Prevalence of deprescribing claims made by Quebec community pharmacies

Deprescribing is the patient-centred process, supervised by a healthcare professional, of reducing or stopping a medication to improve health outcomes. Beginning in late 2022, community pharmacists in the province of Quebec have been able to claim for public healthcare reimbursement for their deprescribing interventions. The legislation enables pharmacists to bill for an initial deprescription consultation when planning an intervention targeting a medication that poses a risk of adverse outcomes for the patient.Following the initial consultation, up to two follow-up interventions can be reimbursed within a six-month period. Regardless of whether the intervention results in dose reduction or medication cessation, pharmacists in Quebec can bill for the completion of the deprescribing process. The legislation also distinguishes between deprescription and drug discontinuation, as each process is associated with distinct billing codes. The extent to which pharmacists in Quebec have billed for deprescribing practices since the implementation of the new legislation is unknown. To investigate this issue, Quebec researchers quantified the billing claims associated with deprescribing in Quebec community pharmacies between January 1, 2023 and November 30, 2024. They also examined which medication classes were deprescribed most frequently during this period.The study included all interventions associated with a deprescribing service code that were provided in the 1,906 community pharmacies in Quebec over 23 months. Interventions included the initial consultation (code A), follow-up consultations (code B) and the end of the intervention (code Z). Classes of medications associated with each intervention were identified and categorized according to the American Hospital Formulary Service (AHFS) classification system.Results showed the following:A total of 90,840 deprescribing claims were recorded during the 23-month study.Claims included 42,594 initial consultations (47%), 36,089 follow-up consultations (40%) and 12,157 deprescribing intervention completions (13%).The monthly number of billed deprescribing interventions increased over the study period.Central nervous system agents were the most frequently deprescribed medications, accounting for 87% of interventions.Antidepressants (33,155 deprescribing claims), anticonvulsants (20,361) and benzodiazepines (15,685) were the most frequently deprescribed medication classes. Next were proton pump inhibitors (3,609 claims), anxiolytics/sedative/hypnotics (3,412), opiate agonists (2,800) and antipsychotics (2,470). The authors conclude that following the implementation of new legislation, pharmacies in Quebec have begun billing for deprescribing interventions. Pharmacists made more than 90,000 deprescribing intervention claims over the 23-month study period, with more than 85% of these claims relating to the deprescribing of central nervous system medications. The number of deprescribing claims per month increased over time, suggesting that pharmacists may have required time to integrate the new legislation into clinical practice. The authors point out that the number of billing claims for deprescribing in Quebec during the study was quite modest. With 1,906 pharmacies in Quebec, the average number of claims associated with initial deprescribing consultations was 22 per pharmacy over the 23-month study period, representing about one deprescribing initiation per month per pharmacy. The authors highlight that Quebec's innovative approach to billing claims for deprescribing also provides a valuable framework for advancing deprescribing research. It allows for more accurate tracking of deprescribing interventions, as medications being deprescribed can be clearly distinguished (by distinct billing codes) from medications that are merely discontinued without a prior deprescribing process. The authors believe that the ability to bill for deprescribing services will be an important tool for studying medication deprescribing in real-world healthcare settings. Its value could be enhanced even further if other regions adopted this model to improve their own healthcare practices and research in this field.ReferenceCalfat AC, Gosselin M, Sirois C. Billing deprescribing interventions: portrait of an initiative in Quebec, Canada. Basic Clin Pharmacol Toxicol 2025;136(6):e70050. (accessed May 8, 2025).

Prevalence of deprescribing claims made by Quebec community pharmacies

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