Therapeutic Class Pricing is similar to our Enhanced Generic Substitution product feature. While the Enhanced Generic Substitution is based on the cost of the lowest-priced interchangeable medication with the same medicinal ingredient, Therapeutic Class Pricing may include a different medicinal ingredient.
Designed to help keep the cost of drug plans affordable, Therapeutic Class Pricing sets reimbursement limits for medications in specific drug classes.
There can be many medications in each drug class that vary in price, but that are prescribed to treat the same medical condition. In each class, a drug that proves to provide effective treatment is classified as a “reference drug.”
We consider several factors when determining a reference drug, including clinical studies, safety data, utilization, approved indications, expert opinion and cost.
5 TCP drug classes
• To treat stomach acid:
o Proton Pump Inhibitors (PPI)
• To treat high cholesterol:
o HMG-CoA Reductase Inhibitors (Statins)
• To treat high blood pressure:
o Angiotensin Converting Enzyme Inhibitors (ACEI)
o Angiotensin Receptor Blockers (ARB)
o Dihydropyridine Calcium Channel Blockers (CCB)
How it works
If a plan member is prescribed Medication A (a reference drug), they’ll be reimbursed based on the plan design.
If a plan member is prescribed Medication B, they can:
• Fill the prescription and get reimbursed up to the cost of Medication A and pay the difference out of pocket.
• Ask their doctor to issue a prescription for Medication A instead. In some provinces, pharmacists may be able to adapt the prescription to Medication A.
While TCP is designed to help control the cost of drugs, it’s not intended to determine the most appropriate treatment. Plan members should talk to their care providers to choose their best course of action.
For more information, contact your Great-West Life group representative.