Benefit Management Services

Express Scripts Canada works with insurance carriers, third-party benefits administrators, the public sector and other organizations that provide health benefits to make the use of prescription drugs safer and more affordable for tens of millions of Canadians who are covered by them.

Dental Benefit Management

Express Scripts Canada's dental claim experts evaluate the suggested fee guides published each year by the Canadian Dental Association and each provincial association, including specialist, denturist and general practitioner codes. On behalf of our customers, they evaluate coverage of new codes and provide coverage recommendations based on their knowledge of industry standard contract wording and customer-specific administrative guidelines.

Pharmacy Benefit Management

Express Scripts Canada's pharmacists – through our pharmacy benefit management program – continuously look for new ways to manage drug plans and provide alternatives to traditional plan designs. Each month, our in-house clinical staff members conduct extensive reviews of scientific and clinical data to evaluate new drugs for their place in therapy, impact on drug plans, and fit with clinical programs. Express Scripts Canada manages hundreds of customized drug plans for customers.

Express Scripts Canada's adjudication system electronically adjudicates pharmacy claims, according to the parameters of the client's drug plan.

NEW Expanded Pharmacy Benefit Management

Express Scripts Canada has added new, more specialized services to its roster of pharmacy benefit management programs.  Express Scripts Canada’s expanded pharmacy benefit management service, which includes home delivery of maintenance prescription medications from the Express Scripts Canada Pharmacy was introduced to the Canadian health benefits marketplace in November 2011. It leverages research and proven best practices in behavioural sciences to enable companies and organizations who provide health benefits to their employees to actively engage them to more effectively manage benefit costs and their health. Plan members interact with a team of highly qualified professionals about their maintenance medications – and the alternatives available to them – so that they can make informed choices with the support of their physician. In turn, each plan member will receive the best possible health outcome while reducing the cost of the prescription drug benefit to themselves and their plan sponsor.