The pharmacy markup for all Ontario Drug Benefit (ODB) high-cost claims (total drug cost equal to or greater than $1,000) is 6%. For claims where the total drug cost is less than $1,000, pharmacies receive an 8% markup on the drug benefit price of the product dispensed.
The maximum allowable wholesale markup on the guaranteed selling price is 6.5% with a cap at $39.00. Terms and conditions apply, notably for certain expensive drugs. There is no pharmacy markup policy.
There is a pharmacy markup of up to 8% allowed for drugs on the Maximum Allowable Price (MAP) and Manufacturer’s List Price (MLP) lists.
The pharmacy markup is the Manufacturer’s List Price (MLP) plus 10.5% (if the ingredient cost is $3,000 or less) or MLP plus 8% (if the ingredient cost is greater than $3,000), or the Maximum Reimbursable Price (MRP) or Pharmacare Reimbursement Price (PRP) plus 8% (including methadone). Exceptions include: ostomy supplies — Actual Acquisition Cost (AAC) plus 10.0% (maximum $50); and compounded extemporaneous products (except methadone and injectables) — AAC plus 2.0% (maximum $50).
Prince Edward Island
A maximum 6% markup is allowed for drugs on a Maximum Reimbursable Price (MRP) list. When no MRP exists, the allowed markup is 10% on the ingredient cost for brand-name drugs for which the prescription cost is $2,702 or less, to a maximum of $250 per prescription, and 9.25% on the ingredient cost for brand-name drugs for which the prescription cost is more than $2,702.
Newfoundland and Labrador
A maximum wholesale markup of 8.5% applies to the Manufacturer’s List Price (MLP) for drug products listed in the Newfoundland and Labrador Prescription Drug Program (NLPDP) database. A 9% Inventory Adjustment Allowance applies for drug products contained in the Newfoundland and Labrador Interchangeable Drug Products Formulary (NIDPF).
No pharmacy surcharge can be applied to the prescription cost under any NLPDP plan.
The actual acquisition cost (AAC) may include a wholesale upcharge of up to 14%.
Pharmacies are allowed a 30% markup on top of the Actual Acquisition Cost (AAC) of a drug product. As of July 2017, pharmacies are allowed a maximum markup of 5% on direct-acting antiviral (DAA) drugs for hepatitis C.
Non-Insured Health Benefits (NIHB)
In general, the price is the same as the respective provincial formulary if listed; otherwise, the price paid will be the price list of a national wholesaler.
Pharmacy markups, if applicable, are set in response to provincial/territorial contexts and therefore differ by province.