WHAT YOU NEED TO KNOW
Prescription drugs can be costly, but paying for them is a lot easier when it’s affordable under your health care plan. The cost you’ll pay depends on the type of medication and how you get it filled.
Prescription Coverage
If you enrol in the Extended Health Care plan, you will have the following prescription coverage:
| Basic Coverage | Core Coverage | Plus Coverage | |
|---|---|---|---|
| Coinsurance | 20% | 90% | 100% |
| Annual maximum | $10,000 | $100,000 | $100,000 |
| Fertility drugs | None | 50% up to $5,000 lifetime maximum | 50% up to $15,000 lifetime maximum |
Dispensing Limits
For most prescriptions, the plan covers up to a 34-day supply. For maintenance medications taken on a long-term basis, you may receive up to a 100-day supply, where appropriate. Ask your doctor or pharmacist whether a longer supply is suitable, as this may reduce pharmacy visits and dispensing fees.
Dispensing Fees
Dispensing fees and pharmacy mark-ups vary by pharmacy and province. Manulife reimburses eligible fees and mark-ups up to its reasonable and customary limits, based on provincial market conditions. If a pharmacy charges more than the allowable amount, you are responsible for the difference. Comparing pharmacy prices can help reduce your out-of-pocket costs.
Pharmacy Requirements
Republic Services' prescription drug program does not require members to use a preferred pharmacy network. Prescriptions may be filled at the pharmacy of your choice.
Certain specialty medications may be eligible for additional support through Manulife's Specialty Drug Care program, which offers voluntary services such as nurse case management.
How the Drug Plan Works
Present your benefits card at the pharmacy for direct processing. There is no drug deductible, and eligible prescriptions are reimbursed based on the coverage level for your selected plan option.
Mandatory Generic Substitution
The plan reimburses eligible prescriptions up to the cost of the lowest-priced interchangeable medication, usually a generic drug. If no interchangeable alternative is available, the brand-name drug is reimbursed at the applicable coverage level.
Brand-Name Drug Approval
If you cannot take an interchangeable generic drug for medical reasons, your physician may submit medical information to Manulife to request approval for the brand-name drug. Forms and instructions will be available through the Manulife plan member site.
My Drug Plan
Use My Drug Plan to look up a medication, review its coverage and check whether a lower-cost generic alternative is available. Access the tool through the Manulife plan member site or the Manulife mobile app.
Quebéc employees age 65 and over
If you live in Québec and are age 65 or older, special prescription drug coverage rules apply. You will be asked to complete a RAMQ declaration during enrolment.
Depending on your situation and the options available under the Republic Services plan, you may choose:
- The Republic Services prescription drug plan for your basic drug coverage; or
- RAMQ for basic drug coverage, with the Republic Services plan providing supplemental coverage.
If you choose the Republic Services prescription drug plan instead of RAMQ for your basic drug coverage, you will pay an additional contribution through payroll. The amount depends on the health option and coverage level you choose.
Health Option Coverage Level Annual Contribution Estimated per Weekly Pay Basic or Core Employee only $2,000 $38.46 Basic or Core Employee + 1 $4,000 $76.92 Basic or Core Employee + 2 or more $4,000 $76.92 Plus Employee only $2,100 $40.38 Plus Employee + 1 $4,200 $80.77 Plus Employee + 2 or more $4,350 $83.65 Estimated per-pay amounts are based on 52 weekly pay periods and may vary slightly due to payroll rounding. These contributions are in addition to any other employee-paid benefit costs that apply to your elections.
For more information, please refer to the RAMQ FAQ.
If you are covered by a collective bargaining agreement, check your union contract, as eligibility and benefits might be different for each program.
