Pharmacists can improve hypertension care (but you have to pay them . . .): A review of remuneration opportunities across Canada

You’ve read it before on these pages—you know that pharmacist care improves hypertension outcomes,^1,2 saves money for the health care system,³ is preferred by patients⁴ and is advocated for by Hypertension Canada.⁵ But there is a missing ingredient—what about payment to pharmacists for these services?

The remuneration landscape is a complex and changing myriad of criteria and payments.⁶ As such, we thought it important to take stock of remuneration opportunities for pharmacists to provide hypertension care.

We surveyed all the provinces and territories for their pharmacist policies on publicly funded remuneration opportunities for pharmacists to manage patients with hypertension. We used a combination of publicly available documents on remuneration policies and verified with officials from local pharmacy professional organizations. We collated and evaluated the publicly funded opportunities and specific criteria for each of the jurisdictions (Table 1). The remuneration structure was organized into initial/annual assessment and follow-up categories.

Table 1.

Remuneration for pharmacist management of hypertension by Canadian province

Initial/annual assessment	$601 $702	$603 $1004	$605	$0	$60 (60-150)6	$40.007 $50.008	$52.509	$52.2010 $15011	$52.5012 $6513	$52.5014	$0	$0	$0
Follow-up	$1515	$2016	$2017	$0	$2518	$15.5019 $19.5020	$0	$2021	$2022 $2513, 22	$11.9623 $12.0024	$0	$0	$0

¹Standard medication review every 6 months, if patient is taking 5 medications.

²Pharmacist consultation, if the pharmacist identifies a drug-related problem or makes a recommendation for a change to the physician.

³Eligibility includes a chronic disease and taking 3 or more of any Schedule 1 drug or has DM and is taking at least 1 Schedule 1 drug or insulin (Standard Medication Management Assessment), or, pharmacists can bill $25 for an assessment that leads to a prescription.

⁴Patient must have 2 or more chronic diseases (Comprehensive Annual Care Plan criteria).

⁵More than 65 years old, taking 5 or more chronic medications, 3 appearing on the Saskatchewan Pharmaceutical Information Program (PIP).

⁶Patient must be taking a minimum of 3 medications for a chronic condition. $90 for long-term care review, $75 for type 1 or type 2 diabetes, $150 for home review (Ontario MedsCheck).

⁷Patients with conditions listed in category 1 services.

⁸Patients with insulin-dependent diabetes.

⁹Low-income seniors taking 3 or more chronic prescription medications. Chronic medications are defined as medications used for the treatment of chronic disease (e.g., diabetes, hypertension).

¹⁰Basic Medication Review Service (BMRS).

¹¹Nova Scotia senior taking 4 or more prescription medications or one of the high-risk drugs on the Beers criteria and under the Advanced Medication Review Service (AMRS).

¹²If patient on 3 or more chronic prescription medications, which are used to treat chronic conditions (PEI Basic Medication Review [BMR]).

¹³If patient has diabetes and is taking at least 1 medication for treatment of diabetes (PEI Diabetes Medication Review [DMR]).

¹⁴Patient with a chronic illness taking 3 or more medications, up to 72 remunerations per pharmacy per year.

¹⁵Maximum of 4 follow-ups per year.

¹⁶Up to 12 follow-ups per year.

¹⁷Up to 2 follow-ups per year.

¹⁸Follow-up education for patients with type 1 or 2 diabetes.

¹⁹Patients with 1 condition listed in categories 1 and 2.

²⁰Patients with 2 or more conditions in categories 1 and 2.

²¹Up to 2 follow-ups per year.

²²Up to 4 follow-ups per year.

²³Less than 65 years old.

²⁴More than 65 years old and on Newfoundland 65Plus Plan.

There is a wide variability between the different jurisdictions across Canada with respect to pharmacist remuneration. In 4 of the jurisdictions (the 3 territories and Manitoba), there is no remuneration established for pharmacist management of hypertension (or anything, for that matter). Ontario and Nova Scotia have the highest reimbursement amount of up to $150 for an annual assessment. Importantly, in most cases, except for Alberta, these reimbursements are not specifically for hypertension care, and in many cases, very specific criteria must be met to qualify (e.g., in Nova Scotia, only patients above 65 years of age on 4 or more prescription medications or 1 or more Beers criteria medication could qualify). In Ontario, patients must be taking a minimum of 3 medications for a chronic condition in order to qualify. This reimbursement structure in Ontario is then further broken down into different categories: $90 for long-term care review, $75 for type 1 or type 2 diabetes and $150 for home review. In general, the jurisdictions separate the remuneration plans based on different patient age cohorts and into the number of patient prescriptions to qualify.

So, what does this all mean? While it is very clear that society would benefit from pharmacists practising to their full scope to detect and manage hypertension (the leading risk factor globally for premature morbidity and mortality), remuneration systems have not kept pace to allow full implementation. Based upon this information, only very few patients with hypertension would qualify for remunerated pharmacist care in Canada. Fair remuneration for pharmacists to manage hypertension should be the number 1 priority of our advocacy partners—we must push this issue with our health policy makers. Society can’t afford for us not to do this. ■