Drug Dispensing Fees in Canada by Pharmacy | Cansumer (2024)

For individuals and/or medications that are not covered under their provincial drug program or other source of insurance coverage, dispensing fees must be paid out-of-pocket.

How much do dispensing fees cost in Canada?

The average out-of-pocket dispensing fee in Canada is $10.88 per prescription, with most people paying between $4.49 to $13.50. The cost varies primarily based on provincial drug program fee caps, type of pharmacy (chain vs independent) and how many other pharmacies are nearby (local competition).

Cost by retailer

Costco’s pharmacy offers the cheapest dispensing fee in Canada ($4.49) and you do not need a Costco membership to use their pharmacy. All you have to do when you visit is tell the employee at the door that you want to use the pharmacy. The company uses low pharmacy fees to get customers in the door to shop for other products.

You can also get your medications refilled via their online pharmacy CostcoPharmacy.ca, which delivers provides free shipping to your home via Canada Post Expedited Parcel in 2 to 5 business days and is available in all provinces except PEI and Quebec. You have to sign for it, so it may end up at your nearest Canada Post location. They will also transfer prescriptions from other pharmacies for you at your request.

Do the numbers not look accurate for your area? Submit a local business’ pricing here and we’ll add it to this page!

Cost by province and territory

Example cost breakdown

The maximum regulated price of an insulin prescription covered by the Ontario Drug Benefit program filled in an urban area:

• Drug ingredient cost paid to the pharmaceutical manufacturer by the wholesaler or pharmacy
• Wholesaler markup to cover storage and shipping costs, plus profit
• Pharmacy markup to cover storage and operation costs, plus profit
• Pharmacy dispensing fee for filling a prescription

Some pharmacies lump all of these costs into one on your receipt, making it look like you didn’t pay a dispensing fee when in fact it was charged but the name of the line item is different.

Compare dispensing fees in your area

Enter your postal code in Lumino Health’s Find a provider tool to see a map of local pharmacies and their dispensing fees. The data is based on recent insurance claims submitted to Sun Life.

In British Columbia, you can use the Blue Cross’ Pharmacy Compass to compare dispensing fees and per pill prices of both brand name and generic medications.

2021 dispensing fees

From quarterly reports by Express Scripts Canada.

Ontario only

Canada excluding Ontario

Factors that affect the cost

The cost varies primarily based on who pays for the drug (provincial fee caps, private insurance or out-of-pocket), pharmacy ownership (chain vs independent) and number of pharmacies nearby (local competition).

Who pays for the drug

Provincial drug programs (public insurance) cap dispensing fees and markup

Each province and territories’ public drug benefit program (Pharmacare) covers the cost of drugs and their dispensing fees for eligible medications (Ontario covers approximately 5,000 different drugs), prescribed to specific groups of people – typically seniors, those receiving social assistance, households with income under a certain threshold or those with high drug costs relative to their income.

Some provinces and territories have placed a cap on the dispensing fees that can be charged to, and reimbursed by their provincial drug program, limiting either the maximum charge, how frequently the charge can be applied on a given prescription, or both. They are intended to compensate pharmacies for providing services while reducing costs for patients and programs paying for prescriptions.

These fee caps are the maximumamountthat a publicdrugplan will reimburse apharmacisttodispenseaprescription. They don’t apply to the prices paid by private insurance plans or by consumers out-of-pocket.

Most also place a cap on the markup a pharmacy or wholesaler can add to drug prices and still be reimbursed for, typically applying it to a list of more commonly used drugs.

These caps also encourage pharmacists to reduce the number of times a prescription is dispensed for medications used to treat chronic diseases by dispensing a 3 month supply instead of just 1 month.

Expenditure for pharmaceutical drugs represents the second largest cost to the Canadian health care system, only behind hospital costs.

Private insurance plans

Private plans have less negotiating power, many of which are charged markups of 12% to 15%. A 2022 study of the difference in drug cost between private and public drug plans in Quebec, it was found that privately insured patients payed 17.6% more on average per drug prescription than publicly insured patients.

Most private health insurance policies will cover a percentage – typically 70% to 90% of the cost of prescriptions, including the dispensing fees and some waive the dispensing fee altogether. You would pay the remaining amount out-of-pocket.

Out-of-pocket payments

People paying cash lack the leverage created by negotiating as a group, so they pay even more. However, provincial dispensing fee caps can have an effect on local dispensing fees.

In Nova Scotia the dispensing fee limit is the lesser of:

1. Usual and customary fee charged to cash customers
2. Maximum fee outlined in the agreement (eg. $12.25 in 2020, increased to $12.54 in 2022)

In 2021, when the maximum was $12.25, most pharmacies charged cash customers that amount or less:

Type of pharmacy

In general, convenience-focused stores cost the most, followed by independent pharmacies, then large chain grocery stores and Walmart, while Costco is the cheapest.

Cheapest: Costco Pharmacy

Costco’s pharmacy offers the cheapest fee in Canada at $4.49 and you do not need a Costco membership to use their pharmacy. All you have to do when you visit is tell the employee at the door that you want to use the pharmacy.

In addition, their markup for all products is capped at 15% and their pharmacy fees are low in order to get customers in the door to shop. The downside is that Costco store are often quite busy so you might wait a while while your prescription is filled, giving you time to look at and buy their other products.

However, with only 105 locations across Canada, getting to one may not be the most convenient option depending on how close the nearest store is.

If there isn’t a convenient location, you can use Costco’s Prescriptions by Mail service at costcopharmacy.ca (all provinces except PEI and Quebec) to have your medications refilled at the click of a button and delivered to your home via Canada Post Expedited Parcel in 2 to 5 business days with free shipping. You have to sign for it, so it may end up at your nearest Canada Post location. They will also transfer prescriptions from other pharmacies for you at your request.

This service is likely ideal for those with a relatively static medication situation.

Expensive: Shoppers Drug Mart

Their higher prices are likely a convenience charge for having so many locations nearby, many of which are open late outside of business hours.

Varies: Independent pharmacies

While not the cheapest option due to not having the leverage that comes with higher volumes, independent pharmacies are generally known for providing more personalized service, getting to know you as a patient and taking more time discussing your history and offering advice. If you have new or evolving health conditions, are regularly changing medications or take more than 3 medications, it may be worth using a good independent pharmacy.

Multiple charges to fill 1 prescription

One Cansumer reader who has a prescription for Botox250 units every 12 weeks reported being charged 2 dispensing fees to have the single prescription filled at the Safeway/Sobey’s pharmacy in Edmonton, Alberta:

• 1 fee for the 200 units vial
• 1 fee for the 50 units vial

even though the prescription was written as one quantity.

Botox comes in 50, 100 and 200 unit vials according to the Alberta Drug Benefit List. The vials come pre-packaged from the manufacturer, so they do not require the pharmacy to do any preparation, only keeping inventory: counting them and stocking shelves.

Consumers wouldreasonably assume that the dispensing fees are charged per drug/prescription because:

1. The province’s website states that when you purchase a prescription, the total cost includes:
   • the cost of the drug,
   • a dispensing fee of up to $12.15, and
   • standard charges for inventory, stocking and other services
2. The province’s Frequent Dispensing Policy limits the maximum number of dispensing fees in a 27 day period to 2 per patient per drug grouping, defined as drugs having the same active ingredient at the same strength.
3. The National Prescription Drug Utilization Information System states a dispensing fee of $12.15 is allowed for each prescription or medication.

In the Alberta agreement, the dispensing fee is for “each act of Dispensing”, which means “providing Pharmaceutical Services which according to law and/or the Coverage must be provided by the Provider according to a Prescription”.

• Pharmaceutical Services: Drug Benefits, Provider Services and/or Pharmacy Services to be provided to and for the benefit of Plan Members.
• Pharmacy Services: includes renewing a Prescription
• Prescription: a direction by a Prescriber for the provision of a Pharmaceutical Service which direction is in a form required by law and/or by the Coverage.

Dispensing fee rules by province

The best source for up-to-date on provincial drug policies is the National Prescription Drug Utilization Information System Plan Information Document.

Alberta

A dispensing fee capped at $12.15 ($18.45 for compounded prescriptions), up to a limit of 3 charges per day per patient and 2 fees per drug per 27 day period. Pharmacies are not permitted to pass on the costs or additional dispensing fees to beneficiaries/Albertans.

The maximum markup is:

• Allowable Upcharge #1 is defined as:
  • 3% of the Manufacturer’s List Price (MLP) as per Alberta Drug Benefit List (generics), or
  • 7.5% of Base Price as per Alberta Blue Cross Drug Price List (ABCDPL) or compound drugs.
• Allowable Upcharge #2 is defined as 7% of: MLP plus Allowable Upcharge #1, up to a maximum of $100.

Alberta Blue Cross, a not-for-profit and the largest benefits provider in Alberta, expects pharmacies to dispense a supply of 90 to 100 days for drugs that are used on a chronic or long-term basis as they will only be paid 1 dispensing fee every 90 to 100 days. Documentation must be provided to support the increased frequency, outlining reasons such as:

• Increased compliance
• Abuse control
• Determination of therapeutic effectiveness, and/or
• Potential drug sensitivities

In most cases, Alberta Health does not pay benefits for more than a 100-day supply of a drug at one time.

The Pharmacy Funding Framework described in the Alberta Blue Cross Pharmaceutical Services Provider Agreement between the Ministry of Health, the Alberta Pharmacists’ Association (RxA) and Alberta Blue Cross. They recently agreed to a 3 extension through March 31, 2025.

More: Alberta Pharmacists’ Association Pharmacy Agreements FAQ

British Columbia

The maximum dispensing fee reimbursed by PharmaCare is $10.00. For daily dispensing, 1 fee per drug per day up to a maximum of 3 dispensing fees and for 27 day supplies, 1 fee per drug per day, up to a maximum of 5. Limits are per pharmacy, not per patient.

Filling 3 different prescriptions incurs 3 separate fees, but 3 orders of the same drug on the same receipt, you only pay one fee.

If a pharmacy charges a higher dispensing fee than the maximum, the customer pays the difference, unless covered by 100%-paid plans (PlansC,W,G,FandZ) or income-based Fair PharmaCare.

The maximum markup for:

• Most drugs maximum 8%.
• High-cost drugs (expected daily cost of the typical dose is equal to or greater than $40.00) maximum 5%.
• Products subject to Actual Acquisition Cost (AAC) pricing – manufacturer’s list price plus a markup of 7%.
• Effective March 1, 2017, the maximum markup on certain high-cost hepatitis C drugs covered by PharmaCare was reduced from 5% to 2%.

Coverage is limited to a maximum 100 day supply for repeat fills for long-term maintenance drugs, 30 day for short-term or addictive prescriptions or as specified in the PharmaCare Formulary Search.

Manitoba

Pharmacy markup on the drug prices listed in the Manitoba Drug Formulary Lookup must be included in the dispensing or professional fee.

The government pays the dispensing fees for prescriptions covered under provincial drug programs such as Pharmacare, spending $54.9 million through the program on dispensing fees in 2016/17 – 22% of the total cost of providing drugs through the program.

Dispensing fees charged to provincial drug programs were capped to $30 per prescription in 2017 in order to save an estimated $11 million annually. An additional $30 can be charged for compounded prescriptions for a maximum of $60 per prescription.

If a pharmacy charges a professional fee higher than the limit, the customer pays the difference.

The wholesale markup Pharmaceutical Distribution Rate is 5%.

Pharmacists or a pharmacy owner must disclose the total price of the drug and professional fee:

1. to a patient at the patient’s request; or
2. to a person responsible to pay for the drug if the person is authorized by law to obtain the information.

Coverage is limited to a maximum 100 day supply.

New Brunswick

New Brunswick caps fees charged to the New Brunswick Drug Plans to $11 and $16.50 for compounds, paying for 1 dispensing fee every 28 days or more.

The maximum pharmacy markup for listed drugs is 8% on the Maximum Allowable Price (MAP) or Manufacturer’s List Price (MLP) lists.

Coverage is limited to a maximum 100 day supply, or 35 days for controlled or addictive drugs.

Nova Scotia

Nova Scotia caps fees to $12.69 and $19.04 for compounds, with the price increasing every year for 5 years:

The maximum pharmacy markup for prescription drugs is:

• 10% on the Manufacturer’s List Price (MLP) if the ingredient cost is $3,000 or less
• 8% on the Manufacturer’s List Price (MLP) if the ingredient cost is more than $3,000, to a maximum of $325 per claim
• 8% on the Maximum Reimbursable Price (MRP) or Pharmacare Reimbursem*nt Price (PRP) to a maximum of $325 per prescription

Prices are listed in the Nova Scotia Formulary.

Coverage is limited to a maximum 100 day supply, or 35 days for controlled or addictive drugs.

More: Pharmacare Tariff Agreement between the province and the Pharmacy Association of Nova Scotia and the Pharmacy Guide.

Ontario

Ontario caps fees charges to the Ontario Drug Benefit (ODB) at $8.83 per ODB prescription filled, unless there are few other pharmacies nearby (rural or remote), then the maximum is:

• $9.93 if there is only 1 pharmacy within 5 km, or the nearest one is 5 to 10 km away
• $12.14 if the nearest pharmacy is 10 to 25 km away
• $13.25 if the nearest pharmacy is more than 25 km away

up to a limit of 2 dispensing fees per 28 days. For a list of chronic medications, the limit is 5 dispensing fees per 365 day period.

Pharmacies are required post their dispensing fees publicly.

The maximum reimbursable pharmacy markup for prescriptions with total drug cost less than $1,000 is 8%, or 6% if greater than $1,000 to the Drug Benefit Price (DBP) listed in the Ontario Drug Benefit Formulary/Comparative Drug Index.

ODB coverage is limited to a maximum 100 day supply, other than newly prescribed or controlled substances.

Prince Edward Island

PEI caps fees charged to the public drug plan is $12.36 and $18.54 (1.5x) for compounds public drug program prescription.

The maximum pharmacy markup for drugs on the Maximum Reimbursable Price (MRP) List is 6%. MRP is the ingredient cost based on the price of the lowest-priced product in an interchangeable category.

If there isn’t an MRP, the markup is 10% for brand-name drugs that have a prescription cost less than $2,702, or 9.25% for brand-name drugs that cost more than $2,702.

Quebec

Quebec caps the professional fee for filling or renewing a prescription $10.03, as determined by the agreement between the Régie de l’assurance maladie du Québec(RAMQ) and the pharmacy owners’ association, l’Association québécoise des pharmaciens propriétaires (AQPP). Other services such as refusal to fill, compounding and therapeutic substitutions have different professional fees.

There is no pharmacy markup, but wholesaler’s markup is limited to 6.5% to a max of $49.

The List of Medications covered by Québec’s basic prescription drug insurance plan. Quebec requires that generic manufacturers provide the province with the lowest price available in other provinces.

Since September 15, 2017, pharmacists are required to provide an itemized invoice that shows a breakdown of medication cost, including:

• Drug cost
• Wholesaler’s markup
• Professional/dispensing fee

Saskatchewan

Since March 1, 2021, Saskatchewan caps the Saskatchewan Drug Plan at $11.85 per prescription for most drugs in the formulary. Pharmacists have the option to charge the fee for each 34 day supply dispensed, for each prescription.

Manufacturer’s prices before markups can be found in the Saskatchewan Formulary.

The maximum markup is based on the acquisition cost of the drug:

The wholesale markup is llimited to 6.5% on generic drugs, 8.5% on most other drugs and is capped at $50 per package size.

In most cases, the drug plan does not pay benefits or credit deductibles for more than a 3-month supply of a drug at a time. The Maintenance Drug Schedule lists drugs that can be dispensed in 100 day and 2 month supplies.

How to save money on dispensing fees?

Ask for a 3 month supply

Drugs used on a chronic or long-term basis, such as cholesterol-lowering or blood pressure medication, oral contraceptives, insulin, etc. can be dispensed in larger quantities to patients with stable medical situations.

Ask your doctor if they can write your prescriptions for refills of 3 months or more, rather than 1 month, to reduce the number of refills you have to do per year and thereby reduce the total dispensing fees you pay.

Shop around

The cost of prescription drugs can vary greatly depending on where you shop. Call your local pharmacies and ask how much it will cost to fill your prescription(s). Ask for a breakdown of the cost of the drugs, including the dispensing fee and drugs themselves.

You may save money by switching pharmacies, even if your insurance covers a portion of the fees.

Frequently asked questions

What is a dispensing fee?

A dispensing fee is an amount charged by a pharmacist for preparing and dispensing a prescription.

It is charged for each separate prescription that they fill, every time they prepare the prescription. Each must be stocked, counted, labelled and prepared in a separate bottle or tube.

Each pharmacy sets its own fees, which vary considerably between pharmacy locations and can become a significant cost for patients – especially those withchronic diseases (frequent refills, even daily) or complex medical situations (many prescriptions). These fees directly impact Canadians’ access to important prescription drugs and the sustainability of Canada’s health care system.

What is a professional fee?

Professional fees are charges for the time and expertise of a licensed pharmacist or pharmacy technician to help patients manage their medications or conditions. A dispensing fee is one kind of professional fee.

What are compound drugs?

Compound drugs are a mixture of 2 or more ingredients that must be prepared specifically for an individual patient. They require more time and resources as well as a sterile environment to prepare, so they often come with a higher fee.

Sources

• Enter your postal code to see local pharmacy dispensing fees on a map – Lumino Health
• National Prescription Drug Utilization Information System – Plan Information Document – Canadian Institute for Health Information
• Dispensing Fee Policies in Public Drug Plans – Patented Medicine Prices Review Board
• DISPENSING FEE REPORT – Ontario only – Express Scripts Canada
• DISPENSING FEE REPORT – All Provinces Except ON – Express Scripts Canada
• Public Drug Plan Dispensing Fees: A Cost-Driver Analysis – Patented Medicine Prices Review Board
• Markup Policies in Public Drug Plans – Patented Medicine Prices Review Board
• Understanding Pharmaceutical Pricing in Canada – Conference Board of Canada
• Private Drug Insurance in Ontario – Ontario Ministry of Health