CSBT’S BCNU Rx PLAN

CSBT’S BCNU Rx PLAN2019-02-25T17:25:17+00:00
CSBT Logo | GroupHEALTH Benefit Solutions - Canada
BC Nurses Union Logo | GroupHEALTH Benefit Solutions - Canada

About the Plan

We are please to inform you that effective October 1, 2017, and retroactive to January 1, 2017, your prescription drugs will be covered under CSBT’s BCNU Rx Plan. This place has been specially designed to meet the terms of the 2014-2019 Provincial Collective Agreement and includes a significant improvement to your drug coverage.

Quick Links

Which drugs require pre-approval before they will be covered by the plan? Click here

Where do I find ClaimSecure’s Special Authorization Form? Click here

Where do I find the ClaimSecure submission form for BC PharmaCare Special Authority drugs? Click here

Where do I find the form to apply for full coverage of a brand name drug? Click here

Frequently Asked Questions

Drug Plan Features

The BCNU Rx plan is managed by ClaimSecure and covers the majority of drugs approved for use in Canada. ClaimSecure reviews drugs to ensure those added to the formulary offer the best mix of clinical and cost-effectiveness.

A small selection of drugs require pre-approval before they are covered by your drug plan. View the list here.

Certain drugs are excluded from coverage under your plan. These include drugs previous excluded, such as vaccines, vitamins, non-prescription drugs, and anti-obesity medication.

Additionally, there is a small number of high-cost drugs with similar therapeutic benefits to those already covered by the plan.

To check how your drug is covered, login into your eProfile on ClaimSecure’s site and follow the steps outlined here.

Click here to view the list of drugs requiring pre-approval.

The easiest way to submit your claims is with the ClaimSecure app. You can take a photo of your receipts, and simply submit them for processing. Once your claim has been processed you can expect to receive payment within two days via direct deposit.

You can also submit your claims online through your eProfile at ClaimSecure.com or complete a paper claim form and mail it to the address listed on the form. Claim forms may be found here.

No, your deductible and co-pay do not change.

Pre-Approval Drugs

There are two types of pre-approval drugs:

  1. Drugs that require ClaimSecure Special Authorization
  2. Drugs that require BC PharmaCare Special Authority

For a complete list of all drugs that require pre-approval, click here.

If you have already been approved for Special Authority, you will not need to go through the application process again. Your Special Authority approval has been transferred over under the new plan and coverage will continue at the point of sale.

The duration of coverage depends upon the specific drug and condition being treated. If your Special Authority approval includes a time limit for approval, you will need to reapply once the approval has expired.

If your new drug does require Special Authorization (from ClaimSecure) in order to be covered by the plan, follow these steps:

  1. Download the Special Authorization Form found here.
  2. Print off the form and complete Part 1 for members (Part 2 is To be completed by Physician)
  3. Ask your doctor to complete the remainder of the form (if applicable – see instructions below)
  4. Fax, mail or email the completed form using the contact info at the top of the form

ClaimSecure Special Authorization – Specialist Exemptions

For certain Special Authorization drugs, when the drug is prescribed by a specialist, the physician is not required to complete his/her portion of the form.

To determine whether your physician needs to complete their portion of the form, view the list of drugs requiring pre-approval here. If your drug is prescribed by the type of specialist listed, it is covered by a Specialist Exemption. In order to receive coverage for a drug covered by a Specialist Exemption, you simply complete Part 1 of the ClaimSecure Special Authorization form, indicating the drug prescribed and your physician’s information before submitting the form to ClaimSecure.

If you have just received Special Authority approval from BC PharmaCare, you are not required to also request Special Authorization from ClaimSecure. You will need to provide confirmation of your Special Authority approval to ClaimSecure. Once logged, the drug will be covered, retroactive to the date of approval by BC PharmaCare.

To provide confirmation of Special Authority approval, complete the ClaimSecure Submission Form for BC Pharmacare Drugs and submit it along with a written copy of your BC PharmaCare Special Authority approval to ClaimSecure for processing.

If you do not have written confirmation of approval from BC PharmaCare but have confirmed approval is in place, please complete a Submission Form for BC PharmaCare Drugs and ClaimSecure will confirm your approval directly with your doctor or pharmacist. Your doctor or pharmacist may also call ClaimSecure’s Special Authorization Team to confirm BC PharmaCare approval over the phone.

The BC government created Fair PharmaCare to help protect British Columbians from high drug costs by subsidizing eligible drugs prescribed by a physician.

To be eligible for BC PharmaCare you must register with Health Insurance BC either online or by phone (1-800-663-7100).

Please note: Your BC PharmaCare deductible will be paid by your private drug plan. Your plan deductible remains $25 per calendar year.

All applications for PharmaCare Special Authority are to be completed by a practising medical prescriber. Your doctor will be familiar with this process and will have the necessary forms.

If your Special Authority request is successful, please forward a copy of the approval form to ClaimSecure using one of the following methods:

By fax
905-949-3029

By mail
Clinical Services, ClaimSecure Inc.
Suite 620, 1 City Centre Drive
Mississauga, Ontario  L5B 1M2

By email
Special.Authorization@Claimsecure.com

If you are prescribed a drug not covered by the plan, you can apply for exceptional coverage through the appeal process (please refer to the next question below) or speak with your doctor regarding a suitable alternative.

To submit an appeal, please submit the following documentation to the Clinical Pharmacist team at ClaimSecure:

  • A completed ClaimSecure Special Authorization form
  • Special Authority denial letter from BC PharmaCare, which clearly identifies the drug denied (if appealing a BC Pharmacare drug)
  • Physician letter outlining the clinical rationale for why the plan member does not (1) meet the coverage criteria, and (2) is not able to use the suggested alternatives.

Please submit the requested documentation to ClaimSecure at:

By email
ClinicalPharmacist@ClaimSecure.com

By mail
Attention: Clinical Pharmacists
1 City Centre Drive, Suite 620
Mississauga, Ontario L5B 1M2

By fax
1-905-949-3029
Attention: Clinical Pharmacist

ClaimSecure’s Clinical Pharmacist team along with the Manager or Director will review the documentation. The decision will be communicated to you in writing.

Retroactive Reimbursement

Any drug that is eligible under the new, enhanced BCNU Rx plan will be eligible for reimbursement retroactive to January 1, 2017.

Out of pocket drug claim expenses submitted for drugs covered under the BCNU Rx Drug Formulary will be reimbursed retroactive to January 1, 2017.

If your drug requires ClaimSecure Special Authorization before it will be covered by the plan, please complete the request form and submit to ClaimSecure. If your drug is approved, Special Authorization approval will be retroactive to January 1, 2017. Out of pocket expenses for an approved drug purchased from January 1, 2017, onwards will be reimbursed.

To obtain reimbursement, please use one of the following methods:

Note: For a complete receipt of all drugs purchased from January 1, 2017, onwards, ask your pharmacist for an ‘Official PharmaCare Receipt’ printout. This may then be used to request reimbursement from ClaimSecure.

  • Complete a Drug Claims Form found on claimsecure.com and submit along with pharmacy receipts, to the address listed on the form.
  • Submit claims online through your eProfile on claimsecure.com
  • Submit via fax to 1-866-613-0530. Include a completed Drug Claims Form found on ClaimSecure.com along with copies of the official pharmacy receipts

Still have questions?

For general inquiries, please contact ClaimSecure by phone at 1-855-324-2444.

For pre-approval drug inquiries, please contact the ClaimSecure Special Authorization team:

By email
Special.Authorization@claimsecure.com

By phone
1-888-479-7587

By fax
1-866-613-0530

Contact Info

Suite 200, 2626 Croydon Drive
Surrey, BC V3Z 0S8

Phone: 1.877.542.4110