National formulary grp1631 e.qxp:travelmedi pass_gb00200-e.qxd

Helping you make the most of your drug coverageYour group benefit plan covers drugs listed on the National Formulary. Although it covers approximately 85% of the mostfrequently prescribed drugs in Canada, you may find yourself with a prescription for a drug that isn’t on the list. This isimportant to understand because non-formulary drugs are either covered at a lower percentage, or not covered at all (in which case you’ll need to pay the full amount.) The table below lists the most commonly prescribed non-formulary drugs, and suggests possible alternative drugs that areincluded in the formulary.
How does it work?Simply take this list with you when you visit your doctor. The decision about which drugs are prescribed is between you and your doctor. Occasionally, a drug your physician prescribes will not be eligible, but another drug that provides a similarbenefit – a therapeutic alternative – may be on the formulary.
If your doctor is unfamiliar with the National Formulary or wants more information, they can call the Physician Help Line at 1-866-645-2548.
Suggested therapeutic alternatives from the National Formulary: Either covered at a lower percentage or not covered at all Alesse/Aviane, erythromycin, tetracycline, Tri-Cyclen, Yaz Benzamycin Gel, benzoyl peroxide >5%, Clindoxyl, Clindasol/Clindets Pledgets/Dalacin-T, Differin, Vitamin A Celexa, Cipralex, Effexor XR, Paxil regular, Prozac, Remeron, Actos, Amaryl, Avandamet, Avandaryl, Avandia, Diamicron,Gluconorm, Glumetza, Januvia, Janumet, Onglyza, Starlix Lamisil cream/spray, Nizoral tablets/cream, Sporanox Diflucan 50mg & 100mg tablets/oral suspension, Lamisil tablets, Antifungal Agents (vaginal yeast infection) Ecostatin vaginal ovule, Gynazole vaginal cream, Amoxil, Biaxin, Ceclor, Cefzil, cephalexin, Clavulin, doxycycline, Avelox, Ceftin, Cipro/Cipro XL, Factive, Ketek, Levaquin, Arthrotec, Motrin, Naprosyn, Voltaren regular/sustained release Celebrex, Mobicox, Naprelan, Naprosyn E/SR, Relafen, Ultradol Anti-inflammatory Eye Drops (cataract surgery) Ocular NSAID: Acular, Voltaren Ocular Steroid: Pred Forte, Ocular NSAID: Nevanac, Ocular Steroid: Lotemax Anti-inflammatory Agents, ASA with codeine 8mg, 15mg and 30mg, Amerge, Axert, Fiorinal, Frova, Imitrex, Maxalt, Migranal, Relpax, Cafergot, Sandomigran, Tylenol No. 1, 2 & 3 Abilify, Fluanxol, Haldol, Invega ER, Risperdal, Seroquel Clozaril, Risperdal Consta injection, Seroquel XR, Zeldox, Zyprexa Advair, Alvesco, Flovent, Qvar, Pulmicort, Serevent, Symbicort Attention Deficit Hyperactivity Disorder (ADHD)/Narcolepsy Dexedrine tablet, Dexedrine Spansule, Ritalin, Ritalin SR Adderall XR, Biphentin CR, Concerta ER, Strattera, Vyvanse DDAVP nasal spray, Rhinyle nasal solution Bezalip SR, cholestyramine, Colestid, Crestor, Lescol/Lescol XL, Lipidil EZ/Lipidil Supra, Lipitor, Lopid, Mevacor, Pravachol, Zocor Linessa, Marvelon, Orthocept, Yasmin, Avaine/Alesse, Angeliq, Estrace, femHRT, Premarin, Prometrium Activelle, Climara Pro, Estalis, Estracomb, Estraderm, Estradot,Estrogel, PremPlus Actonel, Didrocal, Didronel, femHRT, Fosamax, Premarin Dilaudid, Statex Percocet, Tylenol No. 2, 3 & 4 Duragesic/Duragesic MAT, Jurnista, OxyContin, Ralivia ER, Tridural ER and Zytram XL Amevive, Enbrel, Humira, Raptiva, Remicade, Soriatane, Stelara Betaderm, Dermovate, Cyclocort, Dermatop, desonide, Dovobet, Dovonex, Tazorac, Silkis ointment desoximetasone, Elocom, fluocinonide, Halog, Hyderm, Kenalog,Nerisone, Propaderm, Westcort Arava, Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, Simponi Losec, Nexium, Pantoloc, Prevacid capsule/FasTab, Tecta Detrol LA/Unidet SR, Ditropan XL, Enablex, Trosec, Vesicare Please note: The table lists the most commonly prescribed non-formulary drugs, and suggests possible alternative drugs thatare included in the formulary. This list is not exhaustive and not meant to indicate a preference of one product over another.
The possible therapeutic alternatives listed are not necessarily interchangeable. The drugs are shown within therapeuticcategories for illustrative purposes only and not intended to define indications for use.
For more informationFor a comprehensive and up-to-date list of the drugs your plan covers, you can access the Drug Look Up feature on the Sun Life Financial Plan Member Services website at www.mysunlife.ca or contact our Customer Care Centre at 1-800-361-6212.
Group Benefits are offered by Sun Life Assurance Company of Canada,a member of the Sun Life Financial group of companies.

Source: http://clarica.ca/static/canada/Member/About%20Group%20Benefits/Resource%20centre/Static%20files/NationalFormularyGRP1631E.pdf