The purpose of the Public Service Health Care Plan (PSHCP) is to reimburse Plan participants for the reasonable and customary costs they have incurred for eligible services and products as described in the Plan Directive. Reimbursement is considered after they have taken advantage of the benefits provided by their provincial or territorial health insurance plan and programs. The Provincial Specialty Drug Program which provides coverage for certain specialty drugs and treatments is one of these programs.
At the onset of the pandemic, it was agreed that Sun Life would not enforce the Provincial Specialty Drug Program (PDP) for members of the PSHCP to ensure that members and their dependants would continue to have access to their medications without interruption. As provincial programs are once again up and running, this temporary measure has been lifted and the program has resumed.
Sun Life manages the PDP process to ensure that, where appropriate, Plan members have applied to available government programs for specialty drug coverage. This means that claims are submitted to government programs before any reimbursement is provided by the PSHCP. As a result, members and their dependants can maximize their drug coverage.
Please note, the other temporary changes implemented to the PSHCP in 2020 are still in effect and will remain until non-critical business is authorized to resume or as indicated otherwise. These changes include the broadening of the list of accepted mental health practitioners such as social workers in all areas across the country, along with psychotherapists/ counsellors. Additionally, the requirement to have a prescription for mental health services under the PSHCP is still temporarily suspended.
If you have any questions about the Provincial Specialty Drug Program process or the temporary changes to the PSHCP, please contact the PSHCP Call Centre at 1-888-757-7427 (toll-free) or 613-247-5100 (in the National Capital Region).