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New programs and updates to your plan

To: All Eligible OSSTF Members

From: Donna Morrison, Executive Director, OSSTF Benefits

August 26, 2020

Coming September 1, there are several new programs and updates related to your plan. This includes the new Drug Prior Authorization Program, a new partnership with Bayshore Pharmacy Services and updates on dispensing fees and physician referrals for massage therapists.

Introducing the new OTIP Drug Prior Authorization Program

The OSSTF Employee Life and Health Trust (ELHT) and OTIP are pleased to announce the launch of the new OTIP Drug Prior Authorization Program.

Beginning September 1, 2020, this new program will be used for all drug prescriptions requiring prior authorization.

Members who are currently on a prior authorized drug will not be affected by this change.

What drugs will require prior authorization?

Most prescription drugs covered by the OSSTF ELHT Benefits Plan are authorized at the pharmacy when you present your benefits card. However, some medications that have multiple uses and/or are considered specialty drugs require prior authorization before they can be covered.

Specialty drugs are used to treat complex, chronic or life-threatening medical conditions such as: rheumatoid arthritis, Crohn’s disease, multiple sclerosis (MS), pulmonary arterial hypertension (PAH), cancer, osteoporosis and hepatitis C.

Due to their cost, most specialty drugs require prior authorization to confirm that they will be covered by the plan.

About the new prior authorization program

The new OTIP Drug Prior Authorization Program uses an independent, clinical pharmacist team called FACET.

The FACET team communicates directly with your doctor to ensure that you and your eligible dependants receive the most appropriate, safe and effective treatment for the condition. This program will ensure that all specialty drug prescription decisions are objective and based on the most up-to-date, evidence-based information available.

How to access the OTIP Drug Prior Authorization Program

If you or a family member covered under the 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.

Access your medications more easily with Bayshore Pharmacy

Manulife, the insurer, has partnered with Bayshore Pharmacy Services to bring the Specialty Drug Care program (SDC) to OSSTF members. This program will help you manage your specialty medications by delivering them directly to you, providing a 24/7 pharmacy hotline, and phone support with a dedicated nurse.

Beginning September 1, all new and existing claimants starting a new specialty drug will be administered through the SDC program. This will ensure OSSTF members get access to their medications quickly and have access to the advice and support they need.

NOTE: If you are already receiving specialty drugs, you can continue to purchase as you have been. Or, if you would like to switch to the new program, please contact OTIP Benefits Services at 1-866-783-6847.

Physician referrals required for massage therapy

Starting September 1, a physician’s referral will be required for coverage from a Registered Massage Therapist. Your plan will continue to cover these services up to $750 per benefit year. This is not actually a policy change to your plan, but until now, this requirement has not been enforced. Please visit the OSSTF Benefits site for further details.

Dispensing fees reinstated

On June 11, the Ontario government lifted the recommended 30-day supply limit on prescription drugs. This means that you may now fill up your prescriptions every three months, instead of every 30 days. While the 30-day limit was in effect, OSSTF ELHT removed the cap on dispensing fees.

Now that the limits on supply have ended, the six dispensing fee limit per 12-month period for medications will be reinstated effective September 1, 2020.

Questions?

If you have any questions about the new drug prior authorization program, specialty drugs, please call OTIP Benefits Services at 1-866-783-6847 or you can contact Donna Morrison, Executive Director at OSSTF Benefits, at donna.morrison@osstfbenefits.ca.


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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