Regulation - LGIC

Establishing Efficient Pharmacy Reimbursement Policies

Regulation Number(s):
O. Reg. 201/96 (ODBA)
Bill or Act:
Ontario Drug Benefit Act (ODBA)
Summary of Proposal:
On April 11, 2019 the government tabled its 2019 Budget. This year's budget reflects the outcomes of a comprehensive multi-year planning process that built on the findings of EY Canada's line-by-line review, and the ideas identified in the Planning for Prosperity Survey and the Big Bold Ideas Challenge. The government conducted a thorough review of all government programs in order ensure investments are sustainable and modernized. The review is also meant to ensure that duplication is eliminated, and valuable programs and services are sustainable and delivering outcomes for the people of Ontario.

The Ministry of Health and Long-Term Care (MOHLTC) is proposing amendments to the regulation under the Ontario Drug Benefit Act (ODBA) that, if approved, would change pharmacy reimbursement rules related to drug markup and professional services provided to residents of Long-Term Care Homes to establish a smarter, more efficient and fiscally responsible system to deliver publicly-funded health benefits. These proposed amendments include:

1) Prescribing a tiered mark-up payable to pharmacies and dispensing physicians for supplying listed drug products under the ODBA that is based on the cost of the drug dispensed; and,

2) Removing the payment of a dispensing fee for drug products supplied for a long-term care home resident by a pharmacy service provider retained by the long-term care home. Instead of a dispensing fee, these pharmacy service providers would receive a professional fee for all pharmacy services provided to the long-term care home that is based on the number of beds in the home.

See Appendix 1 for additional information
Analysis of Regulatory Impact:
• Ontarians are not expected to be impacted by the proposed changes to professional fees and distribution mark-up payments.

• Some Ontarians could be impacted if pharmacies try to recover some lost revenue through patient charges. Pharmacies may charge up to $2 or $6.11 copayment per drug claim (depending on the category of ODB program recipient); currently some pharmacies have chosen to waive $2.
Further Information:
Proposal Number:
19-HLTC015
Posting Date:
April 25, 2019
Comments Due Date:
May 24, 2019
Contact Address:
Ministry of Health & Long-Term Care
Drugs and Devices Division
5700 Yonge St., 3rd Floor
Toronto ON M2M 4K5