Principals/Vice-Principals (P/VP)
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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
Claims and costs for anti-obesity drugs continue to rise and are now the foremost drug cost driver in the Plan.
Effective September 1, 2026, drugs used for anti-obesity purposes will be reimbursed at 60% (currently 90%) once approved through the FACET prior authorization process.
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 90% level, once approved through the prior authorization process.
If you are affected by this change, you may wish to speak with your physician or pharmacist about treatment options or available patient support programs.
Over-the-counter (OTC) drugs
The Plan will no longer cover over-the-counter products that are not medically essential. Some common examples include Dukoral® (an oral vaccine for travellers’ diarrhea) and Pramox HC Cream (used to relieve itching).
This change is consistent with market practice and is intended to help focus coverage on medically necessary treatments.
Ongoing drug management strategies
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.
Therapeutic Class Pricing for certain drugs
Therapeutic Class Pricing is a common approach used across benefit plans to help manage drug costs.
It works by grouping drugs with similar uses, effectiveness and safety profiles. A reference drug is identified within each group, and reimbursement is based on the cost of that reference drug. If your prescription costs more than the reference drug, you may be responsible for the difference.
Therapeutic Class Pricing will apply to certain categories, including blood pressure medications, stomach acid treatments, and cholesterol-lowering medications, including:
- Angiotensin Converting Enzyme Inhibitors (ACEI) for Blood Pressure
- Angiotensin Receptor Blockers (ARBs) for Blood Pressure
- Calcium Channel Blockers (CCBs) for Blood Pressure
- Proton Pump Inhibitors (PPIs) for Stomach Hyperacidity
- Statins for Elevated Cholesterol
If you’re affected by this change, you will receive a communication with more details.
Prescription drug updates
Zepbound (tirzepatide), one of the anti-obesity GLP-1 drugs on the market, remains under review by the Trustees and is therefore ineligible for reimbursement at this time.
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.
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