Dispensing Fee Policies in Public Drug Plans, 2019/20

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This reference document provides a summary of dispensing fee reimbursement in 2019/20 for the public drug plans participating in the NPDUIS initiative, as detailed in the Plan Information Document published by the Canadian Institute for Health Information.^{Footnote 1}

British Columbia

The maximum allowable dispensing fee is $10.00. No dispensing fee is reimbursed for insulins or needles and syringes for insulin therapy. Other reimbursements include pharmacies providing services to long-term care facilities, which receive $43.75 per bed serviced. A rural incentive program provides a per-claim subsidy ($3.00 to $10.50) to rural pharmacies with monthly claims volumes of less than 1,700. A vaccination administration program reimburses pharmacies $10.00 for each publicly funded vaccination administered by an authorized pharmacist.

Alberta

Effective May 17, 2018, Alberta’s pharmacy funding framework allows for a dispensing fee of $12.15, except for compounded prescriptions prepared in a pharmacy, diabetic supplies, or nutritional products.

This framework also introduced limitations on reimbursement for daily and frequent dispensing. Dispensing fees for daily medication dispensing are limited to three fees per day per patient. Dispensing fees for recurrent medication dispensing between 2 and 27 days are limited to two fees per medication per 28-day period per patient. Exemptions to these rules exist for opioid dependence treatments, acute/short-term dispensing, and drugs under the Alberta Public Health Activities Program.

Saskatchewan

Effective November 1, 2018, the maximum dispensing fee is $11.60. An additional reimbursement is provided for influenza immunization, trial prescriptions, methadone, compliance packaging, and compounding drugs.

Manitoba

Effective August 18, 2017, Manitoba introduced a cap on dispensing fees. Pharmacies are able to charge provincial drug programs up to $30 per prescription, or up to $60 if the specified drug is a sterile compound, regardless of the base cost of a drug or how it is packaged. Pharmacy service providers are compensated by a market-based professional fee. The dispensing fee or professional fee is an all-inclusive fee that reimburses the direct and indirect costs associated with dispensing, distribution, and cognitive service functions, including patient counseling and profit.

Dispensing fees are regulated under the Prescription Drugs Payment of Benefits Regulation, which defines the professional fee as “the amount regularly charged by a pharmacist to persons who are responsible for paying the fee without reimbursement”. This regulation ensures that pharmacy service providers establish a consistent market-based fee for which cash-paying customers are provided equivalent services to that of Pharmacare beneficiaries. Other reimbursements include a maximum dispensing fee of $6.95 for the Employment and Income Assistance Program. For personal care homes, pharmacists are reimbursed $47.80 per bed per month in Winnipeg and $48.70 per bed per month for rural areas.

Ontario

The dispensing fee payable to most pharmacies is between $8.83 and $13.25 for each Ontario Drug Benefit (OBD) prescription filled, with the exception of a capitation model for long-term care home residents, effective January 2020. Fees depend on location, with higher fees paid to pharmacies in rural areas. The table below outlines those higher fees and where they apply:

Source: http://www.health.gov.on.ca/en/public/programs/drugs/programs/odb/opdp_dispensing_fees.aspx

Beginning October 1, 2015, pharmacists were encouraged to provide ODB recipients with a 100-day supply of most chronic-use medications. Pharmacies are entitled to receive a maximum of five dispensing fees per 365-day period, beginning with the first dispensing transaction for identified chronic-use medications. ODB recipients who are deemed to require more frequent dispensing need to be assessed regularly to verify an ongoing need.

Effective August 1, 2018, the 35-day supply limit for Ontario Works recipients eligible for ODB Program benefits is removed. In most cases, persons who are eligible for the ODB Program could receive up to a 100-day supply of medication, regardless of eligibility stream.

Effective January 1, 2020, a new long-term care (LTC) capitation funding model in Ontario shifts the payment model for professional pharmacy services (dispensing fee and professional pharmacy services) for LTC homes from fee-for-service to a fixed per-patient amount. As such, ODB-eligible prescription claims submitted for residents of LTC homes reflect a zero-dollar dispensing fee.

Quebec^{Footnote 2}

Professional fees for the Quebec public plan (RAMQ-administered) are determined in agreement with the pharmacy owners’ association, l’Association québécoise des pharmaciens propriétaires (AQPP), and range from $8.63 to $9.64 per prescription or $0.31 per day to a maximum of $27.90 for daily prescriptions longer than 90 days. Fee schedules differ for prescriptions over 90 days, refusal to fill, compounding, therapeutic substitutions, substitution treatment for opioid dependence, and other services.

New Brunswick

The dispensing fees for eligible claims are shown in the table below:

A rural pharmacy incentive pays an additional $2.00 for the first 10,000 prescriptions filled in a fiscal year. This incentive applies to pharmacies that are 25 km or more apart.

Nova Scotia

Between April 1, 2019, and March 31, 2020, dispensing fees increased from $11.95 to $12.10 for ostomy supplies, from $17.92 to $18.15 for compounded extemporaneous products (excluding methadone and injectables) and from $11.95 to $12.10 for all other prescriptions (including methadone).

Prince Edward Island

The maximum reimbursable professional fee is $12.36, and the compounding fee is the usual and customary charge multipled by 1.5, to a maximum of $18.54. The private nursing home capitation fee is $76.52.

Newfoundland and Labrador

The dispensing fees for eligible claims are shown in the table below:

Yukon

There is an allowable professional fee of up to $8.75.

Non-Insured Health Benefits (NIHB)

Pharmacy reimbursement, which includes dispensing fees, is determined by the NIHB or negotiated between the NIHB and pharmacists’ associations and differs by province.