If you have questions about retiree benefits, please email Joan Sharp (jsharp@sfu.ca). Questions of general interest to retirees will be added to the FAQ, with personal details removed.

Question: My prescription is not among the drugs listed in the Pacific Blue Cross Blue RX formulary under SFU retirees’ extended health coverage. The drug is similar to other medications on Health Canada’s list of approved drugs. How can I appeal denial of payment for my medication?

Answer: One of our members wrote to the Benefits Review Committee, Pacific Blue Cross, PO Box 7000, Vancouver, BC, V6B 4E1, appealing the lack of coverage for an eyedrop prescription. He provided the following reasons:

• According to documentation on the Blue RX plan, Blue RX covers brand-name and generic prescriptions for drugs used to treat all major diseases and conditions. This drug is a generic version of the drugs that already appear on the Blue RX formulary.
• From the Blue Rx plan, “There are a very small number of drugs that are not covered under Blue RX. These excluded drugs typically have similar therapeutic benefits to ones already covered by Blue RX but are much more costly.” The rejected drug is a generic version of other approved drugs, likely with a smaller cost.

Outcome: The claim was paid for our member and the drug was added to the Blue RX formulary.