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Alberta Government Announces a New Pricing Structure for the Reimbursement of Prescription Drugs

News Release

This communiqué concerns you if you have plan members residing in Alberta.

The Government of Alberta recently announced the implementation of a new four-year prescription medication reimbursement structure, which affects the drug claim process under group policies administered by Industrial Alliance.

The table below illustrates the previous Alberta drug reimbursement structure, through March 31, 2014:

Actual drug acquisition cost Dispensing fee Additional inventory allowance (AIA)
Up to $74.99 $10.22 $1.71
$75.00 to $149.99 $15.53 $2.00
$150.00 and more $20.94 $5.03

The following tables present the new Alberta structure (as of April 1, 2014) for formulary and non-formulary drugs*:

FORMULARY

Effective April 1, 2014 April 1, 2015 April 1, 2016 April 1, 2017
Drug Price Source Manufacturer List Price
Dispensing Fee $12.30 $12.30 $12.30 $12.30
Tolerance** 3% 3% 3% 3%
U&C Markup*** 5.5% 6% 6.5% 7%

NON-FORMULARY

Effective April 1, 2014 April 1, 2015 April 1, 2016 April 1, 2017
Drug Price Source Alberta Blue Cross Base Price + 7.5% tolerance embedded in unit price
Dispensing Fee $12.30 $12.30 $12.30 $12.30
Tolerance** 0 0 0 0
U&C Markup*** 5.5% 6% 6.5% 7%

This new pricing structure applies to every Industrial Alliance group in Alberta using a drug card. It also includes a maximum markup limit of $100. This additional control measure will be implemented in our system as of June 1, 2014.

For further information, here are the publications issued by the Government of Alberta:

If you have any questions or concerns regarding this matter, please contact your benefits advisor or your Industrial Alliance group account executive.