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Alberta pharmacists worried about cuts to service fees

In saving costs, patient care put on the backburner

WRITTEN BY SONYA FELIX ON MARCH 7, 2018 FOR CANADIANHEALTHNETWORK.CA

Alberta pharmacists received some bad news last week when the Health Minister announced a new compensation framework for pharmacies that “will reduce government healthcare costs and make life more affordable for Albertans.”

The new agreement came after a year of discussions between the Alberta Pharmacists’ Association (RxA), Alberta Health and Alberta Blue Cross (ABC). Margaret Wing, RxA’s CEO describes the process as “difficult,” particularly because RxA was required to sign a non-disclosure agreement that meant they couldn’t consult with pharmacists or inform them of what was coming.

Consequently, pharmacists were surprised and dismayed at the February 28 announcement of the new deal, described by government as “first of its kind in Canada.” Alberta Health’s press release stated that the government worked closely with RxA to reach “a fiscally responsible agreement that respects pharmacists and protects the stability of the industry.”

Effective May 17, 2018, the new funding agreement is expected to save $150 million over the next two years by reducing the rate of health spending. Instead of a 12.3% increase in pharmacy compensation funding over the next two years, the new framework will slow growth to 4.3%.

Savings will come from cutbacks to pharmacy service fees, including:

  • A lower dispensing fee, down from $12.30 to $12.15;
  • A limit on the number of frequent dispensing fees;
  • A reduction in the fee for administering publicly funded immunizations, such as flu shots going from $20 to $13;
  • Elimination of extra money that pharmacists with Additional Prescribing Authority (APA) previously received for annual care plans, standard medication management assessments and follow-ups; and
  • A limit of 12 follow-ups for comprehensive annual care plan follow-ups ad standard medication management assessments––previously no limit.

As well, in the second year a new risk-sharing component will kick in to ensure budget targets are met. At least 10% of government funding to pharmacies will be withheld each quarter to be used to address any pharmacy compensation budget shortfall. The percentage can increase if required to meet budget targets, but if expenditures are less than the budget, the holdback funds will be redistributed to pharmacies.

“We recognize that pharmacists were hopeful for an agreement that would further advance their role as frontline healthcare providers. However, considering the Alberta Government’s significant fiscal challenges and sole focus on containing costs, we believe that we have achieved the best funding framework possible for pharmacy practice in our province, given the current economic environment,” RxA president Mark Elderkin said in a statement.

Still, it is no surprise that Alberta pharmacists are upset about the agreement. “They are trying to determine what the impact will be to patient care and their communities,” Wing says. “They will have to make adjustments.”

Pharmacists with APA designation may be especially upset that they will no longer receive extra compensation for services. “Pharmacists work hard to get the APA status and the work involved in making prescribing decisions requires a lot of time to perform safely,” says Aileen Jang, pharmacist/owner of Medi-Drugs in Edmonton.

Jang also expresses concern about the impact on patients from new limits on the frequency of dispensing and the change in the frequency of follow-ups. “Monitoring INR and adjusting doses for warfarin are a good example,” she says. “Without proper monitoring, the results could be lethal. No other health profession gets told how often a patient is allowed to be cared for, and yet pharmacists are being imposed a limit that was arbitrarily set and uninformed by evidence.”

While the focus of the new framework is mostly about reducing spending, the agreement does add a couple of paid pharmacy services: $20 for an assessment to ensure continuity of care in the event of a declaration of a state of emergency and $13 for administering more publicly funded vaccines that will be phased-in.

But Wing doesn’t believe these new services will make up for revenue lost to fee cuts. “The volume of pneumococcal and dTAP vaccine administrations will be insignificant when compared to the $7 reduction in public health vaccine administration fee,” she says. As well, “the billing code for continuing care during state of emergency will just provide more clarity to the service being provided. Historically, pharmacists billed Emergency Prescribing, which is the same amount of $20.”

For pharmacists like Jang, the new framework is a signal that patient care isn’t important to the provincial government. “Instead they are focusing solely on a budget that is largely beyond the control of pharmacists as drug costs are not set by pharmacies but by government and big pharma,” she says. “For these reasons, pharmacists are upset and are demanding dialogue. But repeated attempts to engage have been met with ignorance and empty promises.”

More information on the funding agreement is available here.



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