July 6, 2012

Alberta Funds Pharmacy Services Effective July, 1 2012

by Beverley Herczegh, Director

Funding for cognitive pharmacy services got a welcome boost when Alberta, the first to implement expanded scope, finally announced its funding model effective July 2012.

Noteworthy in the Alberta model is the absence of a funding cap and the focus on payment for patient assessment as opposed to fee for service. Perhaps even more important is the fact that funding of pharmacist services is not dependent on savings from generic pricing savings. We’ll closely watch now to monitor how this change impacts the delivery of patient assessment services by pharmacists in Alberta. In this province, pharmacists may now undertake a comprehensive annual care plan- that’s a tall order with the potential to significantly impact outcomes and costs. Pharmacist will need support in this new work and measurement to illustrate value will be critical.

Therapeutic substitution is also in place in five provinces with funding in three. This is clearly potentially very significant depending on the degree to which pharmacists comfortably undertake professional autonomy and liability. On this particular front, it is possible that payors may become the most influential with pharmacists uniquely positioned between payor and patient at that critical point of decision.

In short order, pharmacists right across Canada will be refilling (continued care) and adapting prescriptions as a way to facilitate patient access to timely care. Injecting is already underway in BC, AB and NB, with BC restricted by the standards of practice to immunizations only. Expect to see Ontario pharmacists authorized to inject flu vaccines for fall 2012 as the regulations have now been posted for public consultation and are expected to pass through cabinet this September. Already approximately 600 Ontario pharmacists are trained to inject and two more training sessions have been added this summer. It is an OPA goal to have an injection trained pharmacist in every pharmacy by Dec 2013.

Of significance to all of these changes is that funding, while different in every province, is now in place in every province except Manitoba (no expanded scope yet) and PEI (expanded scope so far limited to continuing car and emergency supplies). Much of this funding has come into place in the past 12 to 18 months.

What does this mean for you?

  • Physician as influencer in prescribing is being diluted
  • Depending on your portfolio, you may need to consider how you can ensure appropriate product knowledge and positioning at the patient-facing pharmacist level
  • Pharmacists always have been, and with expanded scope will even moreso, be the most trusted and accessible health care provider available to an increasingly engaged patient
  • The devil is in the details on these new authorities with standards of practice spelling out the “rules” around who, when, how often, where and under what circumstances. Do your homework before getting too far with any plans to engage at this level

Regardless of how one views pharmacist prescribing and/or expanded scope, delivery of healthcare in the future will require expanded scope practice by pharmacists and other HCPs such as nurse practitioners and physicians assistants.

Other funded services are underway in some provinces such as minor ailment prescribing in SK and NS. More on this next time…