PocketPills is an online pharmacy service that can help manage your medications and the cost of your prescriptions. This is an optional offering that you may select. Through PocketPills both employers and employees of our plan will see significant savings. With lower costs per prescription, claims amounts will be reduced, resulting in lower out of pocket expense for plan members, better claims experience, and possible future premiums cost-savings for employers.

All drugs newly approved in the Canadian market are evaluated by a Green Shield Canada (GSC) committee of pharmacy experts before being added to the formulary for reimbursement. Drugs are assigned to one of three categories: “covered,” “not covered,” or “prior authorization required.”

• Covered drugs are full benefits of the plan.
• Not covered status are drugs that provide no additional therapeutic value over those already listed in the formulary or no cost advantage when compared to existing alternatives.
  • Plan member may pay the full drug cost or consult their prescribing physician about alternatives.
• Prior authorization required is assigned to drugs considered a second-line therapy or are high-cost specialty drugs with potential for inappropriate prescribing and use.
  • Plan member must meet specific criteria to access benefits; first-line therapy must appear in claims history for auto-approval and/or the prescribing physician completes a special authorization form indicating therapeutic need.

This type of formulary management balances the need of plan members to have access to medically necessary drug therapies with plan sustainability. Consult with GSC for more detailed or specific information. More information on drug coverage can be found in the Benefits for Active Members: Summary of Coverage located in the Document Library.

For prior authorization drugs, PocketPills pharmacists would not be able to dispense the medication. It would get flagged at adjudication, at which point the pharmacist would reach out to you to discuss and identify whether you are eligible or not―therefore, no surprises for you! Just a reminder, if you had an existing prescription that was covered by Green Shield Canada prior to January 1, 2022, your drug has been grandparented in to the Active plan. Only new drugs prescribed after January 1, 2022, are subject to the managed formulary criteria.

It is important to check the Plan Member Online tool offered by GSC to find out whether your drug is covered or will need prior authorization. It can be found under the “Your Health Benefits” heading, then select the “Drug” tile. You’ll be able to find out

• whether a drug is covered under your drug plan
• if you will need to pay a copayment (and if so, how much)
• if the drug needs a physician’s authorization (and if so, whether your doctor can print the authorization form directly)

Enter the name or DIN number of your drug, then select who the drug is for on your plan.

A few tips

• Drug Name: you must enter at least the first three letters of the drug name. For example, if you enter “Tyl” for Tylenol, then all drug names that begin with “Tyl” will be displayed.
• DIN: to search by DIN, the full DIN must be entered for the search tool to display the drug.
• Select Participant: some drugs have use restrictions based on things like your age. This is why the tool will ask who the drug is for under your plan.

To access the tool, you will have to register for an account with GSC everywhere. If you had an account on the previous site, you can log in with exactly the same username and password you used. If you haven’t registered, this video guide walks you through the registration process.

You can also call the Green Shield call centre and check with an agent: 1-888-711-1119.

If you have any questions or want to learn more, please e-mail Benefits@united-church.ca.