Inspiration for remuneration

Remuneration for pharmacy services depends on a number of factors, amongst which the health-care payment systems. And these can be very different between the different countries in Europe. Additionally, the payment for services is often part of a total remuneration package for the medicines themselves. Inspiration for working with payment for services provided by pharmacists may be found in various articles.

A systematic review on remunerated pharmacy clinical services has been published by:

Sherilyn Houle et al. Paying pharmacists for patient care: a systematic review of remunerated pharmacy clinical care services. CPJ/RPC, 2014; 147(4):209-232. This review refers to 60 remunerated programs identified in Canada, US, Europe, Australia and New Zealand. It concludes that most commonly remunerated service is Medication Review and that third-party based programs are largely based in the US. Paying pharmacists for patient care.pdf

Some studies focusing on remuneration models:

• Linda D. MacKeigan. Alternative Reimbursement Systems in Community Pharmacy: Structure, Perceptions and Performance. J.Res.Pharm.Econ. 2001;11 (2):53-74. Linda Mackeigan_Alternative Reimbursment Systems in Community Pharmacy_structure,perceptions and.pdf
• C Bernsten, Y Gariepy, EM Lutz, PW Reid and PJ Schneider. Developing New Economic Models for Payment for Services by Pharmacists. The report of the Working Group. Int Pharm J 2009; 25 (2).  30-45 
• C. Bernsten, K. Andersson, Y. Gariepy, S. Simoens. A comparative analysis of remuneration models for pharmaceutical professional services. Health Policy 2010; 95 (1):1-9. Bernsten2010_a comparative analysis of remuneration models for pharmaceutical professional servi.pdf

• J.M. Ganther. Third Party Reimbursement for Pharmacist Services: Models of Insurance Coverage Development. Medscape/ J Am Pharm Assoc. 2002;42(6). 

• List of additional references about service fees (MS Word document, until 2010)ReferenceList_ServiceFees 2010.pdf

• Snella et al. Pharmacist Compensation for Cognitive Services: Focus on the Physician Office and Community Pharmacy. Practice Insights 2004. 

Snella2004_Pharmacists compensation for cognitive services.pdf

• Sachdev. Sustainable business models: Systematic approach toward successful ambulatory care pharmacy practice. Am J Health-Syst Pharm 2014. sachdev2014_sustainable business models in pharmacy.pdf 
• Nutescu and Klotz. Basic terminology in obtaining reimbursement for pharmacists’ cognitive services. Am J Health-Syst Pharm 2007. 

Nutescu2007_basic terminology in obtaining reimbursement.pdf 

• Abstracts from the 3rd International PPRI Conference 2015: Pharmaceutical Pricing and Reimbursement Policies: Challenges Beyond the Financial Crisis. J Pharm Policy Pract 2015;8: Suppl 1

• Gregório, Russo and Lapão. Pharmaceutical Services Cost analysis Using Time-Driven Activity Based Costing: A Contribution to Improve Community Pharmacies’ Management. Research in Social & Administrative Pharmacy 2015 Gregorio 2016_pharmaceutical services cost analysis.pdf  

While the above papers approach the theme of remuneration focusing on models of payment, others focus on specific types of services for which remuneration has been achieved in the country.

Please note that this an area where changes happen very rapidly. Therefore, the fact that a certain service is described as being paid in 2014, does not necessarily imply it will remain the same in 2016.  These are listed under broad themes for easier analysis:

Medication management, pharmaceutical care and equivalent terms:

• American College of Clinical Pharmacy White Paper on Collaborative Drug Therapy Management and Comprehensive Medication Management ACCP White paper on colaborative drug therapy management.pdf  
• Saito. Current status of Community Pharmacies: Expectations as a Health Information Hub, the Enforcement of Revised Pharmaceutical and Medical Device Act, and a New Role as Stakeholders.  Paper in Japanese. Abstract in English Current status of community pharmacy_Japan_only abstract in english_2015.pdf   

Anticoagulation services

• Liu et al. Warfarin usage among elderly atrial fibrillation patients with traumatic injury, an analysis of United States Medicare Fee-forService enrollees. J Clin Pharmacol. 2015; 55(1): 25–32. Liu 2015_warfarin_fee for service.pdf  
• Brochure from New Zealand describing the Community Pharmacy Anti-coagulation Management service NZ-CPAMS - Background Information for General Practice 13 May 2013.pdf  

Polypharmacy and medication review: 

• Feinstein et al. The depth, duration, and degree of outpatient pediatric polypharmacy in Colorado fee-for-service Medicaid patients. pharmacoepidemiology and drug safety 2015; 24: 1049–1057  Feinstein2015 fee for service medicaid.pdf 
• Bulajeva et al. Medication review practices in European Countries. Administrative Pharmacy 2014; 731-740.  Bulajeva_RSAP 2014_Medication review practices in European countries.pdf  

New medicines service: 

• Appraisal of the New Medicines Service in the UK. Appraisal of the New Medicines Service 2014.pdf  

Other services:

• Nazar et al. Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS). BMJ Open-2016-Nazar-PERMSS UK.pdf  

Between 2005-2007 a series of articles on community pharmacy services appeared in the Annals of Pharmacotherapy. In some of the articles, information about remuneration can be found. The articles are not free.

• Karen B. Farris, Fernando Fernandez-Llimos, S. I. Benrimoj. Pharmaceutical Care in Community Pharmacies: Practice and Research from Around the World. Ann.Pharmacother. 2005;39 (9):1539-1541. (the introduction)
• D. B. Christensen, K. B. Farris. Pharmaceutical care in community pharmacies: practice and research in the US. Ann Pharmacother 2006;40 (7-8):1400-1406.
• M. S. de Castro, C. J. Correr. Pharmaceutical care in community pharmacies: practice and research in Brazil. Ann Pharmacother 2007;41 (9):1486-1493.
• Christiane Eickhoff, Martin Schulz. Pharmaceutical Care in Community Pharmacies: Practice and Research in Germany. Ann.Pharmacother. 2006;40 (4):729-735.
• E. Guignard, O. Bugnon. Pharmaceutical Care in Community Pharmacies: Practice and Research in Switzerland. Ann.Pharmacother.  2006;40(3): 512-517.
• H. Herborg, E. W. Sorensen, B. Frokjaer. Pharmaceutical care in community pharmacies: Practice and Research in Denmark. Ann Pharmacother 2007;41 (4):681-689.
• E. J. Jones, N. J. MacKinnon, R. T. Tsuyuki. Pharmaceutical care in community pharmacies: practice and research in Canada. Ann.Pharmacother. 2005;39 (9):1527-1533.
• J. W. Foppe van Mil. Pharmaceutical Care in Community Pharmacy: Practice and Research in the Netherlands. Ann.Pharmacother. 2005; 39 (10):1720-1725.
• Daisy Volmer, Kaidi Vendla, Andre Vetka, J. Simon Bell, David Hamilton. Pharmaceutical Care in Community Pharmacies: Practice and Research in Estonia. Ann.Pharmacother. 2008;42 (7):1104-1111.
• L. O. Tommy Westerlund, H. Thony Bjork. Pharmaceutical Care in Community Pharmacies: Practice and Research in Sweden. Ann.Pharmacother. 2006;40 (6):1162-1169.

Later, an update of these papers describing the functioning of the health care system and pharmacy in Europe, has been published. However, this paper does not mention remuneration. It does provide though a useful list of services available:

• S. A. Martins, J. W. F. Van Mil, F. Alves da Costa. The organizational framework of community pharmacies in Europe. Int J Clin Pharm: 2015;37:896-905. 

Example countries (please add your experience)

Netherlands

The Dutch Healthcare is totally privatized through a number (around twenty, but basically three large ones, with each a number of commercial brands) of insurance companies. Although the governments also pays into their funds, all Dutch citizens must choose an insurance and pay a premium of around 2000 Euro/year. There is a co-payment for medicines and specialist services of max. 350 Euro per person (2015). Each insurance company (and there are approx. twenty) makes separate contracts with each health care provider, and there may be mayor differences between the contracts. In the field of pharmacy, the chain pharmacies may negotiate a contract for all their pharmacies, but pharmacies that are not part of a chain must negotiate individually. This causes significant between-pharmacy differences for both the basic remuneration (for different types of dispensing & requirements) as well as remuneration for special service. As an example below (open the pdf) the remuneration by the different larger insurances for medication review in the contracts of one major chain for 2015.

Remuneration The Netherlands 2015.pdf

Portugal

The Health Care System in Portugal is Public (National Health Service), mainly financed trhough taxes. There are also large and growing insurers, but still we consider our health care system to be mainly public. Co-payment for medicines results from a part of the Naitonal budget attributed annually to health. In December 2016, the first pharmaceutical service became remunerated in Portugal, as a result of various studies conducted by CEFAR, jointly with other reputed universities, and successful political negotiations by the National Association of Pharmacies and the Minister of Health (see legal document attached). There had been other services remunerated in the past (before 2010). Currently, there are additional initiatives in Public Health being tested and valued, which may ultimately lead to achieving further services being compensated. 

Payments in Portugal.pdf

The service that just got reimbursed is "The needle exchange programme". Below is the legal document, stating that each "exchange" is paid at 2,40 € (in Portuguese). The protocol that contributed to this successful negotiation is also provided below. For further information, please contact Suzete Costa (suzete.costa@anf.pt).

Protocol Needle exchange Portugal.pdf 

Legal document stating the fee established available at

https://dre.pt/application/file/105292093

Slovenia

Advanced Medication Review reimbursed. See news at PCNE newsletter (Volume 11, Number 4. December 2016)

Switzerland

Hersberger and Messerli published a very nice review describing services provided in Switzerland, including detail on the associated remuneration. To be highlighted the Polymedicationcheck (paid at 45 €, having an annual limit established), which may then lead to the identification of needing as an additional service the Dose Administration Aid system (paid at 20€/week). For further detail, Hersberger, K. E., & Messerli, M. (2016). Development of clinical pharmacy in Switzerland: involvement of community pharmacists in care for older patients. Drugs & aging, 33(3), 205-211 available at https://www.ncbi.nlm.nih.gov/pubmed/26884391