Effective April 1, 2026, reimbursement for brand name drugs that have therapeutically generic equivalents will change.

What is the change?

As part of the April 1, 2026 renewal, Memorial’s plan will no longer reimburse for brand name drugs that have a generic equivalent. If claimants choose to continue treatment with a brand name drug, the reimbursed amount will be limited to the cost of the generic. Any additional cost will be considered an out-of-pocket expense.

• If you are a claimant having a brand name drug dispensed for the first time, this change is effective May 1, 2026. Any claims incurred after that date will be reimbursed at the cost of the generic only.   
• If you are an existing claimant who is being reimbursed for a brand name drug that will no longer be eligible, you will be notified by letter in mid to late April by Medavie Blue Cross. They will encourage you to talk to your healthcare professional who prescribed your current medication(s) to determine if generic drugs are right for you. Should your prescriber indicate that there is a medically substantive need for you to remain on the brand name medication, they can send Medavie Blue Cross a copy of the Health Canada Side Effect Reporting Form for review (available at your prescriber’s office). If Medavie Blue Cross does not receive this documentation from your prescriber, any claims incurred as of May 1, 2026, will be reimbursed at the cost of a generic only.

What is a generic equivalent?

Generic drugs are designed to be therapeutically equivalent to their brand name counterparts. This means it contains the same active ingredient, in the same strength, same dosage form, and route of administration. Health Canada requires generic manufacturers to demonstrate bioequivalence, ensuring that the drug behaves the same way in the body – absorbing and acting within an acceptable range compared to the original product.

The reason generics work for most drugs is because:

• Active ingredient is identical: The therapeutic effect comes from the active molecule, which is the same in both brand and generic.
• Strict regulatory standards: Generics must meet rigorous quality, safety and efficacy requirements under the Food and Drug Regulations.
• Bioequivalence testing: Clinical studies confirm that generics deliver the same amount of drug to the bloodstream at the same rate.
• Non-medicinal differences rarely affect efficacy: Variations in color, shape or inactive ingredients generally do not impact how the drug works for most patients.

For the majority of medications, these factors ensure that generics provide the same clinical benefit as brand-name drugs, at a significantly lower cost. Exceptions are rare and usually relate to drugs with a very narrow therapeutic index or patient-specific sensitivities to inactive ingredients.

Why make this change?

Health expenses continue to rise as both utilization and costs increase. Ensuring the financial stability and longevity of the plan is always a consideration with the management of the plan. Making this change ensures claimants maintain eligibility for necessary treatments while reducing costs. Changing to mandatory generic substitution will equal savings not only for impacted claimants, but for Memorial’s claims experience. With a lesser amount being reimbursed by the plan, costs will increase at a slower rate. Making this change allows for cost savings without reducing benefits available. Memorial’s goal is always to offer a competitive and sustainable benefits package for employees and retirees.