When we look at prescription drug costs, I can probably speak to two key buckets. One would be related to the cost of the actual dispensing of the prescription, so that's your drug cost along with your dispensing fees and your markups.
With that, there's a number of plan management things that we offer to our plan sponsors to try to keep the number of dispensing activities at a reasonable level. For example, if you're on a chronic disease medication and you're stabilized on it, we have programs to try to encourage use of less dispensing, such as dispensing a three-month supply as opposed to monthly dispensing. Those are some of the cost drivers in terms of the dispensing.
We also, as Dianne alluded to, have a pharmacy agreement with our Alberta pharmacies whereby we have caps on the dispensing fees and the markups that they can charge. Through those mechanisms, we're able to control the cost.
The challenge, though, with the drugs that are now being dispensed is the very high cost drugs, the orphan drugs, the specialty drugs. More and more, we're seeing these biologics being used for very chronic common diseases. We have drugs now for treating cholesterol that used to be hundreds of dollars per patient per month. Now we're at between $7,200 to $22,000 per patient per month.
Another cost consideration and the second bucket of costs is really the mix of drugs. As I'm sure many of you have heard, if we look at drugs for treating diabetes, there are some that are in the cost range of 18ยข a day versus some that are $3 per day. At Alberta Blue Cross we put in processes similar to what was talked about with the Canadian Forces, things like step therapy and special authorization. Those are processes that we use to try to manage the cost and, at least hopefully, influence prescribing maybe some of the more cost-effective therapies.