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Developing Recommendations for the Reimbursement of Expanded Professional Pharmacist's Services in Ontario

119 The Ontario government has initiated a number of changes to the prescription drug system over the past 5 years. Many of the changes are intended to reduce the money paid by the Ontario Ministry of Health and Long-Term Care (MOHLTC) for medications, through reductions in the reimbursed cost of generic medications and indirectly through banning professional allowances paid to pharmacists by generic manufacturers. These changes generated controversy and were played out in the public arena. At the same time as the funding reductions were announced, the Ontario MOHLTC also made a commitment to increase the funding available for professional services to patients provided by pharmacists, although the specifics of the funding were not described at the time of the announcement. The Expanding Professional Pharmacy Services Working Group (EPPS WG) was established in August 2010 to provide advice to the Minister of Health and Long-Term Care and the Executive Officer of Ontario Public Drug Programs, on pharmacist’s professional services that could offer value to Ontarians and were deemed ready for immediate implementation by community pharmacists. The work of the EPPS WG was intended to provide expert advice on the specifics of the commitment made by the MOHLTC to increase funding for professional pharmacist’s services. The services under review were patient-focused clinical services that occur immediately before, during or shortly after dispensing a medication or may be patient-focused nondispensing professional clinical services that are appointment-based or offered outside of the dispensing process. Policy-makers often rely on expert committees to generate recommendations that can help inform health policy decisions. Structured expert committee discussion of a topic, including a consideration of literature evidence, is one method to improve evidence-based decision-making by policy-makers. The ideal characteristics of respectable work produced by expert committees are that the work is transparent, evidence-based, systematic and takes into account the needs, constraints, values and preferences pertinent to the organizations, people and setting affected by the recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) is an increasingly accepted approach to grading quality of evidence and strength of recommendations. GRADE has been used worldwide to help develop recommendations about drugs, technologies, prevention screening and other health services. It incorporates processes that facilitate high-quality work by expert committees. It provides a structured approach that allows expert committees to address the ideal characteristics. The GRADE process separates judgments made about the quality of the literature evidence on the effectiveness, safety and other considerations from judgments made on the strength of the recommendations for the topic under review. GRADE itself was created based on the findings from an overview of the literature that examined the essential components of a system to grade evidence. The GRADE approach has been used by organizations worldwide, including the World Health Organization, the American College of Chest Physicians, the National Institute for Health and Clinical Excellence in the United Kingdom and the Canadian Agency for Drugs and P O L I C Y R E V I E W