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Posted by Simon Pagé, Group Insurance and Group Annuity Plans Advisor, March 27 2019
Health Insurance
Pharmacist Prescription Fees: Information for your Employees

prescription-fee

On March 5, 2019, La Facture, a French TV program along the lines of Marketplace, carried a story showing that pharmacies have different practices with respect to the fees they charge to fill a prescription. The coexistence of a public drug insurance plan alongside private group plans further adds to this inconsistency. In this article, we will discuss what your employees should know when they go to the pharmacy in order to achieve substantial savings for themselves and your group insurance plan.

As a reminder, since September 15, 2017, Quebec pharmacists are required to provide additional details on their invoices for drugs included on the list of prescription drugs covered by RAMQ. This legislation was enacted to provide consumers with maximum information on the price of their medications.

Pharmacist prescription fees

Pharmacists charge fees to cover the direct and indirect expenses related to their professional services and the ongoing operation of their pharmacy, along with their profit margin. There is a wide disparity between the prescription fees charged to clients with public or private coverage:

Public plan

  • Under the public plan, pharmacist fees are set by the government. Therefore, a pharmacist cannot charge a different amount, as this would be illegal. All pharmacies are on the same footing. The amount set by the government for 2019 is close to $9 per prescription, regardless of the cost of the medication prescribed.
  • For 90-day supplies, pharmacists automatically bill the prescription fees 3 times, as agreed with the government and as shown in the TV story.

Private plans

  • For private group insurance plans, pharmacist fees are not set by the government, but rather determined by pharmacists themselves. The free market rule applies: pharmacists charge the prescription fees they want (without any set maximum).
  • For your information, based on the data submitted during a conference by Telus in 2018, the professional fees charged in Quebec in 2017 were close to $17.00 on average (approximately twice the public plan amount).

Thus, there is clear inequity between the two plan types, and there is no indication that either the government or the AQPP (Quebec Association of Owner Pharmacists) want to address this matter.

Solutions for your employees

Is there any way to get around this thorny problem? Absolutely! Until such time as the legislation is adjusted, employees covered by a private plan can become smart prescription drug consumers:

Shop around for pharmacies

  • “Shopping around for a pharmacy” is becoming increasingly popular. As each pharmacy sets its own prescription fees, some are more affordable than others.
  • Therefore, employees could save quite a bit (sometimes up to 50%) by purchasing their medications at the right place. The group insurance plan will also come out ahead.

90-day supply

  • Another solution is to ask the pharmacist for a 90-day supply instead of one for 30 days (medical condition permitting). Why? Simply to save on pharmacist prescription fees, as the pharmacist would be expected to charge the fee only once instead of three times, generating potential savings of up to 30%.
  • However, as shown in the TV program, pharmacists are not required by law to charge their fee only once. Some pharmacists charge their fee three times for a 90-day supply. It is legal, but is it really “acceptable”?
  • Employees can discuss this matter with their pharmacist in order to be billed more fairly.
  • Nothing prevents them from going elsewhere if their pharmacist refuses to charge the fee only once.

As we can see, prescription fees charged to employees covered by private plans vary widely from one pharmacy to the next. However, as consumers, we have some leverage on prices. If all consumers shopped around for their pharmacy (as they do for most of their purchases) and asked for 90-day supplies, substantial savings could be achieved.

Would you like to know more on good practices for responsible prescription drug consumption? Download our smart drug consumer quick reference guide and show it to your employees!

good-drug-consumer

Group Insurance and Group Annuity Plans Advisor | Holding a Bachelor of Actuarial Science degree, and Associate of the Canadian Institute of Actuaries, Simon Pagé worked as group annuity plans advisor for large consultants and actuarial firms. With his 15 years’ experience, he has developed a renowned expertise, notably in the selection, development and implementation of annuity plans. In addition, Simon holds a permit in group insurance adding to his expertise and bringing a global vision in benefits related issues for his clients.
Simon Pagé, Group Insurance and Group Annuity Plans Advisor