Community pharmacies’ uptake of billable services are adding up—to the tune of more than 25 million claims for the latest fiscal year of 2023-24. Prescription renewals, adaptations, minor-ailment assessments and medication reviews all forged ahead, with significant gains in almost all provinces. Meanwhile, COVID-19 vaccinations were down by a third and influenza vaccinations also slowed. Even so, pharmacies still administered an impressive 11.4 vaccines for flu and COVID-19.
Since 2012, the Canadian Foundation for Pharmacy has collected provincial claims data for pharmacy services that are publicly funded, for inclusion in CFP’s annual Services Chart . Below we summarize claims-data trends over the past several years. All provinces operate with a fiscal year ending on March 31, therefore, unless otherwise stated, the latest data reported here is for the fiscal year ending on March 31, 2024.
The roller-coaster ride for flu shots appears to be winding down. After a record-high of 5.9 million in 2022-23, community pharmacies administered 5.6 million vaccinations in 2023-24, a decline of 5%.
The biggest year-over year increase—48%—occurred in 2020-21, catapulting the total from 3.7 million to 5.4 million. Flu vaccinations dropped by 9% in 2021-2 as pharmacies focussed their efforts on administering 18 million COVID-19 vaccines, then rebounded by 19% in 2022-23 to set the new record of 5.9 million.
Regionally, the biggest declines occurred in P.E.I. (17%), Nova Scotia (10%) and Ontario (9%). Two provinces increased their flu-shot count, Quebec (5%) and B.C. (3%), while Manitoba saw virtually no change (increasing by less than half of one percent).
The volume of COVID-19 vaccinations, at 5.8 million, was within striking distance of flu vaccinations (5.6 million) in 2023-24. Contrast this with 2021, during the height of the COVID-19 campaign, when pharmacies administered 3.6 COVID-19 vaccines (18 million in total) for every one flu vaccine (5 million in total).
COVID-19 vaccinations in 2023-24 were down by a third (34.3%) compared to 2022-23 (8.1 million). Almost all provinces experienced double-digit drops, most notably Saskatchewan (59%), New Brunswick (47%) and Ontario (46%). Quebec was the one exception: COVID-19 vaccinations in community pharmacies declined by only 4% in that province.
After four years of strong gains, resulting in 4.4 million claims in 2022-23, prescription renewals may be settling into a more moderate pace of growth. Nonetheless, the increase of 7% in 2023-24, to 4.7 million, represented more than 300,000 additional renewals by community pharmacists.
Pharmacies in all provinces except Manitoba and Ontario can bill the government for renewals. In April 2023, Newfoundland and Labrador expanded its funding to include all residents, in addition to beneficiaries of its public drug plan. As a result, claims for renewals in that province alone more than doubled in 2023-24. Similarly, in P.E.I., claims almost tripled following the implementation of universal funding in October 2022. Growth also continued to be strong in B.C. (50%) following the October 2022 expansion of the list of medications eligible for renewal.
However, renewals in Quebec dropped significantly, by 18%. That said, community pharmacists in that province still completed close to 1.5 million renewals for patients.
Claims for prescription adaptations surpassed 1 million for the first time in 2023-24. All provinces except Manitoba, Ontario and New Brunswick can bill for adaptations. In July 2023, Nova Scotia expanded its funding to be universal—and adaptations more than quadrupled in that province. Growth was also very strong in Newfoundland and Labrador (55%) and B.C. (45%).
The implementation of programs for minor ailments or common conditions in B.C. (June 2023) and Ontario (January 2023) jettisoned total claims past 2.2 million in 2023-24, more than double the total in 2022-23 (897,000).
Community-pharmacy-based programs to assess and prescribe for minor ailments exist in all provinces; however, the degree of funding varies widely. In Manitoba, for example, pharmacies can bill for assessments for urinary tract infections (UTIs) only, out of a total of 13 conditions for which they have authority to assess and prescribe. In Quebec and P.E.I., pharmacies can bill for all 35 eligible conditions in their respective programs.
Community pharmacists in B.C. steadily incorporated more non-dispensing services into daily practice following expansions in scope and funding in fall 2022 and spring 2023.
Prescription renewals jumped 50% to 690,100 in 2023-24, following a surge of 67% in 2022-23 (460,100). In 2021-22, prior to the expansions in authority, pharmacists had conducted fewer than half as many renewals (276,100) compared to 2023-24.
Similarly, adaptations and therapeutic substitutions climbed significantly following expansions in authority. Adaptations rose by 45% in 2023-24 and 30% in 2022-23, resulting in 68,300 adaptations in 2023-24 compared to 36,200 in 2021-22. Therapeutic substitutions more than doubled in 2023-24, reaching 25,900.
Pharmacies’ adoption rates of three new programs in B.C. were fast out of the gate, across the board. During the six months that pharmacists could administer drugs by injection in fiscal year 2022-23 (starting in October 2022), the government received more than 99,800 billings. That almost tripled in 2023-24, to 294,700.
B.C. Minor Ailments and Contraception Services program launched in June 2023. By the end of the 2023-24 fiscal year 10 months later, pharmacies had billed for 276,100 minor-ailment assessments and 70,200 contraception services (including emergency contraception).
The new services also may have rejuvenated the uptake of billable medication reviews, which have been available to eligible residents since 2012. After declining by 5% in 2022-23, Standard reviews rose by 30% to reach a record high of 218,000. Pharmacist Consultation reviews, which include consulting a physician, climbed 11% to 14,200, following a drop of 10% in 2022-23.
Finally, on the vaccinations front, B.C. pharmacies posted results ahead of national averages. Flu vaccinations increased by 3% in B.C. versus a decrease of 5% nationally; and COVID-19 vaccinations declined by 17% compared to a national decline of 34%. In other vaccination news:
For the second year in a row, claims increased by double digits for Comprehensive Annual Care Plans (CACPs), Standard Medication Management Assessments (SMMAs) and independent prescribing services in Alberta. All these programs and services have been funded since 2012.
Unfortunately, community pharmacies may have become a victim of their own success. When it became clear that billings would exceed the budget cap for the first time, the provincial government cut funding for initial CACP assessments by 30% and slashed the maximum number of billable follow-ups from 12 to four annually, effective November 2024.
Related article: Service claims tell the story in Alberta
Here are the results that contributed to this unfortunate turn of events:
Meanwhile, vaccinations dropped by 9% for influenza (884,900) and by 32% for COVID-19 (774,400), compared to national declines of 5% and 34%, respectively. Pneumococcal vaccinations dropped by 35% (10,300), while Tdap vaccinations climbed by 20% (15,900).
Saskatchewan uses the single category of “prescriptive authority” to capture claims data for prescription renewals, adaptations, prescribing under Collaborative Practice agreements and prescribing as part of medication reconciliations. Claims within this category grew 5% in 2023-24 to 408,400, following a 2% decline in 2022-23 (390,100).
Assessments for minor ailments grew by double-digits for the second year in a row: by 17% in 2023-24 (42,700) following a gain of 13% in 2022-23 (36,400). It’s important to note that in Saskatchewan, as in Alberta, pharmacists can bill only for assessments that result in a prescription. All other provinces pay for assessments whether or not a prescription results.
Community pharmacists administered 164,100 flu vaccines, 3% less than in 2022-23 (168,600) and comparable to the national decline of 5%. However, COVID-19 vaccinations plummeted by 59%, more than any other province, to 88,900 (compared to 214,400 in 2022-23).
With each passing year, Manitoba falls further behind all other provinces in terms of public funding for non-dispensing services. In early 2022 the government began paying pharmacies to assess and prescribe for a single minor ailment, UTIs, out of 13 eligible conditions in its program. Claims data has not yet become available.
Fortunately, data for vaccinations is readily available. Flu vaccinations held steady in Manitoba in 2023-24, at 179,900 compared to 179,500 in 2022-23. COVID-19 vaccinations dropped by 37% to 188,300, consistent with the national trend. Pharmacists administered 2% more pneumococcal vaccines (3,300) and 8% more HPV vaccines (1,100). Tdap vaccinations plummeted by 44% (3,300); however, this follows a surge of 72% in 2022-23 (5,900).
Growth rates for MedsCheck medication reviews are strong. MedsCheck Annuals increased by more than a third (38%) in 2023-24 to reach 910,600, after climbing by 31% in 2022-23 (657,800). Follow-ups jumped by 54% to 173,900.
MedsCheck for Diabetes surged ahead by 57% to 295,300 reviews in 2023-24, after growing by 48% in 2022-23 (187,800). Follow-ups almost quadrupled, to 322,800, resulting in an average of 1.1 follow-ups per initial review.
Ontario’s Pharmaceutical Opinions (POs) program has existed since 2013. Available to beneficiaries of the provincial drug plan only, community pharmacists conducted 245,600 POs in 2023-24, 17% more than in 2022-23 (209,300). In 2022-23, POs climbed by 20%. Despite the gains, service volume is still well below the record high of 356,400 in 2017-18.
Ontario launched its fully funded minor-ailments program in January 2023, for 13 conditions initially and 19 conditions effective October 2023. Community pharmacists conducted 722,500 assessments by the end of the program’s first full fiscal year (April 1, 2023 to March 31, 2024).
Community pharmacies in Quebec reached the 1-million milestone with its program for minor ailments and common conditions, publicly funded since 2016-17. Pharmacists conducted 1.1 million assessments for 35 eligible conditions in 2023-24, an increase of 35% over 2022-23 (822,000).
Pharmacists’ assessments and follow-ups to manage drug therapy and help patients reach therapeutic targets grew by 60% to reach 498,200. More than a quarter of these assessments and follow-ups (189,800) were for anticoagulation management, including INR tests; these services declined by 18% compared to 2022-23 (231,100).
Prescription renewals also reversed direction in 2023-24, declining by 18% to 1.5 million claims from 1.9 million in 2022-23. Meanwhile, prescription adaptations forged ahead. After a three-fold increase in 2022-23 to 585,000 adaptations, the growth rate was a healthy 27% in 2023-24, resulting in 740,900 claims.
Quebec was the sole province to report a moderate increase in influenza vaccinations: growing by 5% to reach 678,000, compared to a national decline of 5%. Quebec also reported much less of a decline in COVID-19 vaccinations: -4% (to 498,000) versus -34% nationally.
Public funding for minor ailments or common conditions began in 2021-22 for UTIs only, expanding to include shingles and contraception management in 2022-23, and expanding again to a total of 11 conditions in 2023-24. Community pharmacists conducted 19,800 assessments for minor ailments in 2023-24; a comparison to the previous year is not possible due to the unavailability of all data. However, separate reporting for UTI assessments reveals an increase of 26% to 10,500 claims in 2023-24—which is 53% of the total.
Separate reporting for contraception management also reveals pharmacists provided 1,600 services, compared to just 500 in 2022-23.
Public funding for prescription renewals began in 2021-22. Claims reached 171,500 in 2023-24, up 11% over 2022-23 (154,000). Data for 2021-22 is not available. Prescription adaptations are not funded by the provincial government.
New Brunswick administered 139,600 flu shots in 2023-24, down 7% from 2022-23. COVID-19 vaccinations fell by 47%, to 154,300.
Prescription renewals, funded for all residents since 2020-21, climbed by 8% to reach 227,600 in 2023-24. Public funding for adaptations expanded to include all residents in June 2023—and the claims count increased five-fold, from 2,000 to 10,000. Universal funding for therapeutic substitutions also began in June 2023 and uptake by pharmacists and patients exploded: from just 420 claims in 2022-23 to 20,000 claims during the 10 remaining months of fiscal year 2023-24.
Community pharmacies can bill for three out of 35 minor ailments, and contraception management. Community pharmacies submitted a total of 27,700 claims for the three ailments in 2023-24; however, a comparison to the previous year is not possible due to missing data for Lyme disease. When claims for Lyme disease are removed from the most recent data, the revised number of total claims, 21,900, is a 2% increase over 2022-23 (21,600).
Assessments and follow-ups for contraception management declined by 22%, to 4,100 claims from 5,200 in 2022-23.
Two full years of data are now available for Nova Scotia’s Community Pharmacist-led Anticoagulation Management Service. Participating pharmacies billed for 19,700 services under the program, an increase of 8% over 2022-23 (18,200).
Public funding for prescription renewals began in October 2022, resulting in 16,800 claims during the remaining six months of that fiscal year. Upon completion of the first full fiscal year, for 2023-24, community pharmacists had renewed 45,300 for their patients.
Interestingly, while public funding for prescription adaptations remains limited to beneficiaries of the public plan, claims almost quadrupled, from 360 in 2022-23 to 1,400 in 2023-24.
Effective October 2022, public funding for common conditions expanded from UTIs only to all 35 eligible conditions (including hormonal contraception and emergency contraception). Community pharmacists performed 26,700 assessments in 2023-24.
In early 2022, the government announced free Shingrix vaccinations in community pharmacies for eligible residents. In just two months, pharmacists administered 5,500 doses. Vaccine coverage appears to have peaked in fiscal year 2022-23, with 19,700 vaccinations, then dropped by 66% to 6,700 in 2023-24.
Flu shots declined the most in Prince Edward Island, by 17% (30,800), compared to the national decline of 5%. Meanwhile, the 28% reduction in COVID-19 vaccinations (34,500) was somewhat better than the national drop of 34%.
The government expanded the funding of prescription renewals to include all residents effective April 2023. As a result, claims more than doubled, from 77,200 in 2022-23 to 166,100 in 2023-24.
Although funding for adaptations remains limited to beneficiaries of the public plan, growth has been strong and steady for several years, increasing by 55% to reach 6,800 in 2023-24. In 2019-20, the claims count was 1,800.
Public funding for nine out of 33 minor ailments plus hormonal contraception began in April 2023. Community pharmacists completed 15,000 minor-ailments assessments and 1,000 contraception assessments and follow-ups by the end of fiscal year 2023-24.
Flu vaccinations fell by 8% to 80,100, compared to the national decline of 5%, and COVID-19 vaccinations dropped by 20% to 65,500, compared to a drop of 34% nationally.
As part of its annual Changing Face of Pharmacy report, the Canadian Foundation for Pharmacy...
The federal and provincial governments have enacted a wide range of temporary laws, regulations...
This free webinar puts the spotlight on how community pharmacies are changing their practice to provide more primary-care services.
