Abstract P113: Variations in 24 Hour Ambulatory Blood Pressure Coverage Across Canada and the United States

Introduction: The gold standard for diagnosis hypertension is a 24-hour ambulatory blood pressure monitor (ABPM). In-office blood pressure may be falsely high in 30% of individuals (white coat hypertension) or falsely normal in 20% of individuals (masked hypertension). We hypothesize that ABPM funding varies across Canada and the U.S, and sought to investigate this hypothesis. Methods: We reviewed the fee schedules in 14 jurisdictions: 10 Canadian Provinces, three Canadian Territories, and the U.S. Centre for Medicare and Medicaid Services - CMS. We collected data on a) if ABPM is funded, b) indications approved for funding, and c) the reimbursement amount. We summarized this data descriptively. Results: Five jurisdictions (Alberta, Saskatchewan, Quebec, New Brunswick, the U.S. CMS) cover ABPM. The U.S CMS has specific indications for use and limits frequency to one annually, while Saskatchewan limits it to five annually (Table 1). Reimbursement amounts vary widely, from $14.70 to $81.16 (CAD), as do reimbursement components. Prior research using IBM’s MarketScan commercial claims database identified a median ABPM reimbursement by U.S private insurers of $89 (USD). Conclusion: ABPM coverage across Canada and the U.S. fluctuates. There is also variation in reimbursement amount and indications among jurisdictions providing coverage. Further studies should seek to measure if this variation corresponds with a variation in ABPM use, diagnostic rates of masked and white coat hypertension, or antihypertensive spending per capita. We would advocate for jurisdictions that do not currently fund ABPM to consider coverage in light of this geographic variability.