Principals/Vice-Principals (P/VP)

Mandatory Generic Substitution

Your Plan reimburses you based on the cost of the lowest-priced interchangeable drug – most often a generic version of the brand-name drug. Generic drugs contain the same active ingredient(s) as the original brand-name drug, are equally effective, and typically cost far less.

This lowest-priced reimbursement level applies even if your doctor writes “no substitution” on your prescription. So, if your doctor prescribes a brand-name drug, you have a couple of options:

  • Ask your doctor or pharmacist for the generic version to maximize your reimbursement.
  • Go ahead and get the brand-name drug. In this case, you will be responsible for paying the difference in cost between the prescribed brand-name drug and the generic drug.

The exception process

If a brand-name drug is required for medical reasons (e.g., a specific drug allergy), you will need to go through an exception process with Canada Life before the plan will cover it. Your doctor will need to complete a Request for Brand Name Drug Coverage form and provide medical evidence.

  • If your request is approved, you will be reimbursed for the cost of the brand-name drug.
  • If your request is denied, you will be reimbursed based on the cost of the generic drug. If you believe your request should have been approved, you can escalate this through the appeals process with medical evidence.

Health Canada closely tests and regulates generics – and if a generic product is not identical to the brand-name product, it is taken off the market. You might also be surprised to learn that a number of large brand-name drug companies also manufacture generics.

For everything you need to know about your benefits:

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