Bills 41 and 31: A look at the 4 million services performed in 2021 by Quebec pharmacists

The data collected by ProfessionSanté.ca from the RAMQ is unequivocal. Last year, pharmacists billed the Régie for some 3.8 million acts arising from Bills 41 and 31, for a total amount of $60.6 million. Activities resulting from Bill 41 are particularly on the rise, growing from 700,000 in 2020 to 1.7 million in 2021 (up 140%). As for those from Bill 31, they show, among other things, that pharmacies have significantly contributed to the vaccination campaign against COVID-19, and to a lesser extent against influenza and other viruses, with the administration of 2 million doses of vaccine. “These are very good figures that I'm happy to see,” enthused the president of the Order of Pharmacists of Quebec (OPQ), Bertrand Bolduc. “We can be proud: the pharmacists responded, 'We're here!'” Read: Mask wearing to become a 'personal choice,' Quebec public health director says His predecessor from 2009 to 2014, Diane Lamarre, sees in this compilation “a gift for me and for all Quebecers. I knew that it would be demanding for the pharmacists, because they were given a very high level of responsibility and accountability, but that it would produce great results to improve the first line," she says, measuring the progress made since the debates around Bill 41, in 2009-2011, during which she remembers having fought to make the term “pharmaceutical care” heard by the federations of doctors and nurses. The surge of 140% of these actions newly enabled by Law 41, unprecedented since 2015, is not mysterious. There has certainly been a pandemic effect, but this growth is above all explained by the regulations implementing Law 31 coming into effect on Jan. 25, 2021, which abolished the deductible and co-insurance fees for clinical services in pharmacies. "These changes have lifted a major obstacle, both for patients and for our members, who were not comfortable charging them for free services at the doctor's," observes the president of the Association of Pharmacists Owners of the Quebec (AQPP), Benoît Morin. “These figures show that when the conditions are met and they are given the means, pharmacists can use their clinical skills, interdisciplinarily or independently. It benefits their patients and their doctors who save time.” The deputy editor of Québec Pharmacie, Christophe Augé, says he's surprised by the explosion of acts aimed at modifying drug therapy. Read: $21,500 fine for $242K in kickbacks: Another ex-partner of Quebec's deposed 'king of pharmacy' sees sanctions "They've multiplied by 10 in one year, that's not nothing," observes the pharmacist owner under the Familiprix banner in Ascot Corner, in the Eastern Townships. He points out these acts “include a lot of things that we could do before in terms of adjustment, but for which we were limited by the franchise fees.” Morin nevertheless points out that previously, these adjustments were only aimed at patient safety. Since Bill 31 came into effect, “we are also concerned about the effectiveness of treatments, which reduces the risk of side effects and limits waste, ” he says. For her part, Diane Lamarre, who continues to practice pharmacy in addition to being the health columnist for the TVA network, is delighted with these 125,000 therapeutic adjustments made last year. “They indicate great vigilance on the part of pharmacists who no longer fill a prescription with their eyes closed, but revalidate all the parameters,” said the former PQ MP. Doing even more There's also been a noticeable increase in “assessments for the need for prescription of a drug,” whether for the treatment of minor conditions (urinary tract infection in women, atopic dermatitis, cold sores, etc.) or for those where no diagnosis is required (smoking cessation, emergency oral contraception, traveller's diarrhea, etc.). Here again, the abolition of franchise and co-insurance fees has worked in favor of pharmacists, notes Morin. "We should be able to do more, especially for minor conditions. These are acts that pharmacists or specialized nurse practitioners can perform independently and which relieve family doctors all the more." Read: Strategy 101 for your pharmacy practice Up 150%, prescription extensions support the idea of relieving general practitioners. Except that the latter complain of still receiving far too many faxes on this subject from pharmacists. “This activity should not be trivialized,” says Lamarre. When a pharmacist extends a prescription, he bears the same responsibility as a doctor, and if he refers to it, it's because it is justified. When a patient takes eight treatments, it's quite healthy to consult the prescriber. It’s an advanced collaborative practice, she notes. :Sometimes it's the patient who asks for a fax to be sent back to his doctor,” points out Bolduc, adding that pharmacists can only renew a prescription twice a year, for a limited period. “It's clear we'll have to continue to communicate with the doctors." With regard to 'adjustment of the dose of drugs for reaching therapeutic targets' services, which increased fivefold between 2020 and 2021 for conditions such as high blood pressure, diabetes, dyslipidemia or migraine, Augé considers pharmaceutical practice to be moving towards more autonomous management. “Before, we had to obtain the therapeutic targets from the doctor. Without these targets, nothing could be done. Today, we no longer need the go-ahead of the doctor, we can establish the targets ourselves and then take care of the follow-up.” This development, the president of the APPQ wishes to extend to other conditions, such as mental health disorders, the treatment of chronic pain or that of attention deficit. “We could be more involved, without replacing the doctors. Because once the diagnosis has been made, these conditions require recurring adjustments that can be made by pharmacists,” says Morin. The year of vaccination As for the new actions resulting from Bill 31, 2021 will undoubtedly remain the year of vaccination for pharmacists. With the help of their nurses, they administered more than two million doses of vaccine, mainly against COVID-19 and influenza. While some may have reservations, “the pharmacists vaccinated for real.” underlines Augé, who notes that more than half of his colleagues (3,485 to be precise) have embarked and have become vaccinators. “Pandemic or not, pharmacies will remain places of vaccination,” Bolduc believes. Read: U.S. 'test and treat' strategy aims to give Americans free COVID antivirals in same pharmacy where they test positive Also gratifying for the profession was how doctors didn't hesitate to seek the opinion of pharmacists, as evidenced by the 15,000 consultations billed to the RAMQ by the latter. "It was already done informally, but it formally recognizes our expertise" says Augé, adding that "it goes in the direction of interdisciplinarity." According to Lamarre, the pandemic forced the need to favour this style of interdisciplinary work. "We must seize these opportunities to speed things up. If we want to improve access to care, we must multiply the entry points into the network. Because of their proximity to patients and their availability, pharmacists are essential.” This article originally appeared in our sister publication Profession Santé and has been translated from the original French.

Bills 41 and 31: A look at the 4 million services performed in 2021 by Quebec pharmacists

Register for free access or login.

Related Topics