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Claims trends paint compelling picture for services

Claims trends paint compelling picture for services | Concept image depicting an upward trend on a light blue background - The Canadian Foundation For Pharmacy

Claims trends paint compelling picture for services

NOVEMBER 2019 – Pharmacists reached a new milestone in the 2018-2019 flu season by administering more than 3 million flu shots, a 9% increase over the previous season and a continuation of strong gains since 2012-2013. These numbers from provincial ministries of health confirm that flu shots are the most consistently successful service under an expanded scope of practice, in all provinces where it’s available (i.e., every province except Quebec, which is in the process of giving pharmacists authorization to administer vaccinations).

Additional research from the Public Health Agency of Canada bolsters the growing popularity of flu shots in the pharmacy.

Its Seasonal Influenza Vaccination Coverage Survey for the 2017-2018 season found that pharmacies (34%) surpassed physicians’ offices (30%) for the first time in terms of where people got their vaccinations.

Each year the Canadian Foundation for Pharmacy gathers provincial claims data for its online chart entitled, “Professional service fees and claims data for government-sponsored pharmacists services,” which also appears in its annual Changing Face of Pharmacy report. The charts shown here highlight trends in claims data trends over five years or more, for selected provinces. Unless otherwise stated, the year ending date is March 31.

British Columbia

After levelling off for a few years, the number of Standard Medication Reviews increased by 11% to reach 194,800 by year ending March 31, 2019, compared to 176,000 the previous year. Prescription renewals/adaptations continue to climb steadily, increasing by 8% to reach 259,100.


Despite cuts to professional service fees that took effect in May 2018, pharmacists in Alberta increased their billings for professional services. Overall, Alberta continues to set itself apart with its growth rates for pharmacists’ services, some of which are unique to that province (i.e., comprehensive annual care plans [CACPs] and additional prescribing authority [APA]). Currently almost half (48%) of pharmacists in Alberta have APA, which enables them to initiate prescriptions and manage ongoing therapy. Pharmacists with APA submitted 406,500 claims for their prescribing activity this year, a jump of 35% over the previous year (which reported an impressive gain of 44% over 2017).

Claims for CACPs and standard medication managments (SMMAs) have rallied after a bit of a tumble last year. Claims for CACPs, for which pharmacists bill $100 per plan, grew by 18% to reach 257,500, compared to 218,500 a year ago and 253,900 two years ago. Meanwhile, the growth in number of follow-ups for CACPs continued unabated, growing by 10% to reach 1.2 million follow-ups. This translates into an average of 4.6 follow-ups for each initial, annual CACP.


Saskatchewan is one of three provinces in Canada (with Alberta and Quebec) where pharmacists can bill government for assessing and prescribing for minor ailments. Last year the provincial government increased the number of eligible billable conditions from 16 to 25, including uncomplicated urinary tract infections, and as a result the number of claims jumped by 67% to reach 27,900. 


Pharmacists in Ontario continue to struggle with onerous documentation requirements, implemented in late 2016, for the province’s MedsCheck programs. The number of claims for all of the types of MedsChecks (i.e., MedsCheck Annual, MedsCheck for Diabetes, MedsCheck for Long-Term Care and MedsCheck at Home) continue to steadily decline. This year, claims for MedsCheck Annuals dropped by 13% to 401,400 (compared to 461,500 a year ago, and a high of 779,900 in 2015).

Claims for Pharmaceutical Opinions, available to beneficiaries of the public plan only, decreased by 7% (331,600 compared to 356,400 for the previous year). This year’s activity almost matches that for the year ending 2015, when pharmacists submitted 331,500 claims.


Quebec saw its biggest gain in assessments and prescribing for 21 eligible minor ailments, where claims increased by 30% to reach 323,000 (compared to 248,200 for the previous year). Claims for prescription renewals, limited to just one claim per patient annually, were essentially flat (285,000 this year compared to 281,900 for the previous year). Claims for prescribing to help patients reach therapeutic targets inched forward 3% to reach 244,000.

Note: Claims data for Quebec are for year ending Dec. 31 in 2016; and year ending June 30 in 2018 and 2019

Claims data for services other than the flu shot in Manitoba and the Atlantic provinces are not reported here due to the lack of public funding, or because funding is limited to beneficiaries of public plans only.

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