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Important information for HSA’s RPNs re: Pharmacare coverage

Re: Pharmacare Tie-in – Grievance and Arbitration Award

In the last round of bargaining, the Nurses' Bargaining Association (NBA) agreed to modify the existing drug plan in the collective agreement to include a Pharmacare Tie-in. You were advised of these changes in January 2013.

The Pharmacare Tie-in was supposed to go into effect on February 1, 2013. However, as a result of problems our members were having with their drug coverage, the Nurses Bargaining Association negotiated that the changes be deferred until June 1, 2013. When a number of concerns remained unresolved, an industry-wide grievance was filed. The grievance was referred to arbitration and an award has now been issued to resolve the issues in the grievance.

HSA is writing to let you know about the award and to ensure that you are advised of the steps you must take if you are having problems with your drug coverage and would like assistance.

Arbitrator's Award

The award covers all nurses under the Nurses Bargaining Association collective agreement and will be funded by a combination of employer and pre-existing collective agreement contributions. Under the award there is:

1. Grand-parenting of out-of-province employees on LTD as of April 1, 2013
If you are on Long Term Disability benefits and were living out of province as of April 1, 2013, your drug coverage will return to the previous plan. You will need to make a claim by the claims filing deadline for any medications that were not covered since June 1 using the Pacific Blue Cross (PBC) extended healthcare claim form.

2. Coverage for designated drugs for impacted employees/ dependents
Your bargaining association is working with external experts to determine the list of drugs to be grand-parented. Grand-parenting will apply only to members and their dependents who were on an approved claim between December 2012 and May 2013. Once the list of grand-parented drugs has been decided it will be made available to members.

3. Remedies for individual grievances
Members will have until February 27, 2014 to file a grievance concerning gaps in their drug coverage. Examples of issues members may file grievances about include:

No longer being able to access a medication that is a non-benefit under the BC Pharmacare program; Non-approval of Special Authority drugs after a Special Authority request has been made by your doctor to Pharmacare, ie: Pharmacare has denied you coverage for a Special Authority drug; Pacific Blue Cross not recognizing various Pharmacare Special Authority exemptions, preventing you from obtaining approved medications.

Remedies for individual grievances will be determined on a case by case basis in consultation with a team of external experts according to criteria including the medical condition being treated and appropriateness of Pharmacare alternatives. Possible remedies to members' grievances include grand-parenting of coverage for individual drugs for individual members and/ or reimbursement for reasonable costs for nurses who have had to pay out of pocket for previously covered medications. Under the award, a total of $3.5 million dollars per year has been allocated to resolve all of the outstanding drug coverage issues. While we are hoping to resolve the majority of drug coverage issues, please be advised that there will likely not be coverage for every drug for every nurse.

4. Service improvements at Pacific Blue Cross
Many of the problems our members have been encountering with the Pharmacare tie-in have been the result of implementation issues at PBC. A number of service improvements will be put in place including a dedicated person(s) at PBC to liaise with HSA and other union members covered by the collective agreement, a new process to improve communication between pharmacists and PBC, and an expedited reimbursement process.

Important Next Steps

Filing Individual Grievances

You will have until February 27, 2014 to file a grievance concerning gaps in your drug coverage. Decisions about grievance remedies will be made after February 27 once a full review of every individual grievance has been completed.

To file a grievance on your behalf we require that you complete the enclosed form and return it to us in the enclosed self-addressed stamped envelope before February 27, 2014. Until we have your authorization and drug coverage information we cannot proceed with filing a grievance on your behalf. If you fail to contact us and provide the required information we will not be able to file a grievance on your behalf and no remedy will be available to you.

If you have had any out-of-pocket expenses please provide copies of medication receipts.

If you are taking a medication that requires Special Authority from BC Pharmacare to be covered, you must complete the process of applying for Special Authority. Follow up with your doctor as soon as possible if s/he has not applied to Pharmacare for Special Authority on your behalf. If your Special Authority request is denied by BC Pharmacare, please obtain a copy of the denial from your physician and contact HSA immediately for assistance.

Service Problems at PBC

On a going forward basis the Nurses Bargaining Association will be meeting regularly with PBC to address service problems. If you encounter any issues with processing of Special Authority approvals, recognition of Special Authority exemptions, using your Blue Net card or any other processing issue, please call HSA so that we may take your issue forward for resolution.

Questions

If you require further information or have questions, please contact the HSA office by phone at 604 439 0994 or toll-free 800-663-2017 or by email at pharmacare@hsabc.org

Attachment (Questionnaire and Release Form)

 

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