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Understanding limits on pharmacy mark-ups and dispensing fees

Your group benefits plan makes it easy and convenient when filling a prescription. Your drug claim gets processed right at the pharmacy counter and instantly you are told the amount covered by your plan.

But you may be wondering how drug amounts are determined and how much is covered under your benefits plan?

Your group benefits plan may include limits on pharmacy mark-ups and 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, understanding pharmacy mark-ups and dispensing fees may help you save money.

The cost of prescription drugs

prescription cost

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.
  • A Dispensing Fee is the professional fee a pharmacist charges to fill your prescription.

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

Pharmacy mark-ups

If the pharmacy is dispensing a drug that costs $100 and they apply a 10% mark-up on top of the drug ingredient cost (the amount they paid to buy the drug), the pharmacy may claim up to $10 (10% of the $100).

If the pharmacy is charging a mark-up on a drug claim that is greater than the dollar amount set by your group benefits plan, the mark-up allowed will be reduced to the maximum dollar amount set by your plan. Therefore, unreasonably high drug mark-ups may impact your prescription costs and how much you need to pay out of your own pocket.

Dispensing fees

The allowable dispensing fees vary by province; therefore, your specific claim is calculated and adjusted similar to the process for pharmacy mark-ups. Here are some cost-saving ideas for filling prescriptions:

  • Shop around. Because the cost of prescription drugs vary 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, 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? We are here to help. Check your benefits booklet for benefit plan terms and coverage details. You can also contact OTIP Benefits Services at 1-866-783-6847 or send us an online note.

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