Pharmacy Benefact
A B u l l e t i n f o r P H A R M A C Y S e r v i c e P r o v i d e r s f r o m A l b e r t a B l u e C r o ss
Number 439 • March 2014
UPDATE 3
Alberta Blue Cross Pharmaceutical Services
Provider Agreement
April 1, 2014 is fast approaching and time is running out to submit your signed new Agreement. As communicated earlier, in order
to avoid a lapse in direct-bill claims adjudication as of April 1, 2014 and to allow adequate time for verification and processing,
we would appreciate a signed copy of the new Agreement returned to Alberta Blue Cross as soon as possible. If you are a chain store
pharmacy, the new Agreement was provided to the appropriate head office site for signing.
As announced in Pharmacy Benefact 432, issued February 21, 2014, Alberta Blue Cross is answering your questions about the new
Agreement through a series of communication pieces sent out over the next several weeks. The purpose of these pieces is to provide
clarification on a variety of topics relating to the new Agreement.
Please note t hat all Benefacts regarding the new Agreement will be located on our Alberta Blue Cross website, located at
http://www.ab.bluecross.ca/providers/pharmacy-home.html along with a copy of the new Agreement.
Today’s update focuses on how to submit your drug cost pricing.
Drug cost pricing
The price on your invoice is no longer the price submitted, with the exception of purchased compounds. Your prescription cost billable
to Alberta Blue Cross is based on:
• Drug cost – based on the Manufacturer List Price (MLP) or the Base Price plus
• Allowable Upcharge #1 – set at 3% of the Manufacturer’s List Price or Least Cost Alternative Price or 7.5% of the Base Price plus
• Allowable Upcharge #2 – set at 5.5% to a maximum of $100 for April 1, 2014, to March 31, 2015. It will increase by 0.5% each year
until it reaches 7% in April 1, 2017, until March 31, 2018. The value of Upcharge #2 is calculated on the sum of the Manufacturer’s
List Price/Least Cost Alternative Price plus 3% or the Base Price plus 7.5% plus a
• Dispensing Fee – $12.30 for all products with the exception of compounds made in store, which have a dispensing fee of $18.45.
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Diabetic supplies and medical supplies are to be submitted at the usual and customary retail price in the drug cost field. Allowable
Upcharge #1 & #2 and dispensing fees cannot be charged for these products.
The following chart demonstrates the pricing components
Drug listed in ADBL
Brand or Generic
Drug listed on
Alberta Blue Cross
Drug Price List
(ABCDPL)
Compound
(purchased)
Compound
(made in store)
Manufacturer List Price
(MLP) – as published
in the Alberta Drug
Benefit List (ADBL)
Base Price – as
published in the
Alberta Blue Cross Drug
Price List (ABCDPL)
Purchased compound
price (invoice price)
Manufacturer List Price
(MLP) or Base Price
Allowable Upcharge #1
3% of MLP
7.5% of Base Price
NA
7.5% of MLP and/or
Base Price
Calculated drug cost*
(aggregate of the drug
cost and the Allowable
Upcharge#1)
MLP + Allowable
Upcharge 3%
Base Price + Allowable
Upcharge 7.5%
Purchased compound
price (invoice price)
Manufacturer List Price
(MLP) or Base Price +
7.5% of MLP & or Base
Price
What do I use for the drug
cost
Software field
Allowable Upcharge #2
Software field
Dispensing Fee
Software field
Total Price
Drug Cost field
Year 1= 5.5% of Drug Cost*
Year 2 = 6.0% of Drug Cost*
Year 3 = 6.5% of Drug Cost*
Year 4 = 7.0% of Drug Cost*
All to a maximum of $100
Upcharge field (previously the Additional Inventory Allowance Field)
$12.30
$18.45
Dispensing Fee field
Calculated Drug Cost* + Allowable Upcharge #2 + Dispensing Fee
Thank you again for your cooperation and patience throughout this transition.
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We’re here to help!
Questions regarding how to submit your new Alberta Blue Cross
Pharmaceutical Services Provider Agreement should be directed to:
Alberta Blue Cross Pharmacy Agreement Management Team at
[email protected] or 780-498-8292.
Questions regarding the new claims submission process or the management
of claims with dates of service prior to April 1, 2014 (such as reversals)
should be directed to:
Alberta Blue Cross Pharmacy Services Provider Relations
Edmonton and area 780-498-8370
Calgary and area 403-294-4041
Toll free 1-800-361-9632
For questions regarding:
terms and conditions of the Agreement
Base Price or Manufacturer’s List Price (MLP)
changes to the Drug Benefits Fees, Allowable Upcharge #1
or Allowable Upcharge #2
how the Agreement relates to out-of-province pharmacies
Please contact:
Cindy Bullerkist, Alberta Blue Cross Pharmaceutical Services at 780-498-8515 or
Susan Casey, Alberta Blue Cross Pharmaceutical Policy at 780-498-7367.
When you have questions:
For assistance with benefit or claim inquiries, please contact an Alberta Blue Cross Pharmacy Services Provider Relations
call centre representative at:
780-498-8370 (Edmonton and area) • 403-294-4041 (Calgary and area) • 1-800-361-9632 (toll free)
FAX 780-498-8406 (Edmonton and area) • FAX 1-877-305-9911 (toll free)
®The Blue Cross symbol and name are registered marks of the Canadian Association of Blue
Cross Plans, an association of independent Blue Cross plans. Licensed to ABC Benefits
Corporation for use in operating the Alberta Blue Cross Plan. ABC 82320.439 2014/03