Dispensing fee caps

A dispensing fee is the professional fee a pharmacist charges to fill a prescription. Applying a dispensing fee cap limits the amount that the pharmacist will be reimbursed for dispensing the drug. In some provinces there is no limit to the amount that a pharmacist can charge. With ongoing drug reform taking place across the country, applying a cap not only helps manage drug plan costs but it encourages members to shop around to ensure that they have limited out-of-pocket expenses. Applying caps provides controls in advance of escalating dispensing fees.

Limited number of dispensing fees

Manulife’s Limited Number of Dispensing Fee (LNDF) program is designed to help encourage plan members to be smart shoppers when it comes to having their prescriptions for maintenance drugs filled at the pharmacy, keeping more money in their pockets – and the plan’s.

The program typically limits the number of dispensing fees to six per 12-month period for maintenance medications.  Drugs included in the program are:

  • drugs prescribed to treat chronic medical conditions (most maintenance drugs), and
  • drugs that can be reasonably expected to be dispensed every two to three months, without negatively affecting the plan member.

When drugs included in the LNDF program are dispensed every two or three months, savings can be realized since fewer dispensing fees are claimed.  At the same time, medication compliance may be improved by reducing the need for monthly pharmacy visits by the plan member to pick up a new prescription..

Not all drugs prescribed for long-term use fit into this program, such as biologic drugs and products where there is potential risk of abuse or misuse (example: narcotics and controlled drugs).  Drugs requiring more frequent dispensing are not included in this program.

Educational materials for plan members provide easy to understand information on the LNDF program, along with valuable tips to help them become smart shoppers at the pharmacy. An online resource centre is also available on the Plan Member Secure Site, which can help them determine if a drug prescribed is excluded from the LNDF program.

Markup

A pharmacy mark-up is an additional amount a pharmacy may charge for a drug, above the original drug cost. Manulife Financial applies maximum thresholds in each province to limit the amount a pharmacy can charge. More stringent controls on markup are applied for pay-direct plans since the pharmacist knows immediately how much will be considered. Through ESI Canada, Manulife imposes limits on markups in each province to manage drug costs and protect employers and plan members from unusually high prices.

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