Dispensing Fee Policies in Public Drug Plans, 2021/22
This reference document provides a summary of dispensing fee reimbursement in 2021/22 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 $12.10 for each publicly funded vaccination administered by an authorized pharmacist. However, as of March 31, 2021, the amount paid for each COVID-19 vaccine administered in pharmacies has increased to $18.00.
PharmaCare covers a dispensing fee for daily dispensed medications up to 100 days from the original prescription date.
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.
Temporary measures related to the COVID-19 pandemic:
- Between March 20, 2020, and June 15, 2020, a 30-day supply limit on prescription drugs was in place to prevent stockpiling.
- Between October 1, 2020, and March 31, 2022, the Assessment for the Administration of a Publicly Funded Vaccine fee temporarily increased from $13 to $15.
Saskatchewan
Effective March 1, 2021, the maximum dispensing fee changed from $11.60 to $11.85. An additional reimbursement is provided for influenza immunization, trial prescriptions, methadone, compliance packaging, and compounding drugs.
Temporary measures related to the COVID-19 pandemic:
- Between March and May 20, 2020, a one-month (to a maximum of 35-day) supply limit on prescription drugs in any 28-day period was in place to avoid stockpiling.
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. Starting December 1, 2021, trained pharmacists are authorized to prescribe drugs for uncomplicated cystitis and can claim a $20 professional fee for this service.
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.
Temporary measures related to the COVID-19 pandemic:
- Between March 19, 2020, and May 11, 2020, a one-month supply limit on prescription drugs was in place to prevent stockpiling.
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 the standard fee at $8.83, and higher fees up to $13.25 paid to pharmacies in rural areas.
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 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. The implementation of the annual per-bed capitation payment will be phased in gradually from April 2021 to 2025.
Temporary measures related to the COVID-19 pandemic:
- Between March 20 and June 15, 2020, a 30-day supply limit on prescriptions was recommended to prevent stockpiling.
QuebecFootnote 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), charged at $10.03 per prescription as of April 1, 2021. 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:
| Drug category | Dispensing fee |
|---|---|
| Drugs on the Manufacturer List Price (MLP) List | Up to $11.00 |
| Drugs on the Maximum Allowable Price (MAP) List | Up to $11.00 |
| Extemporaneous preparations (compounds) | Up to $16.50 |
| Methadone for chronic pain | Up to $11.00 |
| Drugs for opioid dependence (e.g., methadone, buprenorphine/naloxone) | Up to $9.50 |
A rural pharmacy incentive pays an additional $2.00 for the first 10,000 New Brunswick Prescription Drug Program prescriptions filled in a fiscal year. This incentive applies to pharmacies that are 25 km or more apart.
Temporary measures related to the COVID-19 pandemic:
- Between March 20, 2020, and April 23, 2020, a 30-day supply limit on prescription drugs was in place.
Nova Scotia
Between April 1, 2021 and March 31, 2022, dispensing fees increased from $12.25 to $12.39 for ostomy supplies, from $18.37 to $18.59 for compounded extemporaneous products (excluding methadone and injectables) and from $12.25 to $12.39 for all other prescriptions (including methadone).
Effective October 18, 2021, pharmacists are authorized to prescribe medications for Lyme disease prevention, anticoagulation management and antiviral treatment of COVID-19, and can claim a $20 professional fee for this service.
Temporary measures related to the COVID-19 pandemic:
- Between March 18, 2020, and May 12, 2020, a 30-day supply restriction on prescriptions was in place.
Prince Edward Island
The maximum reimbursable professional fee is $12.36, and the compounding fee is the usual and customary charge multiplied by 1.5, to a maximum of $18.54. The private nursing home capitation fee is $76.52.
Temporary measures related to the COVID-19 pandemic:
- Between March 20, 2020, and May 22, 2020, a 30-day supply limit on prescription drugs was enforced to prevent stockpiling.
Newfoundland and Labrador
The dispensing fees for eligible claims are shown in the table below:
| Plan | Drug cost | Dispensing fee |
|---|---|---|
| The Access Plan, The Assurance Plan, and The Foundation Plan |
$0.00–$49.99 | $11.96 |
| $50.00–$249.99 | $23.93 | |
| $250.00+ | $50.00 | |
| The 65Plus Plan | $0.00–$249.99 | $12.00 |
| $250.00+ | $40.00 |
Temporary measures related to the COVID-19 pandemic:
- Between March 19, 2020, and May 4, 2020, a 30-day supply limit on prescription drugs was enforced to prevent stockpiling.
Yukon
The maximum allowable professional fee increased from $8.75 to $11, effective July 2021.
Temporary measures related to the COVID-19 pandemic:
- Between May 14, 2020, and June 13, 2020, a 30-day supply limit on prescriptions was in place.
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.
Temporary measures related to the COVID-19 pandemic:
- Between March 20, 2020, and June 1, 2020, NIHB accepted claims for greater than 30 days for medications that normally fall under NIHB’s 30-day dispensing policy.
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