Lowest cost alternative limitation

CAEAS-ECAB

Lowest cost alternative limitation

Your Plan reimburses you based on the cost of the lowest-priced interchangeable drug – most often a generic version of the brand-name drug. The drug must be interchangeable by law where the drug is dispensed, or a different drug product with the same dosage form belonging to the same drug class.

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

Ask your doctor or pharmacist for alternatives to maximize your reimbursement.
Go ahead and get the drug. In this case, you will be responsible for paying the difference in cost between the prescribed drug and the lowest cost alternative drug.

The exception process

If a certain 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 drug.
If your request is denied, you will be reimbursed based on the cost of the lowest cost alternative drug. If you believe your request should have been approved, you can escalate this through the appeals process with medical evidence.

For everything you need to know about your benefits: