A History and Criticism of the Old and New MedsCheck Program.
This is a two-part series.
This is a two-part series, with Part I focusing on:
Part II will focus on:
You might want to get a coffee or snack at this point, because I warn you there is a long read ahead.
The "MedsCheck" was introduced in 2007 as a service that pharmacists could provide to patients; pharmacists would review all of the patient's medications and identify and resolve problems with drug therapy if necessary. Eligible patients did not pay the pharmacist directly for this service; rather, the service was reimbursed through Ontario Public Drug Programs (Ministry of Health and Long-Term Care). Pharmacists were finally given more reimbursement for a service that utilized their clinical knowledge and could contribute to more positive health outcomes for patients who received this service.
None of this blog's authors were in practice in 2007, but we know from archived government documents what happened shortly afterwards.
Ontario has had a very complicated history with respect to drug pricing and reimbursement for services. Certainly, there are more details than what has been listed above.
MedsCheck was never meant to be a substitute for all of the revenue lost due to changing generic drug pricing and the banning of rebates and professional allowances. The math, approximately $100 million in annual funding, simply did not offset the revenues lost[i].
However, MedsCheck revenue quickly became a "low-hanging fruit" for pharmacies to recover some of their losses. Many pharmacists completed comprehensive reviews and used this service as a value-added benefit for patients, but some did not, as revealed by the 2015 CBC Marketplace episode[ii].
Ultimately, the original MedsCheck program had problems, and would have had to be revised at some point in the future:
The last point, number 5, is an important one, as I feel it is a basic leading principle for all government funded programs.
In 2013, the Ministry of Health awarded $5.7 million in funding to form Ontario Pharmacy Research Collaboration (OPEN) and one of their objectives was to study the effectiveness of provincial pharmacist-led medication programs[i].
I attended a presentation by Lisa Dolovich (co-lead of OPEN) at the Ontario Pharmacists Conference earlier in July 2016, whose 3 year research evaluated the quality and impact of the program on patients, physicians and pharmacists/pharmacies.
The research was based on government administration and billing records, interviews, surveys of stakeholders and audits.
“For MedsCheck, we found that, over time, the reviews were being provided to less complicated patients and that community pharmacies’ focus was more on the uptake — providing more services — than on the quality of the reviews.[ii]”
Furthermore, OPEN found gaps in the completeness of documentation.
“For example, while most medication lists prepared for patients contained basic prescription information, less than half recorded the reason for the use of the medication and only about 75 percent noted any assessment of medication-taking behaviour.[iii]”
In consideration of the research presented, it should have come as no surprise when the Ontario Pharmacy Council[iv], the pharmacy advisory body to the Ministry of Health, decided to "refresh" the MedsCheck program, and address the above issues (to varying degrees of success/failure)[v].
Instead of generally one form that a pharmacist would complete during the assessment with the patient, there are three:
These forms are mandatory to standardize the MedsChecks process and the Medication Record must be faxed to the primary care provider (e.g. MD or NP) to be remunerated. A record to show a successful fax transmission is required. If a specialized MedsCheck for Diabetes service was provided, there are two additional mandatory forms to complete.
While the intention of standardization is good, the execution is wrought with added challenges.
Part II to be released in a few days, where we critically examine the implementation of the new "refreshed" MedsCheck program. We have received a lot of your opinions and comments regarding the new program, and we encourage you to keep sending them in. We will incorporate your feedback (anonymously) in Part II.