.   

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