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Claims data tell interesting stories

Claims data tell interesting stories

NOVEMBER 2016 – After four years of collecting claims data for its chart on government-sponsored pharmacists’ services, part of its annual Changing Face of Pharmacy report, the Canadian Foundation for Pharmacy is able to pull together an interesting picture of how pharmacists have been able to respond to publicly funded services. For example, pharmacists in Alberta appear to be embracing pharmacy services by way of care plans, as evidenced by the non-stop double- and triple-digit growth rates in claims data for the past four years. Perhaps most encouraging are the leaps made in the number of follow-ups, which help make the case for public acceptance and economic viability.

Comprehensive Annual Care Plans34,900103,000145,700195,200
Standard Medication Management Assessments12,70033,10055,50062,500

Comprehensive Annual Care Plans (CACPs) and Standard Medication Management Assessments (SMMAs) are unique to Alberta, using standardized documentation to set and monitor health goals and to communicate with physicians. CACPs are available to anyone with two chronic conditions or one condition and one risk factor, and SMMAs are available to anyone with with one chronic condition who are taking three or more chronic medication. Pharmacists can also recommend and bill for as many follow-ups as required.

In 2016 (year ending March 31), pharmacists submitted claims for 195,200 CACPs and 62,500 SMMAs, representing increases of 34% and 13%, respectively, over 2015. Follow-ups increased by 42% after almost tripling in number in 2015. Total claims for follow-ups exceeded 614,400 in 2016, which translates into an average of 2.4 follow-ups per CACP or SMMA.

MedsCheck annual reviews 693,200777,900779,900735,300
Expanded MedsChecks 271,300 311,900 338,000 349,800
Follow-Ups 362,800 475,700 511,100 512,200
Pharmaceutical Opinions 279,900319,700  331,500 338,400

In Ontario, meanwhile, the number of claims for MedsCheck annual reviews declined for the first time, by 6%, since the program launched in 2007. As well, the rate of growth for expanded MedsChecks (for diabetes, home visits and long-term care) has slowed to 3%, from 8% in 2015. Nonetheless, Ontario pharmacists continue to provide more than one million reviews annually, which they have done since 2014. However, they conduct half as many follow-ups as they do reviews.

Claims for Pharmaceutical Opinions in Ontario also appear to be leveling off. Pharmacists submitted 338,400 claims in 2016, a 2% gain over 2015. By comparison, claims had jumped 14% in 2014.

Flu shots2012/132013/142014/152015/16
B.C. 193,800 383,300 434,700 420,400
Alberta 170,700 360,000 487,000 475,300
Ontario 246,900 764,000 901,400 867,700
Nova Scotia n/a 78,200 100,700 98,100
New Brunswick 18,000 40,500 53,600 55,100
Total 629,400 1,626,000 1,977,400 1,916,600

Flu shots

In four out of the five provinces where year-over-year data is available, pharmacists administered fewer flu shots during the 2015/2016 season than they did in 2014/2015. Time will tell whether this reflects a plateau in uptake by both pharmacists and consumers, or if it’s a reflection of relatively mild flu seasons. Pharmacists administered just under two million doses in these provinces, representing almost 8% of their collective population.

Prescription adaptations

The number of prescription adaptations in Alberta is triple the number in B.C., which perhaps reflects the fact that the strong uptake of CACPs and SMMAs in Alberta drives a steady incidence of adaptations. As well, almost 30% of all pharmacists in the province have additional prescribing authority, which would also contribute to prescribing activity. 

Rx adaptations2013201420152016
B.C. 176,500190,700  213,300 202,300
Alberta 433,000 542,800 598,400 615,300
Saskatchewan n/a 3,000 3,800 3,100
Nova Scotia 1,700 2,200 1,000 300

It’s also important to note the sharp decline of adaptations in Nova Scotia, likely due to significant changes to payment criteria. As a result, fewer adaptations became eligible for public funding.

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