JANUARY 2023 - Pharmacists in Québec have seized the opportunity to bill for services, with triple-digit growth rates in claims for prescription renewals and adaptations, and assessments for minor ailments. Claims activity held steady or declined in other provinces. Influenza vaccinations dropped across the board, save for a very modest increase in Québec; having said that, total flu shots are still well ahead of pre-pandemic numbers.
Claims for flu shots declined by -9% in 2021-22, to 5.0 million, after skyrocketing by 48% in 2020-21 to reach 5.4 million. Still, the most recent number is 35% ahead of the 3.7 million recorded for 2019-20, before the pandemic hit. Five seasons ago (2017-18), pharmacists administered 2.9 million flu shots.
The biggest declines occurred in Prince Edward Island (-25%), Saskatchewan (-24%), Alberta (-18%) and Newfoundland & Labrador (-15%). Pharmacist-administered flu shots in Quebec, the last province to give pharmacists injection authority, in 2020, increased by a very modest amount (1%). See provincial details below.
The first full fiscal year of reporting reveals that pharmacies administered an astounding 18 million COVID-19 vaccines from April 1, 2021 to March 31, 2022. When you factor in that about 80% of Canada’s 11,400 community pharmacies opted to give COVID-19 shots at the peak of the 2021 campaign, according to data gathered by CFP for its COVID-19 chart, that translates into about 2,000 vaccinations per pharmacy.
When the numbers for influenza and COVID-19 are combined, pharmacists (and in some provinces, technicians, students and interns) jabbed more than 23 million arms in 2021-22.
Prescription renewals & adaptations
While pharmacists in all provinces have the authority to renew prescriptions, not all provinces fund the service. CFP is able to capture claims data for B.C., Alberta, Saskatchewan, Québec and Nova Scotia. Funding for renewals began in New Brunswick began in October 2021; however, claims data is unavailable since it’s combined with data for other pharmacy services. Funding for renewals in P.E.I. began in October 2022 and claims data will be available for the coming fiscal year.
Overall, claims for renewals and adaptations shot ahead by 44% in 2021-22; however, that drops to 4% when Québec is removed from calculations. In Québec alone, claims skyrocketed by 166%. Renewals continue to outnumber adaptations by far, at a rate of about eight renewals for every one adaptation in 2021-22.
Claims for flu shots exceeded 1 million for the second year in a row, with a small drop of -3.8% compared to 2020-21. COVID-19 vaccinations also surpassed 1 million, 1.2 million. With a maximum participation rate of 70% of all pharmacies, that translates into an average of approximately 1,250 COVID-19 shots per participating pharmacy.
After a sharp climb of 44% in 2020-21 for pneumococcal vaccinations (37,941), claims settled right back down, dropping by -54% in 2021-22 (17,458). And claims for other vaccinations (e.g., HPV) appear to be on the rebound: after a -42% drop in 2020-21, they jumped by 66% in 2021-22 to reach 35,773.
Renewals climbed by 2% (276,066) while adaptations dropped by -14% (36,216), for an overall change of -0.5% for the two services combined (312,282). During 2020-21, renewals surged by 17% while adaptations plummeted by -26%.
Standard Medication Reviews appear to be recovering their frequency: pharmacies submitted 176,721 claims, up 7% from 2020-21 (165,604) and a strong reversal from the -16% decline during that first year of the pandemic. For the two years before the pandemic, pharmacists conducted about 195,000 Standard Medication Reviews.
Flu shots in Alberta pharmacies declined by -18% to 898,325 in 2021-22. Nine out of 10 pharmacies administered a total of 4.3 million COVID-19 vaccines during the fiscal year. This works out to 3,000 COVID-19 vaccinations on average per pharmacy, compared to the national average of 2,000.
As in B.C., the increased uptake of pneumococcal vaccinations was a one-year phenomenon. After a 12% increase in claims in 2020-21, the most recent fiscal year saw a -50% drop to 13,120 claims.
Prescription renewals held steady, inching forward 0.3% to 1,169,116 claims in 2021-22, after jumping by 29% in 2020-21. Claims for adaptations were down -12% (143,757), echoing results for 2020-21 (-15%).
Claims for Comprehensive Annual Care Plans (CACPs), which are unique to Alberta and billed at $100 per plan, declined by -9% in 2021-22 (295,830) after increasing by 13% in 2020-21. Pharmacies submitted 1,274,813 claims for CACP follow-ups, down -12% after an 18% growth the previous year. This translates into an average of 4.3 follow-ups per annual CACP, comparable to previous years.
Pharmacists with additional prescribing authority (APA) submitted 9% fewer claims (319,932) for assessments to initiate or manage therapy. However, this is an improvement over 2020-21, when billings were down -21%. During the fiscal year prior to the pandemic, Alberta pharmacists with APA had submitted 444,662 claims.
Claims for influenza vaccinations were down by -24% (176,973), the second-highest decline in Canada after Prince Edward Island (25%). For COVID-19 vaccines, participating pharmacies (about 85% of all pharmacies) administered a total of 628,000 in the province, or about 1,800 vaccinations each.
Outside of vaccinations in Saskatchewan, comparisons cannot be made between 2021-22 and 2020-21 because the province did not release data for 2020-21. Comparisons for the two-year period of 2021-22 versus 2019-20 result in the following observations:
Claims for flu shots declined by -7% (172,541), slightly less than the national average of -9%. Pharmacies administered a total of 446,000 COVID-19 vaccines, or about 1,400 per participating pharmacy (71% of all pharmacies).
Claims for pneumococcal vaccinations dropped by -10%. Meanwhile, claims for HPV, Tdap and Td almost tripled, increasing 168% to 4,570.
Pharmacies in Ontario billed for 1,689,167 flu shots in 2021-22, down -8% from 2020-21. About six out of 10 Ontario pharmacies administered a total of 7,200,000 COVID-19 vaccines, for an average of 2,400 COVID-19 shots per participating pharmacy.
MedsCheck annual and MedsCheck for Diabetes medication reviews both inched forward by 1% (501,152 and 127,294 claims, respectively). This follows strong gains in 2020-21, when annual MedsCheck reviews climbed by 12% and MedsCheck for Diabetes climbed by 22%.
Claims for Pharmaceutical Opinions, available to beneficiaries of the provincial drug plan only, continue to follow a roller-coaster path since CFP began tracking data in 2012. In fact, from a high of 399,935 in 2013-14, trending has been more down than up and, after a sharp drop of -43% in 2020-21 and the latest decline of -9% in 2021-22, claims are at an all-time low of 175,246.
In January 2021, expanded pharmacy services were no longer subject to the co-pays and deductibles of Québec’s universal drug plan. Claims data since then show that patients and pharmacists alike have not looked back:
Even in the submission of claims for flu shots, Québec pharmacies managed to eke out a gain of 1% (579,687) compared to a national decline of -9%. This is just the second full year of claims data—pharmacists did not have the authority to administer injections until the 2020-21 flu season.
For COVID-19, Québec pharmacies billed for 1,775,000 vaccinations. About three out of four pharmacies participated at some point, which translated into an average of 1,200 COVID-19 vaccinations per pharmacy.
Automatic annual increases to the fees for services may be another factor that encourages uptake by pharmacies. These fees are negotiated and secured under three-year agreements between government and the Association québécois des pharmaciens propriétaires (AQPP), which represents all pharmacy owners.
At the time of this article, claims data for influenza and COVID-19 vaccinations are combined in New Brunswick, for both 2021-22 and 2020-21, and not yet available in Nova Scotia for 2021-22. Based on separate reporting for COVID-19 vaccinations, the following picture emerges:
For influenza vaccinations, Prince Edward Island experienced the most precipitous drop (-25%, to 33,607 claims) of all provinces. In Newfoundland & Labrador, after a steep upward trajectory in 2020-21 when the province expanded coverage to include all residents and not just public-plan beneficiaries, claims for flu shots declined 15% (76,415).
In Nova Scotia, public funding for prescription renewals began in March 2020. Uptake soared, with 197,189 claims submitted during the first full fiscal year (2020-21). That translates into an average of 650 claims per pharmacy. In 2021-22, claims declined by -8% (182,399).
2021-22 marks the second year of public funding in Nova Scotia for two minor ailments: urinary tract infections (UTIs) and herpes zoster. Assessments climbed 22% for UTIs (to 16,071) and 41% for herpes zoster (1,249). Pharmacists can also bill for assessments for Lyme disease, but claims data was not available.
Pharmacists in Nova Scotia billed for 3,149 initial assessments for contraception management in 2021-22, down by -41% compared to year one of the program (5,347 claims). Pharmacists also billed for 1,686 follow-ups for contraception management in 2021-22 (data for 2020-21 not available).
In Newfoundland & Labrador, claims for Medication Management Adaptations surged 150% to 88,208, reflecting the fact that eligibility expanded beyond public-plan beneficiaries to include all residents.