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Prescription Drug

Your drug plan covers a portion of the cost of most medications legally requiring a prescription. See below for more details.

Supplier

Insured Portion

Dispensing Fee Limit

Student Pays

Wyckham Pharmacy
90%
$9
10% of total cost
All other pharmacies
80%
$10
20% + excess dispensing fees

IMPORTANT! Advise your doctor and pharmacist that you are on the National Formulary.

Wyckham Pharmacy: Wyckham Pharmacy is located on campus in the basement of the Wyckham House Student Centre. Wyckham Pharmacy has agreed to charge a $9 dispensing fee for students on the Student Health Plan.

Annual Maximum: There is annual maximum of $3,000 for prescription drug expenses per benefit year.

Dispensing Fee Limit: The dispensing fee is covered at 90% at the Wyckham Pharmacy. At all other pharmacies the maximum allowable dispensing fee is $10 and is covered at 80%. Any dispensing fee amount not covered will be payable by the student.

Smoking Cessation: Your drug plan includes coverage Smoking Cessation Products that legally require a prescription. Reimbursed at 80% to a lifetime maximum of $500.

Generic Substitution: The maximum amount payable to an eligible brand name drug will be limited to the lowest priced item in the appropriate generic category.

The National Formulary is a specific list of drugs that are eligible for reimbursement under your drug benefit. Formularies are developed to ensure that prescription drugs are available on a cost-effective basis. It covers approximately 85% of the most frequently prescribed drugs. Formularies are reviewed regularly and as a result, updates are made on an ongoing basis. To find out if your prescription is covered by your formulary, you can click here.

Exception Process: In the event that the drugs covered by the Formulary are not effective in treating the condition, an exception process is in place. To be eligible for an exception, you must have tried one alternative drug listed on the Formulary. An exception drug request form is available below or from your Benefits Plan Office and must be completed by your physician. Completed forms may be returned to SAMRU Student Benefits Plan Office or can be faxed directly to the insurance company.

Request for Coverage of Exception Status Drug form

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