Member Portal - Checking prescription drug eligibility

This guide helps members quickly check prescription drug eligibility, including coverage details, co-pays, and claim requirements based on their plan. Reviewing eligibility in advance can help avoid unexpected costs. For additional support, contact the Member Experience Centre.

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From the Member Portal Dashboard, click **“MY COVERAGE.”**

If Prescription Drugs is an eligible benefit, it will appear under your coverage details. **Click “Prescription Drugs"** tile.

1. **Ensure you select the correct member** before reviewing coverage, as maximums and eligible benefits may vary between members. 2. **Be mindful of the prescription drug category you are reviewing.** Benefit levels and coverage may vary based on your plan type and selected coverage. 3. **Benefit Description:** Review the basic coverage details, including the coverage period and co-pay amount. 4. **Claim Requirements:** Review the list of standard claim requirements that will be needed when completing the digital claim submission form ahead.

**Members can also check their prescription drug coverage by selecting “Check if drug coverage is eligible on your plan.”** **Before proceeding:** You will need the specific prescription drug name and/or the Drug Identification Number (DIN). The DIN is an 8-digit number located on your prescription receipt and/or medication label.

1. **Select the member whose drug eligibility you are reviewing** from the drop-down menu. 2. **Enter the complete and accurate prescription drug name or Drug Identification Number (DIN).** 3. Click **“SEARCH.”**

Click the arrow next to the drug(s) to review eligibility details and any additional requirements prior to submitting a claim.

**“Drug is a Benefit”**\ If the drug is eligible under the member’s plan, this message will appear.

**“Drug Requires Special Authorization or EDS”** or **“This Drug Is Not a Benefit”**\ If the drug is not eligible under the member’s plan, or if it requires Special Authorization or an Exception Drug Status (EDS) letter prior to the initial claim submission, one of these messages will appear.