8.2 Dispensing Fees

General Policy Description

PharmaCare sets a maximum dispensing fee for PharmaCare beneficiaries.

All pharmacies and dispensing physicians enrolled as PharmaCare providers can claim dispensing fees.

Pharmacies can charge more than PharmaCare’s maximum dispensing fee to Fair PharmaCare beneficiaries that have not reached their family maximum.

PharmaCare limits the number of dispensing fees that can be claimed for frequent dispensing. See Section 8.3—Frequency of Dispensing Policy-Fee Limits for details.

Policy Details

Beneficiary eligibility

Beneficiaries covered under Fair PharmaCare or PharmaCare plans C, D, F, G, S, P, W and Z are eligible for coverage of dispensing fees.

The Full Payment Policy applies to all dispenses under fully paid plans (C, D, F, G, S, P, W and Z). This means the beneficiary cannot be charged a dispensing fee.

Dispensing fees, up to PharmaCare’s maximum, are applied to a beneficiary’s Fair PharmaCare deductible and family maximum. Once the beneficiary reaches their family maximum, the Full Payment Policy applies to all dispenses. This means the beneficiary cannot be charged a dispensing fee.

Dispensing fees are not covered under Plan B. PharmaCare’s monthly capitation fee for Plan B facilities covers dispensing activities for eligible benefits.

Pharmacy eligibility

Non-pharmaceutical suppliers are not entitled to charge (or claim) a dispensing fee.

Maximum fee

The maximum dispensing fee reimbursed by PharmaCare is $10.00. Pharmacies may not claim more than $10 for a dispensing fee.

Pharmacies may not claim more than the actual fee charged to any person or agency. For example, if they charge a beneficiary $8.00 for dispensing, they must claim no more than $8.00.