Community pharmacies have been identified as the key locus for delivering pharmaceutical care in primary care.¹ There are many barriers to its implementation, not least of which is remuneration.² In Scotland, 80% of pharmacists agreed that "the current remuneration structure is entirely inappropriate for providing pharmaceutical care". It is thus important to consider alternatives to the present system. This paper presents for discussion a method of costing pharmaceutical care services based on one system in use in the USA � the Resource-Based Relative Value Scale.³

This is a method of calculating the reimbursement appropriate for providing individual episodes of pharmaceutical care to patients based on their presenting pharmaceutical care needs. It requires:

1. 1. patients to be categorised according to estimated need for pharmaceutical care
2. 2. a base reimbursement rate to be developed
3. 3. relative value units to be assigned to patient categories, based on the resources required.

1. Cipolle et al³ have suggested five categories of patients, the majority of which fall into the lowest � these are patients using one or two medicines and with no drug therapy problems. The most frequent condition for which they provide pharmaceutical care services is sinusitis. In the UK, reimbursement for pharmaceutical care services through the NHS is likely to be for patients taking regular prescribed therapy, therefore the categories may differ. A small study in one pharmacy suggested that three categories may be appropriate, although this may change with more data.

2. The reimbursement rate must account for all relevant costs incurred in providing pharmaceutical care services. Those included were:

• staff costs, including time spent
• capital equipment and building costs, including the cost of refitting to provide an appropriate area
• overhead costs
• consumable costs
• opportunity costs, including lost dispensing fees

Some of these were calculated as cost per hour, others were fixed costs per patient. A range of potential costs was used enabling a sensitivity analysis to be performed.

3. Relative value units were obtained by calculating the time involved in providing the pharmaceutical care service and multiplying by the base reimbursement rate. As a range of values were obtained from the sensitivity analysis, the mid-point of each was used to estimate relative costs for each of the three categories of patient.

The base reimbursement rates obtained are in line with that used in the USA⁴ and the overall cost per patient is similar to that found by other UK workers.⁵

1. Krska J, Veitch GBA, Calder G. Developing pharmaceutical care in community pharmacies. Pharm J 2000; 265: R33
2. Krska J, Veitch GBA. Factors influencing the development of primary care-based pharmaceutical care in Scotland. Submitted to International Journal of Pharmacy Practice.
3. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice. McGraw-Hill, USA 1998.
4. Cipolle RJ, Strand LM, Morley P. The pharmaceutical care practice program. Peters Institute of pharmaceutical care 1999
5. Crealey G E, Sturgess IK, McElnay JC, Hughes CM. A costing study of pharmaceutical care provision to elderly patients. Pharm J 2000; 265: R4