Abortion pill still inaccessible as doctors can't bill for providing it

The abortion pill remains out of reach of most Nova Scotia women, because doctors still cannot bill the province for providing it.

Last fall, the province announced funding of Mifegymiso, a two-drug combination using mifepristone and misoprostol to terminate an early pregnancy up to 63 days gestation.

But despite public coverage of the abortion pill, most women are unable to obtain a prescription for the drug because the majority of family doctors — and the province's only abortion clinic — don't yet offer the alternative to surgical abortion.

At issue is the lack of a provincial billing code that pays doctors for overseeing pregnancy termination using the abortion pill.

Dr. Lianne Yoshida, medical co-director of the Termination of Pregnancy Unit at the QEII Health Sciences Centre in Halifax, said prescribing physicians in Nova Scotia can only bill for a regular visit, which doesn't reflect the time involved.

"They are being paid a little bit, but not even close to their colleagues in other provinces," Yoshida said

"It involves more than just writing a prescription. It requires counselling, education about options, sending them for blood tests and an ultrasound, information about how to take the medication safely and what to expect, and follow-up appointments."

'They don't get paid enough or appropriately'

She added that she began the process of applying for a billing code for providing Mifegymiso in Nova Scotia shortly after Health Canada approved it in 2015.

"They get paid but they don't get paid enough or appropriately for what they're doing," said Dr. Ken Wilson, medical consultant with Doctors Nova Scotia. "It's a very low fee and doesn't really adequately remunerate them for the time they spend and what's involved, including counselling patients."

Other provinces have opted for a flat fee for such abortions. Ontario, for example, has a unique billing code that pays doctors about $200 for the initial appointment, including counselling and education, ordering blood work and an ultrasound, and a physical exam. A second billing code pays about $30 for up to two follow-up appointments.

A spokesperson for the Health Department said new drugs are introduced regularly with no requirement for special codes to permit physicians to prescribe them.

"Providing a prescription for a new drug, including Mifegymiso, is covered as part of the fee paid by MSI (the province's medicare regime) for the visit that occurred when the physician discussed the risks and benefits of the new drug with the patient," Tracy Barron said in an email.

However, she said the department has recently been made aware of physicians' concerns that the usual visit fee is not considered adequate compensation for prescribing the abortion pill.

Committee now considering a specific code

Barron said the province's fee committee — made up of representatives of Doctors Nova Scotia, physicians and the department — is currently reviewing an application for a specific code for prescribing Mifegymiso.

"The application has been flagged as a priority and is now proceeding through the usual fee committee process," she said.

Wilson, co-chair of the fee committee, said introducing a new billing code for prescribing Mifegymiso was delayed in part because it was unclear how long such appointments took.

Although he said it's now on a high priority list, Wilson said the fee committee is also in the midst of examining new fees for methadone management and medically assisted death.

"If it's going to be unduly delayed, if it looks like we get bogged down on one of these other issues, I've been pushing the Department of Health to put in an interim fee," he said. "If you can avoid doing that it's probably better because then you don't have to change things a couple of times, but if it's going to be more than six months I'll keep pushing for that."

'Hardly anyone is prescribing Mifegymiso'

Martha Paynter, a Halifax-area nurse and advocate for women's health, said introducing a billing code for Mifegymiso abortions is an urgent issue.

"There is a lot of confusion. You can't go and say you're paying for medical abortions as of November 1st when you haven't even created a mechanism to pay the prescriber," said Paynter, the former chair the Halifax branch of the Women's Legal Education Action Fund.

"Like all prescription medication, you need a prescriber to write you a script," she said. "But hardly anyone is prescribing Mifegymiso because there is no billing code."

Paynter said it's unfair to expect doctors to "take the hit personally" and not be adequately paid for a service that requires thoughtful counselling.

"For patients that have done all the research and are very sure of their decision, it's going to be relatively quick," she said. "But in other cases more counselling and education will be needed, and allowing doctors to only bill for a 10-minute visit is not sufficient."