Our Drug Risk Management (DRM) program reviews:
- all new drugs, and
- existing drugs approved by Health Canada for use in a new disease area (or for new medical conditions).
How it works
DRM helps us determine whether these drugs should be:
- covered under the plan as regular benefits,
- covered under the plan but subject to the prior authorization program if applicable, or
- excluded from the plan for specific or all conditions.
As the drug landscape evolves, we review our coverage for drugs. For example, if Health Canada approves a drug for a new condition, we'd evaluate the drug again for that condition.
We assess the eligibility for drug reimbursement based on factors such as:
- comparative analysis of the drug cost, its clinical effectiveness and safety profile.
- availability of other drugs on the market to treat the same condition.
- plan sustainability.
Drugs under review are not eligible for coverage. After approval, we pay drug claims only on or after the date we added them to the plan.