Capitation in Alberta
Effective May 17, 2018, capitation was implemented in Alberta between the Alberta Pharmacists’ Association, Alberta Blue Cross, and the Alberta government. This new agreement includes:
What is Capitation?
Capitation is a reimbursement method whereby providers receive fixed payments for health services provided to plan members. This means that dispensing fees paid to the pharmacy are limited to a specified number of prescriptions in a specified time frame.
The frequency of dispensing medications in Alberta is as follows:
- Daily dispensing fees are limited to three (3) dispensing fees per day per patient.
- Dispensing fees every 2 to 27 days are limited to two (2) dispensing fees per 28 days per prescription.
Who does it affect?
It affects patients who receive monthly, multiple fills of a medication using compliance packaging, such as 7-day supply, 14-day supply, blister packs, Blister, and Dosett.
Exemptions and Exceptions
The following drug types are exempt from capitation (i.e. a fee is charged):
- Mixtures
- Methadone
- Methadose
- Suboxone
- PFS Services
- Diabetic Supplies
- Nutritional Supplements
Free form drugs are an exception; when trying to process the prescription, you will be prompted to confirm whether or not you want to change the fee for the free form drug.