BCNU members impacted by Pharmacare tie-in to see significant funding for specified drugs
After BCNU launched a grievance in 2013 over the application of the Pharmacare tie-in under the Nurses' Bargaining Association (NBA) contract, the matter was referred to arbitration and an award was issued. The award provided a cap of $3.5 million dollars to be used for additional coverage of some drugs and one-time reimbursement for out-of-pocket expenses relating to the tie-in.
Coverage for Grandparented Drugs for Members and Dependants
If you or a dependant made a drug claim for any grandparented drugs between December 1, 2012 and May 31, 2013, you will be eligible to receive ongoing coverage effective October 1, 2014. Drugs that are grandparented will be covered indefinitely for individual members, for as long as they are needed. All eligible employees will receive confirmation of their ongoing coverage from Pacific Blue Cross (PBC).
The following drugs have been grandparented for eligible members:
- Mycophenolate mofetil (Cellcept)
- Duloxetine (Cymbalta)
- Teriparatide (Forteo)
- Fingolimod (Gilenya)
- Zopiclone (Imovane)
- Pregabalin (Lyrica)
- Pegfilgrastim (Neulasta)
- Filgrastim (Neupogen)
- Montelukast (Singulair)
- Liraglutide (Victoza)
- Omalizumab (Xolair)
To determine the list of drugs to be grandparented, BCNU worked with a team of external experts. For more information about how decisions were made, click here.
Remedies for Members who have filed Individual Grievances
The effective date of coverage for all drugs individually grandparented through the grievance process is October 1, 2014. As the implementation of individual remedies is still in progress, coverage at the pharmacy may not yet be available for all grandparented drugs. Therefore, please ensure you save your receipts from any medications you pay for out-of-pocket and submit them to PBC for reimbursement once you've been notified your drug has been grandparented. Please note that this only applies to claims after October 1, 2014.