Pharmacists’ Medication Management Services
Environmental Scan of Canadian and International Services
August 2010
Prepared by:
Kiran Battu, BSc(Pharm) candidate (University of Waterloo)
Co-op Student, Canadian Pharmacists Association (May-August 2010)
Phil Emberley, BSc(Pharm), MBA
Director, Pharmacy Innovation, Canadian Pharmacists Association
© Canadian Pharmacists Association • August 2010
Page 1
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
DISPENSING-RELATED MEDICATION MANAGEMENT SERVICES
Trial
Prescription
Methadone
Maintenance
Program /
Methadone
Managed Care
Pharmacist may issue a trial
prescription for a specific drug
covered by the provincial drug
plan. The pharmacist may be
required to follow up with the
patient to take appropriate next
steps.
Pharmacists may choose to
participate in this program in
which they dispense
methadone with direction
interaction with the patient.
BC
No
SK
No
QC
No
BC
No
SK
No
ON
© Canadian Pharmacists Association • August 2010
No
AAC of quantity
given + U&C fee
(max $8.60) for
trial + U&C fee
for balance
U&C fee (max
$9.15) for the
trial quantity.
+ $7.50
Alternative
Reimbursement
for the balance.
For trial
prescription
(seven days):
$8.44/$7.89
For remainder
of prescription:
$8.44/$7.89
AAC + U&C fee
( +/- $7.70
interaction fee)
$3.50 per day
($24.50/week)
No
No
No
No
No
No – but
pharmacists are
encouraged to
complete the
methadone
workshop provided
by CAMH
Trial Prescription Program covers 41 drugs in specific strengths and
dosage forms for a maximum of 14 days’ trial supply.
Actual Acquisition Cost (AAC) of the quantity dispensed + U&C fee (max
$8.60) for the trial.
Another full U&C fee (max $8.60) when balance is given.
Only a specific group of medications, which are all benefits, are
included. The trial may be for 7 or 10 days. A follow up by the
pharmacist is required to assess tolerance and take appropriate action.
If medication is continued, no additional fee may be claimed on the
remainder of the prescription however an Alternative Reimbursement
fee of $7.50 is paid even if the balance of the prescription is not
dispensed.
Pharmacists are reimbursed differently depending on how many
prescriptions are filled at their pharmacy annually. For the trial
prescription (seven days), pharmacists are reimbursed $8.44 if they
dispense fewer than 40 500 prescriptions annually, or they are
dispensed $7.89 if they dispense more than 40 500 prescriptions
annually. For filling the remainder of the prescription, pharmacists are
reimbursed an additional $8.44/$7.89.
An interaction fee of $7.70 is paid on top of the U&C fee and AAC only
to those pharmacies that choose to participate in the Methadone
Maintenance Program. Other pharmacies only receive the U&C and AAC
The “managed care fee” is $3.50 per day ($24.50/week) and is paid only
for “face to face” interactions between the pharmacist and patient.
There is a methadone maintenance program in Ontario (Methadone
Maintenance Treatment Program) however this program does not
reimburse pharmacists for providing methadone. Many pharmacists still
dispense methadone.
Page 2
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
DISPENSING-RELATED MEDICATION MANAGEMENT SERVICES
Pharmaceutical Pharmacist may offer a
Opinion
‘pharmaceutical opinion’ to
physicians for any of the
following reasons:
Transmission of Pharmacists in QC are
a drug profile
reimbursed for transferring a
patient’s profile.
Refusal to
Fill/Dispense
Pharmacists are compensated
for refusing to dispense a
prescription.
Possible reasons for refusals
include (depending on
jurisdiction):
- interception of
forgeries/falsified prescription
- drug abuse/inappropriate use
- prior intolerance, allergy, or
failure
- irrational choice of product,
quantity or duration of
treatment
- interactions, incorrect dose
(too high or low)
- therapeutic duplication
QC
No
$18.65
No
QC
No
$8.44
No
BC
No
SK
No
2 times
the U&C fee
1.5 times the
U&C fee
(max $13.73)
No
Pharmacists are only compensated for interception of forged
prescriptions that result in cost savings to PharmaCare.
No
Remunerates pharmacies. Drugs are limited to Prescription Review
Program Drugs (i.e. Narcotics, benzodiazepines)
QC
No
$8.44
No
NL
No
$7.15
No
© Canadian Pharmacists Association • August 2010
Valid reasons include:
- Interrupting a drug, prevent taking a drug, substituting a drug, or
modifying a drug related to any of the following situations (allergy,
interaction, contraindication, duplication, pregnancy or nursing,
ineffectiveness, side effect or intolerance, toxicity)
- Responding to circumstances leading to the: addition of a required
complementary medication, supervision of medication therapy,
preparation of a withdrawal schedule related to benzodiazepines,
modification of the administration system for parenteral products.
Valid reasons for refusal include:
- prior intolerance, allergy, failure or non-response to treatment
- falsified prescription
- irrational choice of product, quantity or duration of treatment
- significant interaction
- dangerously high dose
- sub-therapeutic dose
- overuse
- product not working for indication
- therapeutic duplication
Reason for refusal is known drug abuse. Service will be compensated
upon receipt of a claim form and a written summary explaining the
incident and submission of the original written prescription.
Page 3
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
DISPENSING-RELATED MEDICATION MANAGEMENT SERVICES
Compliance
Packaging
Pharmacists can provide
medications in compliance
packaging (blister
packs/dosettes) to make it
easier for the patient to adhere
to their medication regimen.
Most provinces provide this
service. These are a couple
examples.
Emergency
Prescription
Refills
In the absence of an existing
prescription, but when there is
an immediate need for drug
therapy, a pharmacist is able to
provide a prescription
depending on the regulations.
No controlled substances can
be prescribed.
No
$6.25 for 7 day
supply
$25.00 for 28
day supply
$31.25 for 35
day supply
QC
No
$16.56 ($4.14
per week)
Or $8.44 ($2.11
per week)
BC
AB
SK
SK
MB
ON
No
Only SK residents who met criteria set out in the Medication Assessment
and Compliance Packaging DPEBB policy are eligible. A medication
assessment must be performed prior to approval and payment of a
compliance packaging fee.
No
For treatment period under 28 days. 25% of the fee is payable for each 7
days. If the patient meets certain criteria, the compensation rate is
$16.56 ($4.14 per week). If the patient does not meet the criteria, the
compensation rate is $8.44 ($2.11 per week). If the pharmacy dispenses
over 40 500 prescriptions annually, the compensation rate for a patient
who does not meet the criteria is $7.88 ($1.97 per week).
No
No
Pharmacists cannot actually initiate a prescription unless it’s for
emergency contraception. Instead they can only provide a refill of an
existing prescription.
No
No
Pharmacist can initiate a prescription.
No
This only applies to emergency contraception.
No
Pharmacists will be able to initiate a prescription.
No
It is possible that pharmacists may be authorized to perform this service
however until the regulations are drafted, it is not certain.
No –
regulations
being
drafted
No –
regulations
being
drafted
No –
regulations
being
drafted
QC
No
No
This is limited to oral contraceptives.
NB
No
No
Pharmacist can initiate a prescription.
© Canadian Pharmacists Association • August 2010
Page 4
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
DISPENSING-RELATED MEDICATION MANAGEMENT SERVICES
Prescription
Renewal
Pharmacists can renew a
prescription to ensure
continuity of care without
prescriber consent but with an
update to the prescriber.
NS
No –
standards
being
drafted
No
Prescribing in an emergency is limited to refills. Therefore, the
pharmacists cannot initiate a new prescription. More information to
follow once regulations and standards are released.
PEI
No
No
Prescribing in an emergency is limited to refills. Therefore, the
pharmacists cannot initiate a new prescription.
BC
No – but
only
recently
legislated
AB
No – but
only
recently
legislated
SK
No – but
only
recently
legislated
MB
No
ON
No – but
only
recently
legislated
QC
No
NB
No – but
only
recently
legislated
© Canadian Pharmacists Association • August 2010
Up to a
maximum of
$8.60
Most provinces
are not yet
reimbursing
pharmacists for
providing this
service.
No – but pharmacist
must read and sign
the Declaration
Form in the PPP –
58 Orientation
Guide
No – but pharmacist
must complete the
Orientation to the
New Practice
Framework
Pharmacists in Saskatchewan can have Level I or Level II prescribing
authority which is designated based on a collaborative practice
No – except for agreement between health care providers and whether or not the
orientation training pharmacist has undergone additional training (for Level II). Pharmacists
must communicate all prescribing decisions to the original prescriber
and this is known an interdependent prescribing.
Regulations still
being drafted
Regulations still
being drafted
No
Pharmacists can adjust medication therapy (make renewals) for an
individual patient or a group of patients, according to direction from the
physician, in the form of a prescription.
No
Page 5
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
DISPENSING-RELATED MEDICATION MANAGEMENT SERVICES
Adapting a
Prescription
Pharmacists can adapt a
prescription to change the
dose, formulation, or regimen
of the prescription to enhance
patient outcomes.
NS
No – but
only
recently
legislated
Standards still being
drafted
PEI
No
No
BC
AB
No – but
only
recently
legislated
No – but
only
recently
legislated
SK
No – but
only
recently
legislated
MB
Yes
ON
Most provinces
are not yet
No – but
reimbursing
only
pharmacists for
recently
providing this
legislated
service.
QC
NB
NS
Up to a
maximum of
$8.60
No
No – but
only
recently
legislated
No – but
only
recently
legislated
© Canadian Pharmacists Association • August 2010
No – except
orientation. See
previous service.
No – exception
orientation. See
previous service.
Yes – pharmacists
must complete SCPapproved training
programs
Pharmacists in Saskatchewan can have Level I or Level II prescribing
authority which is designated based on a collaborative practice
agreement between health care providers and whether or not the
pharmacist has undergone additional training (for Level II). Pharmacists
must communicate all prescribing decisions to the original prescriber
and this is known an interdependent prescribing.
It is possible that pharmacists may be authorized to perform this service
however until the regulations are drafted, it is not certain.
Regulations still
being drafted
No
Pharmacists can adapt medication therapy for an individual patient or a
group of patients, according to direction from the physician, in the form
of a prescription.
No
Standards still being
drafted
Page 6
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
DISPENSING-RELATED MEDICATION MANAGEMENT SERVICES
Making a
Therapeutic
Substitution
Pharmacists can make a
therapeutic substitution to
another drug within the same
therapeutic class to best suit
the needs of the patient.
BC
AB
SK
No – but
only
recently
legislated
No – but
only
recently
legislated
Yes
ON
Yes
QC
No
NS
No – but
only
recently
legislated
No – but
only
recently
legislated
© Canadian Pharmacists Association • August 2010
No – except
orientation. See
previous service.
No – exception
orientation. See
previous service.
No – but
only
recently
legislated
MB
NB
Up to a
maximum of
$17.20
Yes – pharmacists
must complete SCPapproved training
programs
Most provinces
are not yet
reimbursing
pharmacists for
providing this
service.
No
Pharmacists in Saskatchewan can have Level I or Level II prescribing
authority which is designated based on a collaborative practice
agreement between health care providers and whether or not the
pharmacist has undergone additional training (for Level II). Pharmacists
must communicate all prescribing decisions to the original prescriber
and this is known an interdependent prescribing.
It is possible that pharmacists may be authorized to perform this service
however until the regulations are drafted, it is not certain.
It is possible that pharmacists may be authorized to perform this service
however until the regulations are drafted, it is not certain.
Pharmacists can make therapeutic substitutions for an individual patient
or a group of patients, according to direction from the physician, in the
form of a prescription.
No
Standards still being
drafted
Page 7
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
NON-DISPENSING MEDICATION MANAGEMENT SERVICES
Immunization
and
Administration
of a Drug by
Injection
Pharmacists are able to
administer a drug or substance
by injection for preventative
measures or for the treatment
of anaphylaxis.
BC
No – but
only
recently
legislated
MB
No
NB
NS
Seamless Care
Fee
Medication
Assessment /
Review /
Management
Medication
Assessment /
Review /
Remunerates pharmacies for
services related to medication
reconciliation for clients who
are transferred from an
institution to community
setting.
Pharmacists are compensated
for providing a medication
consultation to eligible patients,
reviewing all their medications.
No – but
only
recently
legislated
No – but
only
recently
legislated
SK
No
$10.00
Yes
Yes
Not currently
paid for
Yes – Training
1.5 times the
U&C fee
(max $13.73)
No
No
To be
determined – in
pilot phase
No
SK
No
Max $60.00
No
No
$60.00 per
MedsCheck
$25.00 per
follow-up
© Canadian Pharmacists Association • August 2010
Regulations are still being drafted.
Pharmacists must complete an accredited education program on
administration of injections by IM and SC route.
Standards still being
drafted.
BC
ON
Pharmacists can administer IM, SC or TD injections. Restricted to
immunizations and treatment of anaphylaxis. Only patients > 5 years.
No
Other provinces may also provide this service but they do not
compensative pharmacists/pharmacies.
Medication Management is a comprehensive service where the
pharmacist prepare and review a detailed medication history with the
patient, identify any drug therapy problems, set patient-focused goals
and implement solutions to meet those goals, monitor and follow up,
and communicate and collaborate with other members of the patient’s
health care team.
Medication Assessments are available only to eligible SK residents who
meet criteria set out in Medication Assessment and Compliance
Packaging DPEBB Policy. Only one assessment per patient per year.
MedsChecks are available to patients taking three or more prescribed
medications to treat chronic conditions. MedsCheck Follow-up may be
conducted under defined criteria: discharge from hospital; a
pharmacist’s documented decision (under defined criteria); a physician
Page 8
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
NON-DISPENSING MEDICATION MANAGEMENT SERVICES
Management
(continued)
QC
No
NB
No
NS
No
MedsCheck
$60.00 –
suggested fee
paid by patient
To be
determined – in
pilot phase
$150.00
No
No
No
Home Medicines Review (HMR)
Residential Medication
Management Review (RMMR)
Order and
Interpret
Laboratory
Pharmacists are authorized to
order, receive and interpret
the results of a laboratory
Medication Review Service (MRS) is an insured service under the Nova
Scotia Seniors’ Pharmacare Program available in community pharmacies
for patients who meet the criteria. The $150.00 fee is subject to a copayment by the patient.
HMRs involve the patient, general practitioner (GP) and the pharmacist.
The GP generates a referral to the local pharmacy and the pharmacist
conducts an interview, in the patient’s home. The HMR program aims to
enhance the quality use of medicines and reduce the number of adverse
medicines events, by assisting patients to better manage and
understand their medicines.
Pharmacists provide a medication review for permanent residents of
Commonwealth funded residential aged care facilities, who are not
eligible for a HMR.
Australia
No
Australia
No
$130.00/RMMR
No
To be
determined – in Only an accredited The MUR will complement the HMR program however it will be an inpilot phase
pharmacist can pharmacy medicine review between pharmacists and patients. This
$29.6 million provide this service program is new and is in its pilot phase.
AUD invested
Australia
Pharmacists are reimbursed for
being available outside their
practice hours. If a call is
received between the hours of
10:00PM and 8:00AM the
following day, the pharmacist
will be reimbursed for making a
visit within those hours.
PharmaCheck is medication review service offered to patients taking
three or more prescription medications for a chronic condition.
$194.07/HMR A
Only an accredited
rebate is also
pharmacist can
provided to the
provide this service
GP for referral
Medicines Use Review (MUR)
On Call Service
or nurse practitioner’s referral; or a planned hospital admission.
Pharmacist may conduct a medication review also known as a
therapeutic evaluation to ensure optimal patient therapy outcomes and
a reduction in adverse effects.
QC
No
$27.13
Only an accredited
pharmacist can
provide this service
No
The same fee is paid to the pharmacist for visits made on the following
days: Sunday, New Year’s Day, January 2, Good Friday, Easter Monday,
the Fete de Dollard, The Fete Nationale, Canada Day, Labour Day,
Thanksgiving Day, Christmas Day, and Boxing Day.
The additional fee is not payable to the pharmacist is the pharmacy is
open to the public during the days and periods indicated above.
AB
No – but
only
recently
legislated
© Canadian Pharmacists Association • August 2010
No
Page 9
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
NON-DISPENSING MEDICATION MANAGEMENT SERVICES
Tests
screening when necessary for
the purpose of medication
monitoring.
MB
No
Regulations still
being drafted
ON
No – but
only
recently
legislated
Regulations still
being drafted
QC
No
No
NB
NS
No – but
only
recently
legislated
No – but
only
recently
legislated
Minor Ailments Pharmacists can supply
Scheme
medicine for the treatment of
certain minor ailments as
Northdetermined by
ern
legislation/regulations. The
Ireland
minor ailments that can be
(NI)
treated vary from jurisdiction to
jurisdiction.
National
Health
Service
(UK)
© Canadian Pharmacists Association • August 2010
No
No
Pharmacist may only order lab tests upon approval by patient’s
practitioner unless the pharmacist is an extended practice pharmacist.
Pharmacists can make use of appropriate lab tests where applicable.
Physician consent is not required.
No
Standards still being
drafted
Consultation fee of £8.50
for first 500 consultations
of the year, £7.50 for the
next 500, £6.50 for the next
1000, £5.00 for all
subsequent consultations
up to a limit of 2250.
+dispensing fee of £1.11
+ cost of the medications,
up to a maximum of two
products.
Payment for MAS is made
on a capitation basis and is
calculated on the number
of patients registered. Each
pharmacy is paid £7300.92
for the first 250 patients
registered yearly, £9253.92
if 251-500 patients are
registered, £11 208 if 501750 patients are registered,
No
Minor ailments that can be treated free of charge are determined by the
Health & Social Care Board (HSCB). The following ailments are included
in the Service: Coughs and Colds, Hay Fever, Head lice, Athlete’s foot,
Threadworms, Vaginal Thrush, Diarrhea and Dhobie Itch (‘jock itch’). The
patient may receive advice only, advice plus treatment from the
formulary (specific for minor ailments), or a referral to the general
practitioner (GP) if serious symptoms are reported.
Patient may be referred by a GP, by the RPh, or by self-referral.
No
An MAS consultation involves a patient assessment and diagnosis of one
of the specified conditions, after which the RPh may offer advice;
treatment (selected from the formulary), counseling and advice; and/or
a referral to another health care professional. Minor ailments covered
include indigestion, constipation, diarrhea, hemorrhoids, mouth ulcers,
teething, headaches, earaches, fevers, dysmenorrhea, fungal infections,
cystitis, emergency contraception and others. Patient may be referred
by a GP, by the RPh, or by self-referral.
Page 10
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
NON-DISPENSING MEDICATION MANAGEMENT SERVICES
£13 218 if 751-1000
patients are registered, £15
228 if 1001-1250 patients
are registered. After 1250
patients have been
registered for the year,
£8.04 is paid per new
patient.
Canada
Diabetes
Medication
Management
Service
This service is an ongoing cycle
of assessment, management
and review of patients with
Australia
type 2 diabetes, provided in
community pharmacy by the
pharmacist, at regular intervals.
Clinical
Pharmacists will be
Interventions by compensated for identifying,
Pharmacists
resolving, and documenting
drug related issues. The
purpose of this program is to
Australia
increase the number of clinical
interventions provided and
documented and improve
communications between
pharmacists and patients and
prescribers.
MTM:
Medication
Therapy
MTM is used to describe a
broad range of health care
services provided by
US
© Canadian Pharmacists Association • August 2010
No
Pharmacists are not paid
for this service
No
Pilot phase.
Estimated
$320/patient
for 5 visits in a 6
month period
No
No
To be
determined.
$97 million AUD
invested in this
program
No
Pharmacists can recommend non-prescription items for minor ailments
(not restricted by regulations). Items however can only be nonprescription. Pharmacists also provide counseling on non-prescription
items and non-pharmacological options to treat specific minor ailments.
Pharmacists must
The availability of the service will be targeted to pharmacists in those
complete the
areas where other diabetes services are not adequate to meet the
competency-based needs of the local population.
training course
No
No
Varies.
However there are MTM services are delivered in both the public and private sectors. In the
Pharmacists can MTM certificate public sector, some state Medicaid and Medicare Part D plans have
be reimbursed
training programs focused on a comprehensive medication therapy review as the
Page 11
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
NON-DISPENSING MEDICATION MANAGEMENT SERVICES
Management
pharmacist, to optimize
therapeutic outcomes for
patients. Services include
medication therapy reviews,
pharmacotherapy consults,
anticoagulation management,
immunizations, health and
wellness program and other
clinical services.
using a
capitated rate,
flat rate per
service or a feefor-service basis
depending on
where they are
working.
Chronic
Medication
Service
MS is a joint service between
Scotland No
GPs and community
pharmacists that aims to
improve patient care by:
- Identifying and prioritizing
risk from medicines
- Minimizing adverse drug
reactions
- Addressing existing and
preventing potential
problems with medicines
- Providing structured followup and interventions where
necessary
Patients register
with the
pharmacy and
then the
reimbursement
scheme is the
same as the one
outlined in the
NHS Minor
Ailments Service
Smoking
Cessation
Services
Pharmacist can provide
smoking cessation counseling
services that range from
SK
© Canadian Pharmacists Association • August 2010
No
$2.00/minute
up to a
maximum of
$300.00 per
available to help foundation of their MTM programs.
pharmacist refine The MTM service model in pharmacy practice includes the following five
the skills required core elements:
for this service.
Medication therapy review (MTR)
Personal medication record (PMR)
Medication-related action plan (MAP)
Intervention and/or referral
Documentation and follow-up
No
CMS process is composed of three stages:
1) Registration of patients
2) Pharmaceutical Care Planning and Patient Profiling
3) Shared care with the patient’s GP establishing a serial
prescription for either 24 or 48 weeks and support for the
patient using disease specific protocols.
Program is entitled Partnership to Assist with Cessation of Tobacco
Yes - PACT training (PACT).
program
Patient must be a beneficiary under the DPEBB.
Page 12
Jurisdictions that Offer this Service
Name of Service
Description
Jurisdiction
Legislative
Additional Training
Changes Reimbursement
Required
Required
Regional Characteristics
NON-DISPENSING MEDICATION MANAGEMENT SERVICES
support through brief
interventions or intensive onon-one counseling. Specifically,
pharmacists can help
individuals assess their
readiness to quit, guide them
through the steps to quitting,
offer advice on medications
that may help, and provide
ongoing support and
encouragement.
patient per year
The Regulation Health Professions Statute Law Amendment Act states
that pharmacists will be authorized to prescribe drugs set out in the
forthcoming regulations which will most likely include smoking cessation
therapies.
ON
No
Regulations still
being drafted
Regulations still
being drafted
Canadian Pharmacists Association
1785 Alta Vista Drive, Ottawa, Ontario, K1G 3Y6
1-800-917-9489
www.pharmacists.ca – research@pharmacists.ca
© Canadian Pharmacists Association • August 2010
Page 13