Patients using the provincial drug program, who thought they might be on the hook for hundreds of dollars in pharmacy dispensing and compounding fees, may be able to breathe a sigh of relief.

As of Aug. 18, dispensing fees covered under the provincial drug program were capped at $30 per prescription, compounding fees were also capped at $30 for non-sterile preparations and no more than $60 for sterile preparations.

Manitoba spent over $52 million on dispensing and compounding fees in the 2016-17 fiscal year. The province said over 90,000 prescriptions billed to the program had dispensing fees over $30, totalling $11.7 million — money the province now expects to save.

In July, a Manitoba couple were advised by their pharmacist that they would be responsible for paying any costs that went over the cap, which could have cost them $1,500 a month.

Certain medications that require compounding, or mixing or tailoring to a patient's specific needs, can cost hundreds of dollars to prepare. Some patients were led to believe that they may have to pay the outstanding bill if it went over the capped amount.

Susan and George Shallcross

Susan and George Shallcross worried they wouldn't be able to pay for George's medical costs after hearing about the cap on compounding fees in July. The couple are now hoping to be exempt from the fees. (CBC)

But on Monday the province clarified an exemption policy for specialty medications that cost more than the provincially allowed amount to dispense.

"Manitoba Health has recognized that there's a sub-group of people that require these specialized products," said Gregory Harochaw at Tache Pharmacy.

Exemptions always part of the plan, says province

In July, Tache pharmacy sent letters to patients advising them of the changes and the possibility of added costs. On Monday, Harochaw said that is no longer the case and that patients were being told about the exemption process.

"All the ones that we talked about before, there's nothing coming out of their pocket," he said.

He said initially his pharmacy was not aware of the exemption process and says he has since received clarification.

Gregory Harochaw

Gregory Harochaw at Tache Pharmacy says the fee capping process now allows for exemptions and he no longer expects to have those costs passed on to patients. (Holly Caruk/CBC)

A spokesperson for the province said the exemption process was always part of the program.

"When the announcement about changes to dispensing fees was made in late July, it noted the province would have a process for exceptions. This includes a process for compounds that take greater than 45 minutes or where special approval is required for coverage of non-benefit compound prescriptions," the spokesperson said in an email.

Pharmacies will now submit a costing worksheet for specialized compounds that will require special approval.

 'I really believe this [confusion] could have been avoided.'
- Gregory Harochaw, Tache Pharmacy

The province posted updated information about the exemption process to its website.

"The development of these additional procedures were the result of intensive consultation with Pharmacists Manitoba and Manitoba pharmacists with an expertise in compounding."

"These new procedures should result in patients not being required to pay anything out-of-pocket for compounding services," the spokesperson said.

Harochaw said there should have been better communication from the start.

"I think if the provincial government would have had a talk first when they drafted new regulations... I really believe this all could have been avoided," he said.

Pharmacy fees won't be passed on to patients, say pharmacists1:38

Cap on fees keeps pharmacies from 'gouging' the system

Until now, pharmacies have set their own dispensing fees when filling prescriptions. The fee is based on overhead costs, profit margins, and market conditions and vary from pharmacy to pharmacy.

Michael Watts, the manager of Brothers Pharmacy, said he applauds the new caps on fees saying it keeps pharmacies honest.

"Unfortunately, there are some pharmacies out there that, rumour has it, are gouging the system. Without a capped fee they can basically charge anything, up to even a $1000 per prescription," said Watts.

Michael Watts

Pharmacist Michael Watts says the cap will prevent some pharmacies from gouging the system, but would like to see further changes to fee structures in the future. (Holly Caruk/CBC)

"At first I think there was a bit of a knee jerk reaction until there was some clarification on the fee schedules, and seems like now those patients aren't going to be on the hook," he said.

Watts says he'd like to see changes that go even further by bringing in set fees that apply to all pharmacies in the province.

'If you are being charged out of pocket for eligible compounds, ask the pharmacy why.' - Quinton Didyk

"I think leveling the playing field would be a really good idea, something like what Indian Affairs does is they have a national schedule that every pharmacy has to adhere to," he said.

He says while the cap on dispensing and compounding fees is reasonable there are some other provincially set fees, like for people of are on Employment Income Assistance, that haven't gone up in years.

"It would be nice if those went up to today's standards, there's some prescriptions that I dispense where I actually lose money because the fees are so low," he said.

Fees more than fair, pharmacist says

CBC contacted several pharmacies to see what pharmacists thought of the new program. The Compounding Pharmacy of Manitoba says Manitoba is the last province to bring in a cap on these kinds of fees and that they are fair.

"The compounding fee cap of $30 for non-sterile and $60 for sterile is one of the most generous fee caps in Canada,"said Quinton Didyk, who owns the Compounding Pharmacy, which serves over half of the pharmacies in the province.  

"Manitoba Health has also developed a special authorization procedure to address the unique cases that may fall outside the boundaries of the policy," he said.

Didyk said none of his patients would be charged out-of-pocket for any fees for compounds that are eligible under the provincial drug program, and encouraged pharmacy customers to shop around. 

"If you are being charged out of pocket for eligible compounds, ask the pharmacy why. Patients can always compare prices between pharmacies."