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
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 these steps.
Click here to view the list of drugs requiring pre-approval.
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.
How do I find out if my drug is covered?
- Click on the “My Coverage” tab
- Choose “Drug” as the benefit type
- Enter the drug name or DIN code
- Click on the relevant result below. Eligibility will be listed near the top.
Pre-approved drugs
- Drugs that require ClaimSecure Special Authorization
- 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.
- Download the Special Authorization Form found here.
- Print off the form and complete Part 1 for members (Part 2 is To be completed by Physician)
- Ask your doctor to complete the remainder of the form (if applicable – see instructions below)
- 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.
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
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.
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?
General inquiries
Please contact ClaimSecure by calling 1-855-324-2444
Pre-approval drug inquiries
Please contact the ClaimSecure Special Authorization team by:
- Email: Special.Authorization@claimsecure.com
- Phone: 1-888-479-7587
- Fax: 1-866-613-0530
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