Canadian Pharmacists Association
Canadian Pharmacists Association

Express Scripts Canada Service Fee

Pharmacist Holding Pills Mask Faded

On November 30, 2023, Express Scripts Canada (ESC) announced it was planning to implement a new monthly service fee for pharmacies effective January 1, 2024. A formal communication with some of the details was sent by Express Scripts Canada to pharmacies. According to their communication, the new service fee is tiered based on total billable claims per billing cycle, with fees ranging from $25-$200/month. The change was initiated without any consultation process. 

CPhA Advocacy

CPhA is strongly opposed to the implementation of these new fees and has been actively advocating on behalf of the profession:

  • Competition Bureau Complaint: CPhA has filed an abuse of dominance complaint with the Competition Bureau of Canada, targeting the longstanding and exploitative practices of ESC. Read our news release to learn more.  
  • Engagement with ESC: After an initial letter sent in November 2023 urging them to reconsider, or at least to provide an opt-in/out clause as other companies have done, CPhA sent a follow up letter to ESC outlining our intention to file a formal complaint with the Competition Bureau.We have also met with senior leadership team members at ESC to better understand the rationale for the fee and to further express our concern.
  • Federal MP Engagement Campaign: CPhA launched an advocacy campaign and developed key messages to assist and encourage pharmacy professionals to engage with their federal MPs about the issue.
  • Engaging with Industry Leaders: Our joint advocacy has also extended to other industry leaders. We continue to hold direct meetings with leadership from other leading insurance companies and PBMs.

What Canadians are saying:

National survey of 1,919 adult Canadians conducted by Abacus Data December 7-12, 2023



CPhA Information Session

With the understanding that pharmacy professionals have a lot of pressing questions regarding the fees, CPhA quickly put together an information session to share an update and help answer questions. Watch the recording of the December 7, 2023 session here.


Key messages for pharmacy professionals

Given the significant impact that these fees will have on pharmacies across the country, we encourage you to reach out to your federal Member of Parliament to share your concerns and to urge them to relay these concerns to the Competition Bureau. You can find the contact information for your MP here. We have also provided some key messages below that can help you in your outreach efforts. If you've reached out to and/or met with your MP, please email us ( with your name, federal riding, MP's name and the outreach details so that we can track advocacy efforts across the country.

Some tips

  • Most Canadians do not understand the role that pharmacy benefit managers (PBMs) play, so if you speak with your MP, ask if they would like more information about what PBMs do.
  • Share your personal stories. While the fee will impact almost all pharmacies in Canada, these impacts will be felt differently by each pharmacy. Make sure you convey how this will impact your own pharmacy.
  • Listen. This is a complicated issue so encourage a dialogue that allows your MP to ask questions and truly understand the issue.

Pharmacy Benefit Managers: Fact Sheet

In addition to the key messages below, we have developed a fact sheet you can use to provide an overview of what a Pharmacy Benefit Manager is and why they need to be regulated. Consider using this as a leave-behind in any MP meetings you have.

Key Messages

  • Introduction of new service fee: As of January 1, 2024, Express Scripts Canada, the biggest pharmacy benefit manager in Canada, has implemented a new service fee for all pharmacies. This mandatory fee essentially just allows pharmacists to continue to directly submit claims electronically on behalf of their patients. If pharmacies do not pay this fee, they will no longer be able to submit claims on behalf of patients. Direct billing is a service that pharmacists provide at no cost to their patients and shouldn’t be expected to pay for. And Canadians agree – 61% of Canadians oppose insurance companies charging pharmacies for these services, indicating a significant disconnect between industry practices and public opinion.
    • The fee was introduced with no consultations and is reportedly being implemented for new services that have not been launched and that pharmacies have not asked for.
  • Concerns about abuse of dominance: We believe that this fee represents an abuse of market dominance under the Competition Act. Express Scripts Canada, as a major player in the pharmacy benefits management sector, is using its position to impose unfair costs on pharmacies. We understand that our national association is submitting a complaint to the Competition Bureau on this matter and that the practices of pharmacy benefit managers in the US is under significant scrutiny.
  • Impact on pharmacies and patients: This fee not only burdens pharmacies financially but also risks increasing health-care costs for patients. In a time when health-care affordability is crucial, such measures are counterproductive and harmful to public health. If left unchecked, such practices could lead to a monopolistic control over pharmacy services, reducing competition and choice for consumers, and potentially limiting access to essential health-care services.
  • Request for intervention: We respectfully request your support in addressing this issue. As my/our elected representative, your voice in bringing this matter to the attention of the Competition Bureau is critical. We need your help to ensure fair competition and to protect the interests of both pharmacies and the patients we both serve in our riding.
  • Urgency of addressing the issue: We urge you to recognize the urgency of this situation. The introduction of this fee sets a concerning precedent for the pharmacy benefit managers in Canada.
  • Call for transparency and fair play: We believe that transparency and fairness in the pharmacy services market is important. Interventions from regulatory bodies like the Competition Bureau are essential to ensuring a level playing field and to safeguarding the interests of both service providers and consumers.
  • Commitment to patient care: As front-line pharmacists, our primary commitment is to patient care and public health. The introduction of such fees hinders our ability to serve our patients effectively and affordably.
    • Please include specifics about how this fee could impact your specific pharmacy practice and your ability to invest in new services.

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