New coverage limits for your benefits plan

To align with similar plans and respond to member preferences, there will be a number of enhancements and changes to your Retiree Benefits Plan effective January 1, 2021.

We’re pleased to advise that coverages for the following benefits have been enhanced:

• vision care coverage has been increased to $250 every two calendar years for adult members,
• new coverage for eye exams to a maximum of $75 every two calendar years for all members,
• the annual per person per paramedical maximum for all categories is now consistent at $500 per calendar year, which will make it easier for you to track your coverage levels and reimbursements, and
• new coverage for the shingles vaccine for all members.

Note that coverage for oral sleep apnea devices has been removed to align with industry standards.

Changes to drug dispensing fee coverage

To better align with industry best practice, new dispensing fee limits for a defined set of drugs used to manage chronic conditions will be introduced. Limiting dispensing fees is common for health benefit plans and benefits carriers.

Dispensing fees for drugs included on the Maintenance Drug list will be limited to five per year, although there are some situations in which 13 dispensing fees are covered (i.e. if you are eligible for blister packaging). All other oral medications (tablets and capsules) used to treat chronic conditions will be limited to 13 dispensing fees per calendar year.

Medications you use for an acute or a non-chronic condition (drugs you don’t take regularly) or non-oral medications (liquids, inhalers, compounds, injectables) will not be subject to this new limit.

You can choose to have more frequent prescription fills for these medications, but you’ll be responsible for covering any additional dispensing fees; we will continue to cover the cost of the drug in accordance with the terms of the Retiree Benefits Plan.

Less frequent prescription fills mean:

• fewer trips to the pharmacy are required, which may be helpful if you’re less mobile or to simply give you more time for other activities.
• a decrease in your out-of-pocket costs for the co-pay, which could add up if you’re taking multiple medications to manage your chronic conditions. You can save even more by getting your prescriptions filled at one of our Preferred Pharmacy Network (PPN) partners. Learn more about the PPN.

Find out if your medication is impacted by using the Drug Look up tool on our Member Profile or on the Pacific Blue Cross Member App after January 1, 2021. In the interim, we invite you to speak to your pharmacist about possible impacts to the drugs you’re taking.

Learn about Fair PharmaCare and PharmaCare deductible reassessments.

Communication

Pacific Blue Cross will be communicating directly with plan members impacted by these new limits to ensure you understand the changes. We are also reaching out to pharmacies and pharmacists across the province so they can advise you on how to avoid paying additional costs on dispensing fees.

If you are impacted, we encourage you to talk to your pharmacist to ensure a smooth transition for your prescriptions effective January 1, 2021.

If you have additional questions about any of these changes, please contact us at 604 419-2000 (toll free at 1 800 USE-BLUE) and our Customer Service Representatives will be pleased to assist you.