Pharmacy fee reimbursement

Predictable funding, new dispensing fees and an updated pharmacy services framework that compensates pharmacists for the services they provide to Albertans is at the heart of the new 2-year agreement between the Alberta Pharmacistsí Association, Alberta Blue Cross and the Alberta government.

Prescription pricing effective May 17, 2018

  • The cost of each drug is based on the Manufacturer List Price (MLP) or the Base Price.
    • The Manufacturer List Price is the price for a drug listed in the Alberta Drug Benefit List (ADBL), which is determined by Alberta Health and the pharmaceutical manufacturer.
    • The Base Price is the price per unit of a drug, a drug product or a product. This price is established by Alberta Blue Cross and listed in the Alberta Blue Cross Drug Price List. The Base Price applies to drugs not listed on the ADBL.
  • Two allowable upcharges, referred to as Allowable Upcharge A & Allowable Upcharge B. These allowable upcharges will apply from May 17, 2018 to March 31, 2020.
  • One dispensing fee of $12.15 for each prescription, except for compounded prescriptions prepared in store, diabetic supplies or nutritional products. This $12.15 fee will apply from May 17, 2018 to March 31, 2020.
  • Dispensing fees for daily medication dispensing will be limited to 3 fees per day per patient. Dispensing fees for recurrent medication dispensing between 2 to 27 days will be limited to 2 fees per medication per 28-day period per patient.
  • The pricing structure table below is used for most prescriptions dispensed.
     
Year: May 17, 2018 April 1, 2019
Medication Cost: Manufacturer list price as published in Alberta Drug Benefit List
Allowable Upcharge A: 3% 3%
Allowable Upcharge B: 7% to a
maximum of $100
7% to a
maximum of $100
Dispensing Fee: $12.15 $12.15

Compounded prescription pricing

Compound prescriptions prepared in a pharmacy

  • Pricing for drug ingredients is based on the pricing in the Alberta Drug Benefit List (ADBL) or Alberta Blue Cross Drug Price List.
  • The cost of a compounded prescription is the aggregate cost of all ingredients used, plus:
    • an allowable upcharge A of 7.5%
    • an allowable upcharge B of 7%
    • the dispensing fee of $18.45

Purchased compounded prescriptions

  • When compounded prescriptions are purchased from a compounding and repackaging pharmacy, the drug cost is the purchased compound price, plus:
    • an allowable upcharge B of 7%
    • the dispensing fee of $12.15

Frequent dispensing of medications

  • Daily dispensing fees are limited to 3 dispensing fees per day per patient.
  • Dispensing fees every 2 to 27 days are limited to 2 dispensing fees per drug per 28 days per patient.
  • Drug products for opioid dependency treatment (at this time methadone and buprenorphine/naloxone) are excluded from the fee limits for daily or 2 to 27 day dispensing.
  • Drug products which fall under the Alberta Public Health Activities programs for all Albertans (at this time naloxone and Mifegymiso) are excluded from the fee limits for daily or 2 to 27 day dispensing.
  • Nutritional products and diabetic supplies are excluded from the fee limits for daily or 2 to 27 day dispensing.