The UBC Extended Health Plan provides you and your eligible dependents with comprehensive coverage for medical services, supplies and prescription drugs.
Effective May 6, 2018, specialty drugs that are used to treat specific health conditions and that cost more than $5,000 per person, per calendar year will require pre-approval (“Prior Authorization”). This means that if your physician prescribes such a specialty drug for you or your covered dependents, you and your physician must submit evidence that supports the need for the drug in order to obtain coverage for it under the extended health benefit plan.
If you or your covered dependents were reimbursed for a specialty drug under UBC’s extended health plan in the 12 months prior to the effective date of the program (May 6, 2018), you will be automatically grand-parented and will not be required to apply for prior authorization for that drug. Visit the Prior Authorization webpage for more details.
Specific Health Conditions that Require Pre-approval/Prior Authorization
Certain drugs that are used to treat the following health conditions, and that cost over $5,000 per calendar year, per person, require prior authorization:
- Crohn’s Disease/Ulcerative Colitis
- Hepatitis C
- Multiple Sclerosis
- Psoriatic Arthritis
- Rheumatoid Arthritis
About Prior Authorization
Prior authorization is used in many organizations’ extended health and dental benefit plans for high-cost medical services, supplies, procedures and prescription drugs. This approach ensures that specialty drugs are reimbursed when most needed so that extended health benefit plans remain stable and sustainable.
At UBC, our new prior authorization drug program is referred to as FACET and is administered by an independent, third-party organization called Cubic Health. FACET offers the following:
- Prescription drug experts (licensed pharmacists) who make evidence-based decisions
- Provides expert support in navigating related issues and collaborates with you and your physician to ensure appropriate drug and dose regiments for effective treatment
- Coordination of coverage with the BC Fair PharmaCare Plan and other provincial drug plans, while continuing to provide choices in prescription drug treatment
Additional information about the new prior authorization drug program, including a list of frequently asked questions are available on our FACET Prior Authorization webpage.
Process for Obtaining Pre-approval for Coverage of a Specific Drug
1. Starting May 6, 2018, you can find out which prescription drugs require prior authorization by logging in to Sun Life’s website at www.mysunlife.ca (currently not available on Sun Life’s mobile app).
Once logged in, go to coverage information; medical – drug coverage; drug look up and search by drug name or DIN (drug identification number).
If your prescription drug requires prior authorization, you will receive a message indicating “to be considered for coverage for this drug, have your doctor complete the appropriate form”. You will be directed to the FACET Prior Authorization Drug Program webpage to complete the form (go to Step 2).
If you do not receive this message, prior authorization is not required at this time and no further action is required by you.
2. Go to the FACET webpage to find the Prior Authorization Request Form that matches your health condition.
3. Ensure that you and your physician complete the form – this can be completed through the “fillable” form.
4. Submit the form and supporting clinical information to Cubic Health via one of the following ways:
- Scan and email to UBC@facetprogram.ca
- Fax to 1-844-446-1575
Note: Medical information is submitted directly to Cubic Health, and is not shared with UBC.
5. Allow three business days for review once all necessary information has been received by Cubic Health.
6. If your drug is approved, Cubic Health will notify Sun Life to cover the drug for a one-year period.
7. If the drug you were prescribed cannot be approved, your physician will be contacted by Cubic Health directly to discuss alternatives.
8. Cubic Health will send both you and your physician the decision in writing.