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Rx05 Drug Formulary

A drug formulary is a listing of drugs and medicines covered under a drug benefits plan.Rx05 is a managed drug formulary that provides eligible employees with a base plan design that is very similar to previous drug plan designs with some differences.  Rx05 provides coverage for drugs that have a Drug Identification Number (DIN) and are prescribed by a doctor or dentist and are obtained from a pharmacist.  McMaster University does not determine which drugs are covered.

Frequently Asked Questions

To increase the value we receive from our benefit dollars. The formulary reduces the rate of increase of costs while providing necessary drug coverage for the employees.

As defined by the Ontario Ministry of Health and Long Term Care, ‘generic drugs’ are drug products that contain the same medicinal or therapeutic ingredient(s) as the original brand name drug. Generic and brand name products may look or taste different but both contain the same amount of the same active drug(s). There is no difference in the quality, purity, effectiveness or safety between the generic and brand name versions. Generic drugs usually come to the market once the patent on the brand name drug expires, and as approved by Health Canada.

When an employee submits a brand name drug prescription to the pharmacist which has an equivalent generic drug, the pharmacist is required to dispense the generic drug. In the event that an employee does not accept the generic substitution, they may purchase the brand name drug; however the Extended Health Care plan will only reimburse the employee up to the cost of the generic equivalent.

Pharmacists can connect to the Sun Life database to determine your drug coverage.  They may also call Sun Life directly using the ‘Pharmacists Hotline’.

Once a new drug is approved by Health Canada, an independent review body evaluates the new drug for its medical and cost efficacy. Where clinical evidence supports that the new drug is medically beneficial as a first line treatment, that drug will be added to the plan design. New drugs added to the National Formulary will be added to the Rx05 formulary.

If you have any questions about whether a specific drug is covered under the Rx05 drug formulary, please contact Sun Life directly at 1-800-361-6212 or email askus@sunlife.com . You will need the DIN in order for Sun Life to provide a response.

Normally under the drug formulary a generic drug will be substituted, when available, by the pharmacists.  However your physician can instruct the pharmacists to dispense the brand name version of the drug.  In this case you will be reimbursed up to the level of the least cost generic drug.