Regulation - LGIC
Pharmacy Reconciliation Adjustment Extension
Regulation Number(s):
201/96
Instrument Type:
Regulation - LGIC
Bill or Act:
Ontario Drug Benefit Act
Summary of Decision:
ONTARIO REGULATION 64/23
made under the
ONTARIO DRUG BENEFIT ACT
Made: March 31, 2023
Filed: March 31, 2023
Published on e-Laws: March 31, 2023
Printed in The Ontario Gazette: April 15, 2023
AMENDING O. REG. 201/96
(GENERAL)
made under the
ONTARIO DRUG BENEFIT ACT
Made: March 31, 2023
Filed: March 31, 2023
Published on e-Laws: March 31, 2023
Printed in The Ontario Gazette: April 15, 2023
AMENDING O. REG. 201/96
(GENERAL)
Analysis of Regulatory Impact:
• The ministry does not anticipate any additional administrative or operating costs for small businesses resulting from the proposed extension of the reconciliation adjustment.
• Should the proposal to extend the reconciliation adjustment on a time-limited basis be approved and implemented, the ministry would continue discussions (that were put on hold due to the COVID-19 pandemic) with the pharmacy sector on longer-term savings opportunities.
• This proposal would improve the value of pharmacy payments, an important part of ensuring a sustainable public drug program.
• Should the proposal to extend the reconciliation adjustment on a time-limited basis be approved and implemented, the ministry would continue discussions (that were put on hold due to the COVID-19 pandemic) with the pharmacy sector on longer-term savings opportunities.
• This proposal would improve the value of pharmacy payments, an important part of ensuring a sustainable public drug program.
Further Information:
Regulation
Proposal Number:
23-HLTC027
Posting Date:
February 27, 2023
Summary of Proposal:
• The ministry is proposing a time-limited extension of the current reconciliation adjustment to pharmacy payments under the Ontario Drug Benefit (ODB) Program.
• The current reconciliation adjustment was put in place effective January 1, 2020, following a public posting of a proposal on this Registry under Proposal Number: 19-HLTC015.
• This reconciliation adjustment was initially planned for the period of January 1, 2020 to March 31, 2023.
• The purpose of this time-limited extension is to ensure the continued financial sustainability of the Program, and cooperation on necessary sector innovations and improvements are advanced. This extension is in parallel with recently implemented expansions to pharmacy scope of practice, including new abilities for pharmacists to prescribe medication for common ailments. As part of this consultation, the Ministry is interested in better understanding unique challenges faced by rural and independent pharmacies, and what can be done to overcome these challenges and support their growth and success.
• No change would be made to the method of calculating the reconciliation adjustment. The reconciliation adjustment would continue to reduce an amount from the biweekly payments made to pharmacies under the ODB Program. The amount reduced is a percentage of the sum of the dispensing fee and mark-up paid to pharmacies based on the cost of the drug dispensed, as follows:
o Up to 16% for drug costs equal to or over $1,000; and
o Up to 4% for drug cost under $1,000.
• The reconciliation percentages listed above are maximums that would be allowed under the regulation.
• The reconciliation adjustment would not be applied to professional services, compounding fees, drug costs, co-payments or payments for pharmacy services provided to long-term care home residents.
• The current reconciliation adjustment was put in place effective January 1, 2020, following a public posting of a proposal on this Registry under Proposal Number: 19-HLTC015.
• This reconciliation adjustment was initially planned for the period of January 1, 2020 to March 31, 2023.
• The purpose of this time-limited extension is to ensure the continued financial sustainability of the Program, and cooperation on necessary sector innovations and improvements are advanced. This extension is in parallel with recently implemented expansions to pharmacy scope of practice, including new abilities for pharmacists to prescribe medication for common ailments. As part of this consultation, the Ministry is interested in better understanding unique challenges faced by rural and independent pharmacies, and what can be done to overcome these challenges and support their growth and success.
• No change would be made to the method of calculating the reconciliation adjustment. The reconciliation adjustment would continue to reduce an amount from the biweekly payments made to pharmacies under the ODB Program. The amount reduced is a percentage of the sum of the dispensing fee and mark-up paid to pharmacies based on the cost of the drug dispensed, as follows:
o Up to 16% for drug costs equal to or over $1,000; and
o Up to 4% for drug cost under $1,000.
• The reconciliation percentages listed above are maximums that would be allowed under the regulation.
• The reconciliation adjustment would not be applied to professional services, compounding fees, drug costs, co-payments or payments for pharmacy services provided to long-term care home residents.
Contact Address:
Ministry of Health
Health Programs and Delivery Division
5700 Yonge St., 3rd Floor
Toronto ON M2M 4K5
email: PublicDrugPrgrms.moh@ontario.ca
Health Programs and Delivery Division
5700 Yonge St., 3rd Floor
Toronto ON M2M 4K5
email: PublicDrugPrgrms.moh@ontario.ca
Effective Date:
March 31, 2023
Decision:
Approved