Frequently Asked Questions (FAQ)
Please see below for answers to general MemberRx questions.
MemberRx is a pharmacy created to provide the highest quality pharmacy experience to Ontario’s education community. It is focused on providing specialty drugs and related patient care to plan members.
Plan members requiring certain specialty drugs in the future will be referred to MemberRx by the FACET Prior Authorization program.
Certain existing specialty drug prescriptions will also need to be transferred to MemberRx. At this time, MemberRx is focused on transferring existing specialty drug prescriptions found here.
To learn more about MemberRx, visit www.memberrx.ca.
Is MemberRx an accredited pharmacy?
The pharmacy is expected to be fully accredited and operational by June 2023.
Prior to June, MemberRx may contact plan members who have provided their prescription transfer authorization to collect clinical and logistics information. This is to ensure a smooth transition of prescriptions and the highest quality of pharmacy care for you, your eligible dependants and your colleagues.
Until MemberRx is fully accredited, a patient record will not be held within its pharmacy management computer system and a request for a prescription record transfer will not be made until the pharmacy is licensed by the Ontario College of Pharmacists.
How is OTIP involved in MemberRx?
OTIP is establishing MemberRx with industry-leading pharmacy experts, including those with close ties to CUBIC Health and experts that have worked with OTIP to support detailed pharmacy analytics and the implementation of the FACET program
OTIP is providing the expertise to meet the unique needs of Ontario’s education community and will be communicating with you on important MemberRx-related information.
Why is my benefits plan switching specialty drug providers?
If your benefits plan has made the decision to establish MemberRx as the exclusive distributor of certain specialty medications, the decision was made to address the high cost of providing specialty drugs without compromising access or health outcomes.
When faced with managing the high costs of drug plans, some plan sponsors have chosen to limit the coverage available to its plan members. Your benefits plan is taking an innovative approach that provides you with the same high level of coverage while also keeping the sustainability of the benefits plan in mind.
Through the MemberRx pharmacy model, expensive pharmacy costs will be minimized. This will allow your benefits plan to continue to provide the best coverage, at the best value, for the medications you and your eligible dependants need.
Who is impacted by this change?
Members or their eligible dependents taking certain specialty drugs, the majority of which are currently being dispensed by pharmacies such as Bayshore, McKesson, Innomar and Bioscript, will be impacted by this change. At this time, MemberRx is focused on transferring the existing specialty drug prescriptions found here.
If you or your eligible dependant(s) are currently taking one or more of the specialty drugs listed, you will receive a communication from OTIP with more information and details on how they will help you with the transfer of your existing prescription to MemberRx.
Going forward all plan members who require these specialty drugs will be directed to MemberRx to have their new prescriptions filled through the FACET Prior Authorization program.
What does “exclusive distribution” mean?
All plan members who require certain specialty drugs for themselves or their eligible dependants will be directed to MemberRx to have their prescriptions filled. The requirement to use MemberRx also applies to plan members with existing (and eligible) specialty drug prescriptions.
Exception requests will be considered and will be assessed based on the unique needs of the plan member. For example, exception requests may be granted for clinical or geographical reasons.
If you choose not to transfer your specialty drugs from your current pharmacy to MemberRx they will no longer be eligible for reimbursement through your benefits plan, unless an exception has been granted through the appeal process.
What are specialty drugs?
Specialty drugs are generally high-cost prescription medications (i.e. cost more than $10,000 a year) and require prior authorization. They are typically used to treat plan members with complex health management needs.
Do all prescriptions need to be filled by MemberRx?
No, only certain specialty drugs will be exclusively distributed through MemberRx.
How do I know if the drug I am currently taking will be dispensed by MemberRx?
At this time, MemberRx is focused on providing certain specialty drugs. The list of the specialty drugs that will be initially distributed by MemberRx can be found here. If your drug is not on this list, you can continue to receive your specialty drug from your current pharmacy.
If you or your eligible dependants are currently taking a specialty drug that will be distributed by MemberRx, see below for answers to frequently asked questions.
I am impacted by this change. What does this mean to me?
This means that your existing specialty drug prescription(s) will need to be transferred to MemberRx from your current pharmacy. The transfer to MemberRx will not change your drug, strength, dosage or cost to you. It will only be a change in the pharmacy dispensing the specialty drug.
OTIP will contact you to provide details of how you can provide your authorization to transfer your prescription(s).
What happens once I have provided my authorization to transfer prescription(s)?
Once you have provided your authorization, here is what you can expect before your prescription is transferred to MemberRx:
- No further action will be required by you.
- The transfer of existing specialty drug prescriptions to MemberRx will take place over several months starting in June 2023. This is to ensure a smooth transition of prescriptions and the highest quality of pharmacy care for you, your eligible dependants and your colleagues.
- Prior to the transfer, a member from the MemberRx pharmacy team will reach out to you to verify your personal information, collect additional information (such as other medical conditions and medications you receive), to schedule the transfer and confirm the delivery details for the first prescription refill through MemberRx. This is when your personalized needs will be reviewed, such as the next refill date, FACET assessment date, additional specialty drug needs, etc.
- MemberRx will work with your existing pharmacy to have your prescription transferred without any disruption in supply.
What if I need my specialty drug prescription refilled before I am transferred to MemberRx?
You will continue to receive your specialty drug(s) from your current pharmacy until you have been contacted by MemberRx and the transfer of your prescription is complete.
Can I get other prescriptions filled by MemberRx, including other specialty drugs?
Prior to your prescription being transferred, MemberRx will contact you to discuss your personalized health needs, including other specialty drug needs.
Will I need to change my prescription or get forms completed by my doctor to transfer to MemberRx?
No, you only need to provide your authorization to transfer your prescription. No further action will be required by you, and there will be no change in the drug, strength, dosage, or cost to you due to the transfer to MemberRx.
How will I receive my prescription(s)?
All prescriptions filled by MemberRx will be delivered to you free of charge to the address you provide.
If it is more convenient for you to pick up your prescription, you may do so. MemberRx is located at 5520 Explorer Dr in Mississauga. In June 2023 the pharmacy will be open Monday to Friday 9 a.m. to 5 p.m.
Can I have my prescription transferred to MemberRx now rather than wait?
Prescription transfers to MemberRx will begin in June 2023. After June, it may be possible to transfer your existing prescription earlier than planned.
Please contact OTIP Benefit Services with your contact information and your request will be shared with MemberRx. MemberRx will contact you directly to determine how quickly they can make this change happen for you.
Will this change impact my Coordination of Benefits?
No, this change will not impact your coordination of benefits.
- If OTIP is your primary payor, and you have transferred your specialty drug prescription to MemberRx, you will continue to receive reimbursement for your eligible drug claims per the terms of your benefits plan. Any outstanding balance is then considered by your secondary payor.
- If OTIP is not the primary payor, you will not be required to transfer your existing specialty drug prescriptions to MemberRx and your drug claim will continue to be processed with OTIP as the secondary payor.
Can I complete the Prescription Transfer on behalf of my spouse and/or child who is currently taking a specialty drug?
Yes, you can complete and submit the Prescription Transfer form on behalf your eligible dependant(s) with a specialty drug prescription impacted by this change. Prior to the prescription being transferred, the pharmacy team at MemberRx will contact you and will need to speak to your eligible dependant(s) to confirm their authorization for the prescription transfer to MemberRx.
Will MemberRx ensure my personal information is kept confidential?
Yes, MemberRx is committed to ensuring the confidentiality and protection of personal information and personal health information.
Will I have to pay any out-of-pocket expenses?
No, the transfer to MemberRx will not change your specialty drug cost to you. It will only be a change in the pharmacy dispensing the specialty drug.
All prescriptions filled by MemberRx will be delivered to you free of charge to the address you provide.
What should I do if I made a mistake on my submitted Prescription Transfer form?
If your contact information is correct, no further action is required. Prior to the transfer, a member from the MemberRx pharmacy team will reach out to you to verify your information and collect additional information.
If your contact information was provided incorrectly, please complete a new form.
If you have questions about MemberRx pharmacy services, delivery, or prescription handling, see below for answers to frequently asked questions.
What are the MemberRx pharmacy hours?
Monday to Friday, 9 am. to 5 p.m.
Can I choose where to have my specialty drug(s) delivered?
MemberRx is dedicated to meeting your delivery and dispensing needs.
Prior to the transfer of your specialty drug prescription, a member from the MemberRx pharmacy team will reach out to you to verify your personal information, collect additional information (such as other medical conditions and medications you receive), to schedule the transfer and confirm the delivery details for the first prescription refill through MemberRx. This is when your personalized needs will be reviewed, such as delivery location, etc.
MemberRx will make every effort to maintain your current delivery needs and work with you if there are opportunities to make the delivery process even more convenient. If your needs change at any time after your first delivery details have been confirmed, please contact MemberRx.
My specialty drug has specific handling instructions. Will these be considered by MemberRx?
The transfer of prescriptions to MemberRx is expected to take place over several months beginning in June. Until you are contacted by MemberRx, the arrangement with your current pharmacy will continue.
Prior to the transfer of your specialty drug prescription, a member from the MemberRx pharmacy team will reach out to you to verify your personal information, collect additional information (such as other medical conditions and medications you receive), to schedule the transfer and confirm the delivery details for the first prescription refill through MemberRx. This is when your personalized needs and drug handling requirements will be reviewed.
Can someone else receive or pick-up my specialty drug prescription on my behalf?
Yes, anyone over the age of 18-years can sign for your delivery or pick-up your prescription from MemberRx.
Can my prescription be delivered out-of-province?
Arrangements can be made for out-of-province delivery.
When you are contacted by MemberRx prior to the transfer of your prescription, please mention this. This will allow the MemberRx pharmacy time to coordinate details with the prescriber.
Can MemberRx dispense extra medications?
Arrangements can be made to have extra medications dispensed.
When you are contacted by MemberRx prior to the transfer of your prescription, please mention this. This will allow the MemberRx pharmacy time to coordinate dispensing details with the prescriber.
If I have questions about medications, will there be a pharmacist available to discuss my questions or concerns?
Yes, members of the MemberRx clinical team are available to speak with plan members or their eligible dependant(s) during pharmacy hours, Monday to Friday, 9 am. to 5 p.m.
Dedicated to providing the highest quality pharmacy experience, the MemberRx clinical team will work closely with plan members and their eligible dependants to provide personalized, expert health management and education.
Will MemberRx be able to meet the service and delivery standards as my current specialty pharmacy?
MemberRx is dedicated to providing the highest-level pharmacy experience that meets members’ dispensing and delivery needs.
The pharmacy’s operating hours will be standard to other specialty pharmacies.
MemberRx will also have its own delivery team which will provide flexibility and remove the need to rely entirely on third-party delivery services.
If you have any concerns with MemberRx meeting your specialty prescription needs, please contact OTIP Benefits Services at 1-866-783-6847 to speak to a service representative.
If you have questions about the exception process, please see below.
I don’t know if MemberRx will work for me.
OTIP Benefits Services is available to discuss your unique situation with you. Please contact OTIP Benefits Services at 1-866-783-6847 to speak to a service representative.
NOTE: If you wish to request an exception, you will be asked to provide additional information (e.g. medical reasoning).