• Your policy number (often noted on your benefit booklet or on your personal ID/drug card)
• Your personal certificate number (noted on your personal ID/drug card)

If you do not have this information available, your insurer will not be able to help you when you call their 1-800 number. The insurance company needs this information to be able to look up the specific details of your plan. If you do not know where to obtain your policy and certificate/ID number, you can request this information from your employer. Your human resources department may be a good place to start.

If there is a specific drug that you are considering, you need to know the drug identification number (DIN) for that drug. Each drug has its own unique DIN. By having the DIN handy, the insurer will be able to identify whether the drug is covered under your plan and if there are any restrictions. If you have already filled a prescription for this drug, the DIN can be found on the medication label. You can also search for a DIN by searching the product name in Health Canada’s Drug Product Database at
http://webprod5.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp

• "Can you let me know if there are any limitations or restrictions on my drug plan? For example, are there any drugs that are excluded from the plan? Are biologic drugs covered?"
• "Can you describe the process involved for me to receive coverage for a biologic drug? For example, do I need to apply for provincial coverage first? Is there a prior authorization process that requires that I try less expensive drugs first before I can receive coverage for biologics? If so, what is the process and what information needs to provided?"
• "My doctor prescribed a biologic drug for rheumatoid arthritis. Is there a certain biologic that my plan requires me to try before other biologics are covered?"
• "Can you describe the process involved for me to receive coverage for a biologic drug? For example, do I need to apply for provincial coverage first?"

• "What is the reimbursement level for this drug under my plan (e.g. 80%)?"
  The amount or level of reimbursement that your plan covers will often be given as a percentage of the drug’s total cost. The reimbursement level of some plans may vary depending on whether the drug is brand name or generic.
• "Is there an out-of-pocket maximum?"
  An out-of-pocket maximum is a dollar limit that when reached in a given year out of your own pocket, 100% coverage is provided for the remainder of the year.
• "Is there an annual or lifetime maximum under the plan?"
• "Is there a specific pharmacy that you recommend I purchase this coverage through?"
  Some insurers have arrangements with pharmacies that allow you to receive a higher level of coverage by going to a specific pharmacy. Some pharmacies are also cheaper than others. Be sure to shop around and understand how much you will pay out-of-pocket.
• "Are there any deductibles that I should be aware of? Can you please explain how they work?"
• "Is there a dispensing fee maximum or limit under the plan?"

Did you know that if your spouse has a drug plan, then you may be able to coordinate coverage with their plan as well? What this means is that any money you pay out-of-pocket after submitting your drug claim under your own plan may be eligible for further reimbursement through your spouse's plan.

To find out if your spouse's plan provides coverage for a particular drug, you can contact their drug provider to ask for reimbursement details under that plan. All you will need is the policy number of your spouse's plan as well as your certificate/ID number under that plan.