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To ensure that routine drug costs can be better covered, Medavie offers coverage on dispensing fees, including limited coverage for dispensing fees on maintenance medications.
What is a dispensing fee?
A dispensing fee is an all-inclusive professional fee charged by your pharmacist to cover the cost of storing and preparing medication, as well as providing a service and counselling to patients.
Your pharmacist will apply a Dispensing Fee every time they fill a prescription.
This fee can range anywhere from $4 to $16 for each prescription you fill and can vary from one pharmacy to another. We encourage all our members to shop around to ensure they’re getting the best service for the lowest fees.
Dispensing fees are regulated differently in the provinces of Quebec and Saskatchewan. Dispensing Fee coverage may vary in both provinces.
Does Medavie cover dispensing fees?
Yes, however, there are limits on dispensing fee coverage for certain maintenance medications. For many plans, the coverage applies for up to 5 dispensing fees, per maintenance medication, per 12-month period*. A maintenance medication should be dispensed in a 3-month dose to ensure you do not surpass your dispensing fee frequency limit.
*Some group plans may have differing frequency limits, for clarification on your coverage limits you can ask your pharmacist, check your coverage booklet, or contact us.
What is a maintenance medication?
Maintenance drugs/maintenance medications are prescription drugs that require regular/daily use, commonly used to treat conditions that are considered chronic or long term. A few examples of maintenance drugs that can have a limited dispensing fee include drugs to treat high blood pressure, heart disease, cholesterol, asthma, diabetes, etc.
When will the Dispensing Fee frequency limit start to apply?
You’re considered in the Trial Phase when you have claimed a new prescribed maintenance drug for less than 3 months during a determined period. The Dispensing Fee frequency limit will not apply during this period.
Once a maintenance drug has been claimed for 3 months, you’re considered in the Maintenance Phase and the Dispensing Fee frequency limit will start applying.
How do I find out if one of my prescription drugs has a limited Dispensing Fee?
Your pharmacist will be able to inform you if any of your prescription drugs qualify to the Dispensing Fee frequency limit at the time of claim. We have a built-in feature on our system that will send them a message if any future claim in the remainder of the benefit period will not accept the dispensing fee. You can also contact us for clarification on any dispensing fee limits.
What if I can’t receive my maintenance drug in a 3-month supply?
Some maintenance drugs can’t be dispensed in a 3-month supply. Your pharmacist is aware of these exceptions and will know what to do to ensure you don’t have to pay dispensing fees out of pocket once you exceed the maximum allowed by your drug plan.
Additionally, if you or your health care professional (prescribing doctor, pharmacist, nurse) have concerns about getting a 3-month supply for a prescription drug on the list with Dispensing Fees frequency limits we encourage you to reach out to our Contact Centre to find out what your options are. If your pharmacist refuses to dispense a 3-month supply for a drug included on our list of eligible maintenance drugs because they have concerns, they will have to fill a dispensing fee program exception form explaining the medical reasoning behind their decision.
What if I don't want to receive my maintenance drug in a 3-month supply?
If a participant chooses to fill their prescription more frequently, they will be responsible for paying any additional dispensing fees for the maintenance drug.
Are some maintenance drugs excluded from the Dispensing Fee frequency limit?
Yes. We understand that some maintenance drugs can’t be dispensed in a three-month supply due to patient safety, storage guidelines, cost, and monitoring reasons. This includes drugs dispensed in a blister pack (also called bubble pack, multi-dose dispensers, or Dispill®). Pharmacists are aware of these exceptions and will know the right steps to take so members don’t have to pay dispensing fees out of pocket once the coverage limits have been exceeded under the drug plan.
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