Understanding limits on pharmacy mark-ups and dispensing fees

December 19, 2018

Your pay-direct benefits card makes it easy and convenient when filling a prescription. Your drug claim gets processed right at the pharmacist’s counter and instantly you are told the amount paid by your plan and any amount owing. How did the pharmacy determine this amount for your drugs? Why is it important to have limits on pharmacy mark-ups and dispensing fees?

As per your benefits booklet, your prescription drug plan includes mandatory generic substitution and limits on dispensing fees to help manage the costs associated with prescription drugs. If you share in either the cost of your plan or the cost of your prescription, these limits may help you save some money!

Price of your prescription

Although costs vary depending on where you shop, three factors determine the price of prescription drugs:

  • The Drug Ingredient Cost is the amount a pharmacist pays to buy the drug.
  • A Pharmacy Mark-up refers to any additional amount a pharmacist may charge for a drug, above the original drug cost. The mark-up is applied to help pay for the costs of running the pharmacy.  The ETFO ELHT benefits plan has a 10% mark-up cap.
  • A Dispensing Fee is the professional fee a pharmacist charges to fill your prescription.  The ETFO ELHT benefits plan has an $11.00 dispensing fee cap.

NOTE: In the province of Quebec, pharmacists are not required to provide a breakdown of the drug cost, mark-up and dispensing fee.

There is no limit to what a pharmacy can charge for a prescription. Pharmacists can charge any mark-up or dispensing fee that is considered standard for their store or company. By integrating limits on drug costs, dispensing fees and mark-ups in your benefits plan, your Employee Life and Health Trust is protecting members from unusually high prices and managing drug costs to ensure your plan remains financially sustainable.

Here are some cost-saving ideas for filling prescriptions:

  • Shop around. Because the cost of prescription drugs varies depending on where you shop, call your local pharmacies and ask how much it will cost to fill your prescription(s). You may want to ask what their dispensing fee is; as well you may want to check to see what the drug cost charge is. You may discover you can get a better price somewhere else.
  • Request a three-month supply. For prescriptions that you fill regularly and take on a long-term basis such as cholesterol-lowering or blood pressure medication, oral contraceptives, insulin, etc., get a three-month supply instead of just one month to reduce the number of dispensing fees you are charged.

Learn more about dispensing fees and how to save money on your prescriptions.

Questions about your drug coverage? You can contact OTIP Benefits Services at 1-866-783-6847.

Sources:
Understanding Limits pharmacy mark-ups and dispensing fees, Manulife GC2148E, 07/15

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