Image courtesy of Pharmacy Practice Project, EPICORE Centre & Jim Dobie Photography
In Alberta, pharmacists’ claims for primary-care services have experienced parabolic growth rates in the past two years—so much so that billings exceeded the government’s budget for the first time, resulting in fee cutbacks.
The Canadian Foundation for Pharmacy has collected claims data for pharmacy services from provincial governments since 2012, as part of its annual Services Chart. The most recent data available is for the fiscal year starting on April 1, 2023 and ending on March 31, 2024. Alberta stands out for the steep upward trajectories of two services that are unique to the province: comprehensive annual care plans (CACPs) and independent prescribing authority by pharmacists with additional prescribing authority (APA).
Albertans with two chronic diseases or one chronic disease and one or more risk factors are eligible for a CACP and follow-ups.
In fiscal year 2023-2024, pharmacies’ claims for CACPs jumped 27% to reach 482,089. This follows a surge of 29% in 2022-2023, when 380,357 claims were submitted.
The numbers for follow-ups are even more impressive. Claims leaped forward by 40% in 2022-2023 and by 42% in 2023-2024, and easily exceeded two million for the first time—reaching 2.5 million, in fact, compared to 1.8 million in 2022-2023 and 1.3 million in 2021-2022.
Put another way, pharmacists conducted an average of 5.2 follow-ups per CACP in 2023-2024, up from 4.7 on average in 2022-2023 and 4.3 in 2021-2022.
Stepping back to review claims over the full 12-year period, two setbacks occurred: one in 2017-2018, when fees were reduced, and one in 2021-2022, when COVID-19 vaccinations rolled out.
On the fee front, when Alberta’s funding framework for pharmacy services was put in place in 2012, pharmacists with APA could bill $125 per CACP and $25 per follow-up. Those without APA billed $100 and $20.
In the final month of fiscal year 2017-2018, the government announced it would remove the higher fees of $125 for the initial CACP and $25 per follow-up billable by pharmacists with APA. All pharmacists, with or without APA, would bill $100 or $20. As a result, after five years of steady growth in the high double-digits, claims stuttered at the end of fiscal year 2017-2018 and ultimately dropped by 14% compared to 2016-2017.
A similar story unfolds for CACP follow-ups. From 2012-2013 to 2017-18, they climbed rapidly. The number of follow-ups following an initial assessment rose from less than one per CACP in 2012-2013 to 4.9 follow-ups in 2017-2018. This dropped to 4.6 in 2018-2019, following the reduction in public funding.
Double-digit growth rates for CACPs resumed for the next three years, even during the first year of the COVID-19 pandemic. Growth rates lagged somewhat for follow-ups, such that the average per CACP declined to 4.3 in 2019-2020 and increased marginally the following year, to 4.4.
Then in 2021-2022, as pharmacists focussed on COVID-19 vaccinations, billings declined by 9% for CACPs and by 12% for follow-ups.
After COVID, the good news is that CACPs and follow-ups recovered strongly and set new records during the two most recent fiscal years—including a new high of 5.2 follow-ups on average in 2023-2024. The bad news is these results contributed to a new round of funding cutbacks.
In its October newsletter to pharmacies, Alberta Blue Cross stated: “This year’s publicly funded pharmacy costs are forecast to exceed the mutually agreed upon budget expenditure threshold of $670 million and are expected to continue to grow. As a result, the government will be amending the existing Compensation Plan for Pharmacy Services…so expenditure controls can be introduced and cost overruns can be prevented.” Effective November 1, government reduced the billable fee for a CACP to $70 from $100 and reduced the maximum number of billable follow-ups to four from 12.
In Alberta, pharmacists with APA can independently prescribe any Schedule 1 drug or vaccine. This authority includes prescribing for minor ailments.
After seven years of steady growth, the pandemic caused a two-year slump in prescribing services, leading to declines of 21% in 2020-21 and 9% in 2021-22.
Similar to CACPs, prescribing services more than rebounded in 2022-2023, jumping by 54% to reach a new high of 491,990 claims. That record was shattered in 2023-2024, when claims rose by 59% and reached 781,407.
Unlike CACPs, the government did not recently reduce funding for prescribing services. That said, the fee of $25 per assessment resulting in a prescription has not increased since introduced in 2012. As well, pharmacists could never bill separately for prescribing if it was part of a CACP (or a Standard Medication Management Assessment, another government-funded program in Alberta). In other words, if pharmacists with APA prescribe during a CACP, that service is covered under the CACP fee—which, as noted in the previous section, has declined from $125 in 2012 to $100 in 2018, and to $70 in 2024.
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