Important update on Pharmacare
The Facilities Bargaining Association (FBA) has reached an agreement with the Health Employers Association of BC (HEABC) to address some problems in the implementation of the Pharmacare tie-in.
HEU secretary-business manager Bonnie Pearson says that the roll-out of the program has been challenging for many members and that the changes address a number of common issues.
“We’ll continue to work with employers, Pacific Blue Cross and other bodies to ensure that our members continue to have access to a first-class benefits plan,” says Pearson.
- restores coverage for ten specific high use drugs for members who were prescribed these medications under the previous drug plan; and
- reimburses members for fees charged by doctors for filling out Special Authority requests.
Who is covered
Members (and their dependents covered by the drug plan) can now receive coverage for ten specific drugs that are not included in the Pharmacare list of drugs.
To qualify for this coverage, a member or their dependent must have had an approved claim for one of the listed drugs in the six months (December 1, 2012 – June 1, 2013) before the Pharmacare tie-in came into effect.
- If a member continued to pay for this drug out-of-pocket under the new plan, they can be reimbursed for those costs and covered for that drug going forward.
- Members who stopped taking one of the ten listed drugs under the new plan can receive coverage for that drug going forward.
Pacific Blue Cross will contact all members or dependents who qualify for this coverage. Members do not need to contact the union themselves to qualify.
There is no maximum cap on reimbursements and coverage under this arrangement.
The ten drugs listed in the attached agreement had been identified in the 2012 negotiations as covered, but that coverage was subsequently refused.
The agreement to restore coverage for these ten specific drugs was reached in response to a policy grievance filed by HEU on behalf of the Facilities Bargaining Association.
Special Authority fees
Another area of dispute has been Special Authority fees. HEABC and Pacific Blue Cross have confirmed that members will be reimbursed for any Special Authority fees charged by doctors on or after December 1, 2012.
A member need only complete an Extended Health claim form, and include the original receipt and relevant information.
The parties have been advised that doctors are not to charge members any Special Authority fees, but this agreement will cover anyone who was charged.
- The parties also clarified which Pharmacare rules are applicable to FBA members, including the price per pill limit.
- FBA members will be entitled to a dispensing fee reimbursement of either $9 (as per the previous collective agreement) or the Pharmacare maximum, whichever is higher.
- The parties have also agreed to improved communication and reporting between the benefit provider and the FBA so as to identify and minimize any future implementation issues.
The Pharmacare program was agreed to in the 2012 round of FBA bargaining, and came into effect for members on June 1, 2013. That agreement linked members’ prescription drug coverage to the list of drugs covered by the B.C. government’s Fair Pharmacare program.
“We support the Fair Pharmacare program because it is good public policy and will protect our benefit coverage over the long-term,” says HEU secretary-business manager Bonnie Pearson. “However, we need to continue to address ongoing issues.”