Tag Archives: Ontario Drug Benefit Program (ODB)

This applies to you if you, your spouse or your children are 24 years old or younger, and have drug coverage under a private insurance plan, such as a group benefits plan through Manulife.

What you need to do

Starting April 1, 2019, when you, your spouse, or your children get a prescription drug, let your pharmacist know you’re not covered under OHIP+ anymore. They can submit the claim to your Manulife plan. To make things easier, have your benefits card handy. You can get a copy of it online when you sign in at Manulife.ca or through the Manulife Mobile app.

You may need to do a little extra if you’re taking a high cost drug

To see if a drug requires prior authorization (PA), sign in to your Manulife group benefits account at Manulife.ca. Once signed in, under My benefits select My drug plan and search for the prescribed drug.If this option is not available to you, you can access the list of PA drugs from the forms tab, under Plan Member brochures. If the drug you’ve been prescribed is eligible, requires PA and is not being administered in a hospital, here’s what you need to do:

  • If it was approved and paid for by OHIP+, simply send us your approval letter or a prescription receipt and phone number.
    • Your letter will show it’s been approved under the Exceptional Access Program (EAP).
    • Your pharmacist can give you a copy of the receipt. It’ll show it was paid for under the ODB.
  • If your doctor has prescribed a high cost drug, and you haven’t started taking it, you’ll need to fill out a Drug Prior Authorization form and send it to us.

Getting documents to us

If you need to send us any of the above (an approval letter, a copy of the receipt, or a new Prior Authorization form), here’s how you can do it:

  • Online – Sign in to your Manulife group benefits account and from the home page, use the Send documents feature. You’ll need to select the Drug Prior Authorization form option. Upload the documents and hit Send.
  • By mail or fax – if you do not have the Send documents feature you can still get the documents to us:
    • Fax: 1-855-752-0404
    • Mail: Manulife Group Benefits Health Claims Attention: Prior Authorization Team PO BOX 1653 Waterloo, ON N2J 4W1

And remember, we’ll need your plan contract and certificate number when you send us your documents. You’ll also want to keep a copy of the documents you send us for your records.

Questions?

If you have questions, give us a call or email us.

  • Phone: 1-800-268-6195 Monday to Friday, between 8 a.m. and 8 p.m. ET.
  • Email:  Sign in to your group benefits account at Manulife.ca and send us a note.

You can also find additional information about OHIP+ on the Ontario government website.