If your doctor prescribes a medication that requires prior authorization, it’s important to understand why prior authorization is needed and what next steps will be required.

Drug prior authorization is an approval process to ensure that certain medications being prescribed, or any alternative treatment therapies, can be covered under your benefits plan.  

You can use the online tool, My drug plan, to look up a drug and find out whether it is covered under your benefits plan or if prior authorization is needed. You can also check the approximate out-of-pocket expense (if any) to purchase the drug as well as any alternatives (e.g. generic version of the drug).

Where can I find the My drug plan tool?

1. Go to otip.com and click on the Log in button.

2. Select Health and Dental from the drop-down menu and log in.

3. Click My Claims.

4. Select My drug plan under the My benefits list.

5. Enter the information for your search.

OTIP has partnered with Cubic Health's FACET Program to administer the drug prior authorization program using evidence-based criteria and plan design considerations. Visit pa.otip.com to find the drug prior authorization form for your medication.

If you are a CUPE EWBT member, visit cupe-ewbt.ca (scroll down to key contacts on the home page) to access the FACET Program contact information.   

Eligible plan members and/or their eligible dependants who require certain specialty drugs will be referred to MemberRx by the FACET program. MemberRx is the designated pharmacy distributor for certain specialty medications.

When your drug prior authorization claim is approved, it will include details pertaining to how long the approval is for and when you may need to provide any additional information.

Questions? Contact OTIP Benefits Services at 1-866-783-6847 or by email using our online form.