Further to our communication on September 8, 2025, the CUPE EWBT is providing more clarification on the implementation of TCP in a select number of drug classes.
Why CUPE EWBT is Implementing TCP for Prescription Drugs
Plan changes were required to ensure the sustainability of the benefit plan to the end of the collective bargaining period. When making plan changes, the Trustees, in consultation with Canada Life and independent experts, focused on areas that will not adversely impact member health, but can assist in reducing inefficient spending when our plan is facing significant financial pressure.
TCP is a plan provision that seeks to reduce inefficient spending in categories where there are multiple safe and effective therapeutic options, but differences in pricing.
An Example Using Proton Pump Inhibitors (PPIs)
Prescription drugs in the drug class of Proton Pump Inhibitors (PPIs), used primarily for the treatment of acid reflux, is a great example of where inefficient spending has emerged:
PPIs have been on the market in Canada for over 30 years.
There are 6 major PPIs on the market today: omeprazole, esomeprazole, lansoprazole, dexlansoprazole, rabeprazole, and pantoprazole.
For several historical reasons, there is an enormous price discrepancy in this class of medications. All PPIs are considered equally safe and effective however they range in price from $0.13 to $2.71 per dose (before pharmacy mark-ups). That results in a situation where the most expensive options in the class are 15 to 20 times the cost of the most cost-effective options which are equally as safe and effective.
Within the PPI class, some generic options range in cost from $0.13 to $0.20 per dose, but others range between $1.87 to $2.05 per dose. This is why in some cases members on an existing generic PPI will have their reimbursement reduced.
Switching to a Reference Product
A member’s pharmacist can intervene on behalf of the member and request a change in medication to a reference product to the member’s prescribing General Practitioner (GP) and/or Specialist.
When and How to Request a Medication Exception
In certain rare circumstances where there is evidence of failure on appropriate trials of less expensive options in a given class and/or evidence of documented adverse reactions to less expensive options, the member can request an exception to stay on their existing medication.
In these cases, members would send supporting documentation to the FACET Prior Authorization Program Clinical Team for consideration.
Members can download the Therapeutic Class Pricing Exemption Form directly from this website at the link below. However, only cases where members meet exception criteria outlined above and have appropriate supporting evidence will be considered.
For more information
Visit the Therapeutic Class Pricing (TCP) page, right here on our website. And, you can send any questions you may have to info@cupe-ewbt.ca.
What’s Next
To allow members time to discuss this change with their pharmacist and/or physician, the CUPE EWBT has decided to provide a grace period from October 1 to November 30, 2025.
