By Michael Mui
Communications Manager, BcPhA
A decade of growing costs, an aging resident population, an increasingly complex set of services, and withstanding some of the worst a worldwide pandemic could muster; those are just some of the challenges operators of pharmacies serving long-term care (LTC) homes have had to confront.
These pharmacy operators received some much needed financial relief in March 2023, when Plan B facilities’ fee for service was increased 50% to $65 per month, per occupied bed, up from $43.75. The previous fee had remained the same since 2010.
LTC pharmacies receive this monthly fee as compensation for providing eligible prescription drugs and clinical services to people living permanently in LTC homes, instead of dispensing fees that community pharmacies would receive.
(L-R) CareRx Vice-President of Western Canada operations Omar Saad, CareRx Burnaby pharmacy manager Chelsea Huang, College of Pharmacists of British Columbia Registrar Suzanne Solven, College COO Zachery Solomon, College Deputy Registrar Heather Biggar, and College General Counsel Daryl Beckett during a tour of CareRx Burnaby.
Omar Saad, Vice-President of Western Canada Operations for CareRx, said the fee increase has been needed for a long time. Saad said CareRx serves a large number of British Columbia’s LTC residents and is the largest dedicated LTC-service pharmacy in the province, with locations in Victoria, Parksville, Kelowna, Burnaby and Vancouver.
“We are pleased that the Ministry of Health engaged in a constructive dialogue with our sector and made much-needed changes to the fee structure for LTC pharmacies,” Saad said. “This increase brings B.C. closer to the reimbursement regime for LTC pharmacies in other provinces. It is encouraging that the work of LTC pharmacy is being recognized.”
Saad said costs have always been a challenge for LTC pharmacies, particularly in B.C.
“In the past, we relied heavily on building scale to be able to negotiate better prices on supplies with our vendors, delivery logistics and other operating expenses,” Saad said.
“Our primary focus is the resident and trying to ensure that we support safe, effective medication use. We are health care providers first but we also must consider that any business needs to be sustainable in order to provide quality care.”
In recent years, B.C.’s senior population has boomed.
According to Statistics Canada’s 2021 census, there are now more than one million seniors living in B.C., with people 65 and older making up more than one-fifth of the province’s population. By 2031, the B.C. government estimates more than 1.3 million people will be over the page of 65.
“Residents are living longer,” Saad said. “And they have more complex medication regimes today, more than ever previously. That requires LTC pharmacies to be a lot more innovative in terms of clinical initiatives and programs.”
New health-care services have also added to the complexity of care, medical cannabis, medical assistance in dying, to intravenous transfusion being available in LTC homes, as just a few examples.
“In the past residents would just go to hospital for that. You're starting to see more and more LTC homes starting to provide some of those additional services to be able to free up beds in acute care,” Saad said.
An enormous impact came in the form of COVID-19, which had a disproportionate impact to those who work and live in LTC homes. Suddenly, LTC pharmacies were facing a multiplying number of challenges, from staffing shortages to safety protocols to completely changing how medication deliveries were done.
“Our old model is based on deliveries from one site to the next, then to the next, and we acknowledged right away that if we don’t have enhanced protocols for safety and hygiene, we might end up being the vector that is bringing COVID from one home to the next,” Saad said.
Staff get to work at CareRx Burnaby facility at 180-3700 N Fraser Way.
“COVID-19 really shone the light on some of the gaps that we have in the long-term care homes and showed where pharmacy would be able to step in and fill those gaps."
The fee increase followed a review taken by PharmaCare on plan B compensation. In its announcement, PharmaCare said it would now consider expanding payment for additional clinical services that pharmacies provide to LTC facilities. In 2022, advocacy efforts from the BC Pharmacy Association, LTC pharmacies, and health authority pharmacy leads were made to communicate that the previous fee from 2010 was no longer economically viable.
“The new fee will help ensure continuity of care for more than 30,000 people living in long-term care facilities in B.C.,” said John Capelli, executive director of the Pharmaceutical Policy, Legislation and Engagement Branch of the Pharmaceutical, Laboratory and Blood Services Division of the BC Ministry of Health.
Saad said the funding would help sustain LTC pharmacies in the province and also allow LTC pharmacies to grow.
“That funding would also support us to innovate and invest in technologies as needed,” he said. “We acknowledge and appreciate everybody's help and work in providing that increase, but we also see it as a first phase: B.C. is still well behind other provinces in terms of the funding model, namely Ontario and Alberta, and this is just a step in the right direction.”