HealthWATCH^®/ PharmEXPERT Drug Plan

Prescription medication costs have grown significantly in recent years*, making it more challenging for employers to provide drug plans for their employees. The HealthWATCH^® / PharmEXPERT drug plan is a solution designed to help make drug plans more affordable so that you and your dependents can continue to receive prescription drug coverage as part of your overall health benefits package.

*QuintilesiMS, Canadian Drugstore and Hospital Audit. YTD September 2017; Forecast Update 2017

The HealthWATCH^® / PharmEXPERT drug plan is a component of your overall health benefits package and determines the level of coverage for prescription medications covered under your drug plan. It separates traditional prescription medications into two levels of coverage or reimbursement, called “tiers.” Together, these two tiers cover the majority of traditional prescription drugs that are used to treat common conditions. And members can get savings and exclusive offers at two of Canada’s largest retailers—Shoppers Drug Mart and Loblaw banners, including affiliated supermarkets.*

* Available at Loblaws, No Frills, Fortinos, Zehrs, Real Canadian Superstore, Your Independent Grocer, Extra Foods, Real Atlantic Superstore, and Valu-Mart. Savings and exclusive offers are for products or services unrelated to prescription or pharmacy services.

Most prescription drugs are “traditional.” They treat a wide range of common illnesses or conditions like diabetes, high blood pressure and high cholesterol.

This is in contrast to “specialty” drugs, which are used by a small percentage of people to treat often complex, severe, and less common conditions, or when traditional drugs are not effective. The HealthWATCH^® / PharmEXPERT drug plan is focused on tiering traditional medications with a policy that supports the use of biosimilars.

The tiers of coverage in the HealthWATCH^® / PharmEXPERT drug plan are designed to help make drug plans more affordable so that you and your dependents can continue to receive prescription drug coverage as part of your overall health benefits package.

If a drug doesn’t work well for you, you should talk to your doctor or pharmacist to discuss alternatives. Our Drug Search Tool may help identify medication alternatives that are also on Tier 1.

Your pharmacist and doctor can work together to find the best solution for you, including finding alternatives for Tier 2 drugs.

Of course! You can choose to take a Tier 2 drug and receive the lower level of coverage.

The HealthWATCH^® / PharmEXPERT Drug Plan team, which includes pharmacists, leads the decision-making process, guided by the advice of a Clinical Advisory Board. Their goal is to use a plan-member first approach, to find the right balance between drug plan affordability and helping to keep employees healthy and at work.

Yes, some drugs are not covered under the HealthWATCH^® / PharmEXPERT Drug Plan. There are options if your drug is not listed: ask your pharmacist to work with your doctor to switch you to another more cost-effective drug that could be on Tier 1 (higher level of coverage), Tier 2 (lower level of coverage) or even over-the-counter; or continue to take the drug that is not listed, the plan member will have to pay the full amount out of their own pocket.

Yes. The HealthWATCH^® / PharmEXPERT Drug Plan is an actively managed drug plan. On a monthly basis, medications that are available on the market are reviewed for inclusion on the plan. On a semi-annual basis, medications already on the drug plan may undergo listing changes based on clinical data and guidelines. Listing changes may include delisting or shifts in tiering.