Fees charged to fill prescriptions vary widely, but few customers realize it

A Nova Scotia senior says it’s time for more transparency around prescription dispensing fees that can vary widely from pharmacy to pharmacy.

Eighty-nine-year-old Mary Colpitts of Diligent River, near Parrsboro, said most of her friends are surprised when she tells them the price of a drug includes a fee charged by the pharmacy for services and expertise.

For instance, one of her prescriptions for an antibiotic cost $14, but she was told by the pharmacist that $10 of it was a dispensing fee.

“I thought, ‘Boy, I’m paying an awful lot for $4 worth of medication,”‘ she told CBC News.

Posting fees not required

She doubts many people know about the fee, but said they should be told. While she doesn’t object to the fee, she said she wants others to realize there’s a way to save money on prescriptions.

“I get my drugs three months at a time so I pay one dispensing fee,” she said. “A lot of people get their drugs one month at a time so they pay three times as much as I do [for dispensing].”

There is no requirement in Nova Scotia for pharmacies to post their dispensing fee in the store or to include it on the official prescription receipt, although determining what fee is being charged is as easy as asking the pharmacist.

Health insurance and Nova Scotia’s seniors pharmacare covers the fee up to a point, but those without such plans must pay.

Up to $12.99

Each pharmacy sets its own dispensing fee, which covers services and expertise provided by pharmacists, who not only count pills but ensure the prescription is right for the patient, that it won’t interact with other drugs and that it’s the correct strength.

In some cases, where a pharmacist is required to mix a compound for a prescription, they will charge a higher dispensing fee.

Ontario legislation requires pharmacies to post their dispensing fees. (CBC)

Earlier this year an Ontario company, Express Scripts Canada, published a report on prescription dispensing fees across the country. It based the report on more than seven million private drug claims between January and March to provide the average dispensing fee for each pharmacy in the country.

In Nova Scotia, it looked at individual pharmacies and the average dispensing fee at each. It found those ranged from $4.49 to $12.99.

Need to have a choice

Bill VanGorder, spokesman for Canadian Association for Retired Persons (CARP), said seniors in Nova Scotia spend more on drugs than others in the rest of the country because “our seniors are less healthy.”

He echoes Colpitt’s concern that many just don’t know the dispensing fee.

“They need to be able to have that choice,” he said. “People, especially seniors, who are on a fixed income, can’t make a choice of what they’re paying if they don’t know what the charges are in the various pharmacies.”

But the registrar of the Nova Scotia College of Pharmacists, Bev Zwicker, said people should not rely on just the dispensing fee when deciding where to fill their prescriptions.

That’s because while the fee at one pharmacy may be higher than another, other parts of the “pricing strategy” could compensate for the difference.

“In the end there may not be any difference or the difference may be more in favour of one than the other,” she said.

Requirements vary

VanGorder, however, is in favour of better transparency. He said if people can see both the dispensing fee and the cost of the drug, they make a judgement.

“Not having them separated doesn’t give the customer any idea of what they’re being charged for either,” he said.

Whether the fees are displayed varies from province to province. Ontario is the only province that requires pharmacies to both display their fee in the store and include it on the official prescription receipt.

Legislation in New Brunswick actually prohibits displaying only the dispensing fee and requires advertisements to reflect the whole price.

“The danger of focusing solely on the dispensing fee is that it is only one component in the price-setting exercise,” according to Karen DeGrace, spokeswoman for the New Brunswick College of Pharmacists.

She said regulations relating to advertising intentionally ensure the focus is on one component, adding it would be simple for a pharmacy to say it had only a $2 dispensing fee, but then manipulate other parts of the price to make up for it.