NOVEMBER 2021 – The latest claims data for publicly funded services paints a compelling picture of how the COVID-19 pandemic pushed pharmacists to do more prescription renewals and many, many more immunizations. On the other hand, other services saw drops in billings after years of growth.
Claims for flu shots skyrocketed 48% during the 2020-21 season compared to 2019-20. Pharmacists (and in some provinces, pharmacy technicians) administered 5.4 million shots, up from 3.7 million during the previous season. Five seasons ago (2016-17), pharmacists administered less than half as many influenza vaccinations (2.5 million).
Growth was explosive in Newfoundland & Labrador—up by more than 800%—as last season marked the first that public funding was expanded to all residents (not just beneficiaries of the public plan). Claims from Quebec pharmacists were also recorded for the first time. In the remaining provinces, growth was strong across all provinces, most notably in Ontario (35%), B.C. (34%), and Nova Scotia (33%). See provincial details below.
Pharmacies submitted 9.3 million claims for COVID-19 vaccinations over a period of approximately seven months (March to September), depending on the province (details below). These figures do not include manual billings, which would likely push the total well past 10 million.
When the numbers for influenza and COVID-19 vaccinations are combined, pharmacists (and in some provinces, technicians, students and interns) jabbed more than 15 million arms from October 2020 to September 2021.
Prescription renewals & adaptations
Prescription renewals and adaptations jumped 38% to 2.9 million, compared to an increase of 14% in 2019-20. Renewals were by far the predominant driver; in fact, claims for adaptations were down in most provinces.
In Nova Scotia, claims for renewals literally went through the roof since last year was the first full year that renewals could be billed for all residents (details below).
Areas of decline
Services that saw drops in billings varied by province, depending on what is publicly funded. What is consistent, however, is that all provinces experienced a drop in at least one service, suggesting that gains made in immunizations and renewals negatively impacted other areas. See provincial details below.
Claims for influenza vaccinations surpassed one million for the first time (1.1 million), which represents a 34% increase over the previous flu season. Pharmacists in about 660 pharmacies (48% of all pharmacies in the province) had administered 317,200 COVID-19 vaccinations as of October 4.
It’s also worth noting that claims for pneumococcal vaccinations jumped 44% (to 37,800 claims), while claims for other vaccinations (pertussis, HPV and others) dropped almost an equal amount, by 42% (to 21,500 claims).
Prescription renewals increased 17% to 271,600 claims; however, adaptations dropped 26% to 42,100 claims. Standard Medication Reviews declined 16% to 165,600, which is less than the number of claims first captured by CFP seven years ago (173,800 for 2014-15).
As in B.C., pharmacies in Alberta crossed the million-dose milestone for flu shots, submitting 1.1 claims during the 2020-21 season (up 25%). Nine out of 10 community pharmacies in the province (about 1,400) participated in the province’s COVID-19 vaccination program, administering 2.5 million doses as of August 31.
Claims for pneumococcal vaccinations increased 12% to 26,200, and claims for Tdap shots increased 21% to 11,300.
Prescription renewals climbed 29% to reach 1.2 million claims, but adaptations dropped 15% to 163,337 claims. Claims for Comprehensive Annual Care Plans (CACPs), billed at $100 per plan, remained strong, growing 13% to reach 325,300. CACP follow-ups surpassed that with an 18% growth rate and 1.4 million claims. This translates into an average of 4.4 follow-ups per annual CACP, comparable to the previous year (4.3).
However, pharmacists with additional prescribing authority conducted fewer assessments to initiate or manage therapy. Billings were down 21%, to 352,500 claims, after six years of strong growth.
Claims for flu vaccinations climbed 22% to 232,700. Pharmacists, pharmacy technicians and students in nine out of 10 pharmacies in the province (about 370) administered 350,900 COVID-19 vaccinations as of September 7.
Outside of immunizations, the government has yet to release claims data for 2020-21 for other publicly funded pharmacy services in the province (e.g., prescription renewals and adaptations and minor-ailment assessments).
Flu-shot claims grew 27% in Manitoba to reach 184,600 claims. Pharmacists in three out of four pharmacies (about 300 locations) administered 166,600 COVID-19 vaccinations as of September 28.
Pneumococcal vaccinations increased slightly (up 4% to 3,760), while other vaccinations (for HPV, Tdap and Td) dropped almost by half (46%, to 1,700 claims).
Note: Claims data for Ontario is from April 2020 to December 2020. The Ministry of Health and Long-Term Care is not yet released data for the full fiscal year (i.e., up to March 31, 2021).
Based on available claims data, pharmacies in Ontario billed for 1.8 million flu shots, 35% more than during the previous full flu season. Just over half of pharmacies (about 2,500) are part of the COVID-19 vaccination program, where qualified pharmacy technicians, students and interns are also able to immunize. As of August 23, 3.5 million COVID-19 doses were administered in pharmacies.
While it’s not possible to be definitive about trends in other services due to the missing three months of data, monthly averages suggest that claims are significantly down for Pharmaceutical Opinions. Pharmacies submitted an average of 15,200 claims per month for Opinions from April 2020 to December 2020, down 46% from the monthly average of 28,100 for the full fiscal year 2019-2020.
The MedsCheck medication review program fared better. Claims for annual MedsChecks averaged 36,700 per month for the first nine months of fiscal year 2020-21, comparable to the monthly average of 36,900 for the full fiscal year 2019-20. A year ago, the growth rate for MedsChecks was positive for the first time in years. However, the pandemic appears to have cut short or delayed continued positive trending for this service.
Last year was the first that pharmacists in Quebec had immunization authority. Pharmacies submitted 572,300 claims for influenza vaccinations, followed by 1.2 million claims for COVID-19 vaccinations. Close to four out of five pharmacies in Quebec, or about 1,500, are part of the COVID-19 vaccination program.
Claims for both prescription renewals and adaptations soared, by 108% (to 683,500) and 150% (to 40,000), respectively. Meanwhile, assessments to prescribe to manage therapy held steady, inching forward 2% to reach 239,000 claims (comparable to a 4% increase in2019-20).
However, assessments for minor ailments took a hit after four years of strong growth. Pharmacies submitted 40% fewer claims (219,100 compared to 364,000 in 2019-20).
Claims data for New Brunswick has yet to be released for fiscal year 2020-21. For the remaining Atlantic provinces, claims for influenza vaccinations were as follows:
COVID-19 vaccinations are summarized here:
Last but certainly not least, pharmacists in Nova Scotia are making their mark with prescription renewals. Starting March 19, 2020, community pharmacies in Nova Scotia could bill for renewals. After just 11 days—at which time the fiscal year ended on March 31—they had submitted 10,100 claims. The growth curve has been straight up since then. By the end of fiscal year 2020-21, claims had increased almost 20-fold, to 197,800 prescription renewals.