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What makes up a prescription?

Keeping the cost of your drug prescriptions as low as possible goes a long way to sustaining the ASEBP plan and making it viable. Pursuing this goal is a shared responsibility between you and us, and it all begins by acknowledging that prescription costs are a key part of the discussion.

Prescription Components

In Alberta, a prescription is made up of these cost elements (effective April 1, 2014):

  • Ingredients (the chemicals in a drug):
    • There is an allowable drug cost, as per the Pharmaceutical Services Provider Agreement
      • Manufacturer list price for drugs included on the government's Alberta Drug Benefit List (ADBL), which is approximately 4,000 drugs. These drugs are also usually included on private plans as well
      • Base price for drugs excluded from the ADBL and included on private plans such as the ASEBP Drug Benefit List (ASEBP's list contains approximately an additional 4,000 drugs)
  • Pharmacy Upcharges:
    • A set formula for drugs on the ADBL
    • A different (higher) set formula for drugs excluded from the ADBL and included on private plans
  • Dispensing Fee (the pharmacy’s charge to prepare a drug for sale and counsel you about effectively using it):
    • The Pharmaceutical Services Provider Agreement sets maximums
    • ASEBP applies an additional dispensing fee maximum
Adding up these elements gives you a prescription's total cost.

Reducing Waste

Besides applying maximums to a pharmacy’s dispensing fee, we help keep the ASEBP plan affordable with our early refill limitations: we estimate the date when you'll use 70 per cent of a prescription, and this is the earliest you can refill it. This reduces waste and supports safety by reducing your risk of accidentally taking two pills instead of one.

Brand Name vs. Generic

We also control costs in the ASEBP plan with our least cost alternative (LCA) pricing: when an interchangeable drug can be used to fill your prescription, we'll only pay the least price for your drug claim. An interchangeable drug—often a cheaper generic one—has the same active ingredient(s), strength and dosage as the originally prescribed, often brand name drug.

Example:

Two drugs for treating high cholesterol, a brand name and a generic, are interchangeable because they have the same active ingredient (atorvastatin calcium):


Drug

Drug Cost*

Type

Manufacturer

Lipitor $199.04 Brand Name Pfizer Canada Inc.
Atorvastatin $35.30** Generic of Lipitor Apotex Inc.
Auro Pharma Inc.
Cobalt Pharmaceuticals Co.
Genmed, a division of Pfizer Canada Inc.
Jamp Pharma Corp.
Mylan Pharmaceuticals Ulc.
Pharmascience Inc.
Ranbaxy Pharmaceuticals Canada Inc.
Sandoz Canada Inc.
Sanis Health Inc.
Sivem Pharmaceuticals Ulc.
Teva Canada Limited

* 90-day supply of 20 mg pills (March 1, 2014 cost)
** Cost is 18% of brand name as set by the Government of Alberta as of April 1, 2013

Atorvastatin was introduced partway through 2010 to the marketplace. During the 2012-2013 school year, we paid $530,000 in claims for Lipitor and Atorvastatin, using our LCA pricing. If, however, all those claims had been for Lipitor and we had no LCA pricing, we would've paid $1.6 million—nearly $1.07 million more in claims.

What can you do?

ASEBP manages plan stability and sustainability, however, you have a part to play as well. You can take small actions to make sure both you and the plan remain healthy:

  • Use the plan only when you need to – all of us need medication at some time to help us regain or maintain our health
  • Ask your doctor and pharmacist if there's more than one drug to treat your condition – and if they say yes, ask them:
    • Is one drug more effective than the others?
    • If all the drugs are equally effective, is one less expensive?
  • Take your medication as recommended by your pharmacist – time of day, dosage, with or without food, other medications to avoid, etc.
  • Get your doctor to quickly check out any side effects from your medications
  • Tell your doctor and pharmacist about all the medications you’re on (prescription, non-prescription, herbal treatments) – to avoid any drug-to-drug interactions
  • Ask your doctor for a 90-day prescription once your regimen has stabilized – when using a long-term or maintenance drug
  • Learn more about prescribed medications by contacting our Health Information Line:

Phone: 780-431-5875 (in Edmonton)
Toll-free: 1-888-431-5875
health@asebp.ab.ca

Combining your actions with our holistic approach is a winning combination for the ASEBP plan.

Updated: March 25, 2014