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Your Benefits Plan as of September 1, 2026
Prescription drugs continue to be one of the fastest-growing areas in the Benefits Plan. As costs continue to increase faster than funding, we’re introducing a few targeted changes starting September 1, 2026, that will help manage rising drug costs and support the long-term sustainability of the Plan. These types of changes are increasingly common across benefit plans in the education sector.
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Anti-obesity drugs
In September 2025, we introduced a $2,000 maximum for anti-obesity drugs such as Wegovy, Contrave, Xenical, and Saxenda. While this maximum helped manage
per-Member costs, the number of Plan Members using these medications has continued to grow.
With this in mind, we’ve made the difficult decision to discontinue coverage for
anti-obesity drugs, effective September 1, 2026.
Important note: GLP-1 drugs prescribed for specific medical conditions other than weight management (e.g., diabetes or cardiovascular conditions) will continue to be reimbursed at the Plan’s standard 100% level, once approved through the FACET prior authorization process.
If you are affected by this change, you will receive a communication with more details and information about next steps. You may also wish to speak with your physician or pharmacist about treatment options or available patient support programs.
Generic drugs
Each generic drug has a Manufacturer’s List Price (MLP), which is the base price of the drug. Pharmacies typically add a profit margin on top of that MLP, and the amount varies by pharmacy.
To help keep costs in check, the Plan will now cover:
- The cost of the drug (i.e., the MLP)
PLUS - A maximum of 10% markup (currently 15%)
For example, if the MLP for your drug is $50, the Plan would cover an additional 10% (or $5) for a total of $55 (plus the eligible dispensing fee). If the pharmacy charges more than a 10% pharmacy mark-up, you would be responsible for covering the difference.
Keep in mind: Any difference you’re required to pay can be submitted through your Health Care Spending Account (HCSA).
Ongoing drug management strategy
Introducing MemberRx
As part of our continuing approach to managing drug costs, we’re introducing MemberRx, effective September 1, 2026.
Claims for certain specialty drugs (generally, those that cost more than $5,000 per year) will need to be filled through MemberRx to continue to be reimbursed by the Plan.
MemberRx is a pharmacy specializing in complex and high-cost medications, where you can:
- Submit a prescription online
- Receive delivery to your home or preferred location, at no cost
- Receive additional support to help manage complex conditions
Why this approach?
Specialty drugs make up a small share of prescriptions but a large share of total drug spending. Filling them through a specialized pharmacy supports better monitoring, adherence, and pricing – supporting better health outcomes for Plan Members while helping manage overall Plan costs.
How do I start using MemberRx?
If you are currently taking a specialty medication that must be filled through MemberRx, you will receive a communication with more details and information about next steps – including how to register and how your current prescriptions will be transferred. You do not need to take any action until you are notified.
If you are starting a new drug impacted by this change, the FACET team will help facilitate dispensing through MemberRx once you receive prior authorization approval.
Prescription drug update
Generic versions of Ozempic® (semaglutide) are now available in Canada. The Plan requires mandatory generic substitution, so once provincial drug authorities deem a generic semaglutide interchangeable with Ozempic, reimbursement will be based on the generic price. If you choose to remain on brand-name Ozempic at that point, you would be responsible for the difference between the brand and generic cost.
Reminder: Effective September 1, 2026, the Plan will no longer cover GLP-1 drugs (such as Ozempic® or generic versions) for anti-obesity purposes.
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