I’m worried that my expensive medications will not be covered. Will prior authorization of drugs be required?

August 16, 2024

Most drugs that are not “over the counter” are covered under the OSSTF Benefits Plan. Some drugs may require completion of a FACETs Authorization Form. NOTE: Completion of this form is not a guarantee of approval.

How to access the OTIP Drug Prior Authorization Program

If you or a family member covered under the OSSTF Benefits plan, need to seek approval for a specialty drug under the OSSTF ELHT Benefits Plan, simply follow the steps below:

1. Log in to Health and Dental at www.otip.com.
2. Under My Library, open the Resources tab.
3. Click on the Drug Prior Authorization Form link.
4. Click on Find my form.
5. Select OSSTF Employee Life and Health Trust Benefits Plan.
6. Search for the most applicable form based on your medication name.
7. Fill out the form with your physician and send to FACET using the contact information outlined on the form.

The OTIP Drug Prior Authorization Program website can also be accessed directly by both members and physicians at pa.otip.com.

If you are unsure about whether a medication requires prior authorization, use the Drug Lookup Tool in My Claims to search for the name of your medication. The Drug Lookup Tool will provide details on whether the medication is immediately covered by your plan or if it requires prior authorization.

If all of the information required by the FACET team is provided, a decision about the coverage of a drug requiring prior authorization will be made within two business days. Where additional information may be required, a decision will be made within five business days 99% of the time.

Once the prior authorization decision has been made, you and your physician will be notified by the FACET team and provided with the specific rationale used to make the final decision.

More information about the program can be found in the FAQ section of the OTIP Prior Authorization Program website.

MemberRx

The OSSTF Employee Life and Health Trust (OSSTF ELHT) has designated MemberRx as the exclusive pharmacy distributor for certain high-cost specialty medications. This means that certain specialty drugs will only be covered under your OSSTF ELHT benefits plan if they are dispensed to you by MemberRx. 

• If you or your eligible dependant(s) require one of these specialty drugs, your prescriptions will be sent directly to MemberRx through the FACET Prior Authorization program.

Through the MemberRx pharmacy model, expensive pharmacy and specialty medication costs will be minimized which will help in supporting the sustainability of the OSSTF ELHT benefits plan so that the OSSTF ELHT can continue to provide the best coverage for the specialty medications that plan members and their eligible family members need, at the best value. 

Questions?

• To learn more about MemberRx, visit www.memberrx.ca

 

 

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The information in this document is provided by OSSTF Benefits for general information only. OSSTF Benefits endeavours to have all information current and accurate. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, or suitability of the information included. All information is subject to change without notice.

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