Plan sponsors stand to gain from the improved health and productivity of plan members through a new suite of available benefit offerings: pharmacy healthcare services.
Changes in legislation and evolution within pharmacy have allowed pharmacists to provide more direct healthcare support for plan members—in the area of chronic disease management, supporting those who are already taking medications, and in preventative health, working with members to prevent or delay the onset of disease. Pharmacists are integral members of the healthcare team and represent an untapped resource for plan members/sponsors to get better value from their health benefits. Pharmacies are highly accessible, conveniently located and often open after work hours.
Pharmacy services fall into six main categories [1]:
- Prescribing services—Pharmacists can independently adapt/modify or extend/renew prescriptions without the need for a doctor’s appointment or authorization. In some provinces, pharmacists can substitute one drug for another, or initiate prescriptions.
- Medication reviews—For plan members taking multiple medications for chronic conditions, pharmacists check that all medications (including nonprescription, supplements and natural health products) are appropriate, safe and effective.
- Medication care plans—Based on issues or concerns, often identified during a medication review, pharmacists work with members to set and achieve personal healthcare goals. This care plan may include strategies to overcome nonadherence to medications as well as support for lifestyle changes, such as weight loss.
- Preventative services and health coaching—Pharmacists assess health risk levels for the detection and management of chronic disease and/or provide support for lifestyle changes, such as smoking cessation, that may prevent or delay the onset of disease.
- Injection services—Injection-certified pharmacists administer vaccines against infectious diseases such as influenza, hepatitis A & B and HPV. Depending on the province, pharmacists can also administer medications requiring injection.
- Services for common (minor) ailments—In some provinces pharmacists can prescribe medications to treat a range of common, often recurring ailments, such as seasonal allergies, without the need for a doctor’s appointment or authorization.
Pharmacists are authorized medical practitioners under Canada Revenue Agency’s Income Tax Act, and their services may be reimbursed by benefit plans. Health spending accounts (HSAs) offer an immediate avenue for coverage, without additional cost to plan sponsors. Pharmacists may also be added as a paramedical service provider, and for plans with combined maximums for multiple providers, their services can again be incorporated without additional cost. In some provinces, plan members may also be eligible for government-funded pharmacist services, and private plans may offer supplemental coverage so that plan members can benefit from the broad menu of pharmacy services.
[1] Prescribing and other authorities under expanded scope of practice vary by province. Pharmacists will perform only those services that are permitted under provincial regulations. For a summary of pharmacists’ expanded authorities by province, go to www.blueprintforpharmacy.ca. These documents apply to all provinces and territories except Quebec.
Introducing the Benefits of Pharmacy Services