Project Description

Specialty Medications

What you need to know

FormuCARE™
FormuCARE PLUS™

What are Specialty Medications?

Specialty medications that have a potential annual cost of $10,000 a year or more can have an enormous impact on the cost of your employee benefits plan.

Your plan includes a benefit called Coverage Navigation Services that will help you find alternative coverage options for high-cost specialty medications because, while your employee drug plan covers the cost of commonly prescribed medications or lower-cost specialty medications (up to the limits in your benefit booklet).

Your plan may not cover high-cost specialty medications (this arrangement is known as FormuCARE) or it may only cover the cost of high-cost speciality medications in certain circumstances (this arrangement is known as FormuCARE PLUS).

What are high-cost specialty medications?

High-cost specialty medications target specific, complex and chronic conditions such as, but not limited to, hepatitis C, rheumatoid arthritis, cancer and multiple sclerosis. They have a potential annual cost of $10,000 or more and typically require special handling, administration and monitoring.

For residents of

British Columbia, Saskatchewan & Manitoba

If you live in British Columbia, Saskatchewan or Manitoba your specialty medications may be covered, in whole or in part, by provincial Pharmacare programs.

  • If you are currently on a speciality medication and have already received special authority approval from your provincial plan, there will be no change to your coverage provided your condition supports the continuation of the drug therapy.

  • If your provincial Pharmacare program does not cover your specialty medication, or you are awaiting approval from your provincial program or spouses plan, your plan includes Coverage Navigation Services, a service through ClaimSecure that assists in finding alternative coverage options, including government or manufacturer’s patient assistant programs.

For residents of

Alberta, Ontario, Quebec, Prince Edward Island, Newfoundland, Nova Scotia, New Brunswick, Yukon Territory, Northwest Territory & Nunavut

If you live in these provinces you can use personalized Coverage Navigation Services to assist you with alternative coverage options.

Finding alternative coverage with

Coverage Navigation Services

If you’re prescribed a high-cost specialty medication you can use Coverage Navigation Services, provided through ClaimSecure that assists in finding alternative coverage options, including government programs, manufacturer’s patient assistant programs or a spouse’s benefits plan.

Read ‘Will my specialty medications be covered?‘ and more FAQs.

Accessing your coverage navigation services

Talk to a ClaimSecure Representative to find out what you need to do to enroll in Coverage Navigation Services:

  1. Email: CoverageNavigation@claimsecure.com
  2. Phone: 1.888.479.7587
    • choose option 1
      – Clinical Services at the main menu
    • choose option 3
      – Coverage Navigation from the sub menu

Tip! Use this enrolment form as a reference to understand the questions you’ll need to answer.

Frequently asked questions

Learn more