Alberta’s New Pharmacy Agreement, effective April 1, 2014

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An agreement between the Alberta Pharmacists’ Association and the Alberta government was introduced on April 1, 2014, resulting in a new funding model for prescription drugs.   Pharmacists’ scope of practice will also expand going forward.  These services will be fully funded by the province.

Changes with the new Alberta funding model

Prior to April 1st, dispensing fees varied by the ingredient cost and an inventory allowance was also being calculated.  Under this new arrangement, a maximum and consistent dispensing fee of $12.30 is applied and the inventory allowance has been discontinued.  Under the new model, the dispensing fee will remain at a maximum of $12.30 from April 1, 2014 to March 31, 2018.  A summary of these changes is below.

Dispensing Fees

Acquisition Cost

Dispensing

Fee (prior to April 1, 2014)

Additional Inventory Allowance (discontinued as of April 1, 2014) New Dispensing Fee, beginning April 1, 2014
Up to $74.99 $10.22 $1.71 $12.30
$75 - $149.99 $15.53 $2.00 $12.30
$150+ $20.94 $5.03 $12.30

Pricing Model beginning April 1, 2014

  April 1, 2014 April 1, 2015 April 1, 2016 April 1, 2017
Medication Cost:

Manufacturer list price as published in Alberta Drug Benefit List

Allowable

Upcharge #1*

3% 3% 3% 3%

Allowable

Upcharge #2

5.5% to a
maximum of $100
6% to a
maximum of $100
6.5% to a
maximum of $100
7% to a
maximum of $100

*Allowable Upcharge #1 is 7.5% for non-formulary drugs (Alberta Blue Cross Pharmaceutical Services Provider Agreement (Pharmacy)

How will this new agreement affect your drug benefit program?

  • Sun Life will follow the government pricing.
  • The new funding model offers protection on the mark-ups of high cost drugs with the introduction of a $100 maximum. 
  • We can expect slight increases in claims costs going forward.  

You may see higher dispensing fee costs going forward.   The impact will vary depending on the mix of drugs being used by your employees and dispensing fees of the pharmacies at which they purchase their medications.

We’ll continue to monitor this situation as it unfolds and will keep you updated should anything change.

Questions?

Please contact your Client Service Administrator at 1-877-786-7227.