Manulife Financial

Coverage

Patient: John Doe

DIN Drug name Chemical name Strength Dosage Quantity
02244016 REMICADE 100MG/VIAL INJ INFLIXIMAB 100MG INJ 4

Coverage amount (as of September 04, 2015 in Ontario)

  • Your plan covers
    $0.00
  • You pay
    $4,681.78

Prior authorization required

Prior Authorization is required under your drug plan before this drug can be considered for reimbursement. To confirm if you qualify print and complete the Prior Authorization form.

Enter an email address below to send a blank copy of the form to yourself, or directly to your doctor.

 



Pharmacy savings search

Click here to learn where you can get this drug for less!


Explanation of coverage for REMICADE 100MG/VIAL INJ

  • Plan design limits would result in no amount being payable

Change quantity

Quantity

The default quantity is based on pharmacy prescribing practices in the province. By scrolling down, you can change the quantity to get updated results.

Lower cost alternative

Drug that is deemed a therapeutic equivalent at a lower cost. This is typically a generic drug.

Re-directing to Pharmacy savings search

Results will be close to your current location.

OK

You have requested access to functionality outside of the current site. Are you sure you want to proceed?

OK

You can get through to a customer service representative or take advantage of our self-service interactive voice response (IVR) capabilities by calling 1-800-268-6195 . Representatives are available Monday to Friday, from 8:00AM to 8:00PM EST.

You have requested access to another page. Leaving the current page will cause the loss of the current session information. Are you sure you want to proceed?

OK

You have requested access to another page. Leaving the current page will cause the loss of the current session information. Are you sure you want to proceed?

OK

You have requested access to functionality outside of the current site. Are you sure you want to proceed?

OK

You have requested access to functionality outside of the current site. Are you sure you want to proceed?

OK

You have requested access to functionality outside of the current site. Are you sure you want to proceed?

OK

You have requested access to functionality outside of the current site. Are you sure you want to proceed?

OK

To be eligible for reimbursement, the Massage Therapist must be registered and licensed to practice in the province in which treatment was provided. The Massage Therapist's professional designation and license number are required as part of the online claim submission. This information is usually provided on your receipt or is available from your Massage Therapist.

Need help reading your receipt?

Online claims submissions must be performed by a registered service professional. If your receipt does not have a designation and registration number, you must submit your claim using a paper form.

Please click here to access the paper claim from to complete your submission.

Confirmation Required

Confirmation required: Please confirm the number of people that attended the session:

OK

Your service provider�s designation is no longer being accepted through our online claims system.

Please submit your claim using a paper claim form..

Your session will time out in less than a minute. 

OK

No form found

We cannot find the form you are looking for.

Please contact the customer service for further information.