Enhancing our Anti-Obesity drug plan management with Prior Authorization

August 13, 2024

Read time: 2 minutes

Anti-Obesity medications are currently an optional drug category at Sun Life. As Anti-Obesity medications continue to evolve, we remain committed to drug plan sustainability.

What’s Changing

Starting October 15, 2024, Sun Life will add Anti-Obesity medications to the Prior Authorization program. This change will help plan sponsors better manage the financial impact of these medications to their plan.

Impacted Clients

This change applies only to Clients with:

  • plans that cover Anti-Obesity drugs, but without an Anti-Obesity drug maximum, and
  • a Prior Authorization program that does not currently apply to Anti-Obesity medications.

What you need to know

Below is the key information you need to know as you continue to advise and support your Clients:

  • This is an administrative change only. You or your Client don’t have to take any action.
  • Prior Authorization will apply to Anti-Obesity medications as of October 15, 2024.
  • We won’t disrupt member coverage. All members who claimed an Anti-Obesity medication in the 120 days before this change will continue to receive coverage without Prior Authorization. If the member requires a new medication in this drug category in the future, Prior Authorization will be required. 
  • We’ll communicate this change to Plan Sponsors. We won’t communicate to plan members, as there is no disruption to coverage.

At this time, this administrative change doesn’t apply to plans with an annual or a lifetime maximum for the Anti-Obesity category. 

Prior Authorization forms

  • Plan members can get the form by going to mysunlife.ca/priorauthorization. They can also use the Drug Look up tool in the my Sun Life mobile app.
  • To submit the form, they can use the “Submit documents” feature and enter “prior auth” as the reference number. They also have the options of sending the form by mail to their nearest claims office. Or, they may fax the form to 1-855-342-9915.

Questions? We’re here to help.

Please contact your Sun Life Group Benefits representative.