Shared Dispensing Fee / Fee Limit
The shared dispensing fee, or fee limit, refers to the portion of a pharmacy’s dispensing charge that your insurance plan will cover. Pharmacies add this professional fee each time a prescription is filled to cover handling, verification, and counselling.
How It Works
A dispensing fee is a professional service charge a pharmacy adds each time a prescription is filled, covering the pharmacist's time for verifying the prescription, reviewing drug interactions, preparing the medication, and counselling. Each pharmacy sets its own dispensing fee, which can vary based on location, prescription type, and the pharmacy's policies.
Some plans cap the amount reimbursed for dispensing fees, so the member pays the difference if the pharmacy charges more than the plan allows. When a group plan has a dispensing fee cap, any fee charged above that cap is paid directly by the plan member rather than the plan. A reasonable and customary dispensing fee is the maximum dispensing fee an insurer will reimburse in each province or territory, and any component exceeding that maximum is capped during claim adjudication.
Example:
Suppose an Ontario member fills a maintenance prescription at a pharmacy that charges a higher-than-average dispensing fee, while their group benefits plan applies a reasonable and customary dispensing fee limit. The plan reimburses the dispensing fee only up to its cap, and the member pays the portion above that limit out of pocket. By asking the doctor for a 90-day supply or filling at a preferred pharmacy, the member pays fewer dispensing fees and reduces the out-of-pocket gap.
What to Watch For:
For maintenance medications, insurers often encourage using 90-day supplies or preferred pharmacies to minimize repeated dispensing fees. Caps can also have exceptions: under the federal Public Service Health Care Plan, the dispensing fee cap does not apply to biologic or compound drugs, and pharmacist dispensing fees are limited to a set number of fills per year for maintenance drugs. Where a cap applies, Canada Life has confirmed that pharmacies are able to charge patients the difference if their dispensing fee is greater than the plan's reimbursement cap.
