May 7, 2012

Pharmacy 2012

by Beverley Herczegh, Director

Both Ontario and Québec are “catching up” to the rest of Canada with respect to the expanded scope of pharmacy practice. Work is underway in Ontario with the new registrar, Marshall Moleschi from British Columbia, and in Québec with new legislation on pharmacy practice just adopted. It is clear that the pace of change in pharmacy will persist through 2012.

Who is leading this change, and how will pharmacy practice/business look? Dispensing could be fully commoditized: a technical function with razor thin margins performed by regulated technicians and/or automation in community settings and central fill locations. Or traditional community pharmacy may survive supported by regulated technicians/automation for a more robust community-based primary care with the pharmacist at the right end of the counter (i.e., – not at the cash register). Perhaps a hybrid will emerge where some pharmacists assume strictly clinical roles, others are both clinicians and dispensers, and still others oversee dispensing centres. Those most comfortable in dispensing roles will be easily replaced. Some are nervous. Others are forging ahead into innovative clinical roles.

Significant obstacles to practice change remain an issue. These include:

  • the established dispensing role of the pharmacist
  • lack of standardization in professional process
  • lack of perceived value of expanded pharmacist services
  • lack of supporting technology
  • the need to operationalize cognitive work in community pharmacies
  • economics

As long as enough money is to be made dispensing pills, the shift to patient-centric practice is hindered, in other words "put on the back burner."

In provinces where the business of pharmacy is still relatively healthy (i.e., Québec with 30 day filling and those where professional allowances (PAs) are unregulated) focus on expanded scope is not quite as sharp as in Ontario where the revenue from dispensing requires supplementation by funding for cognitive services. Does the business of pharmacy need to get out of the way of the profession?

While the economics of the business of pharmacy can hinder practice change, the economics of health care in Canada is a major driving force behind it. This is less about pharmacists working to their professional capacity and more about the financial need to provide health care to more patients more affordably. Inadequate revenue for dispensing is a fundamental driver to cognitive work where funding is implemented. The Blueprint for Pharmacy is a strong agent for change in this challenging journey. Professional collaboration is underway, albeit with some challenges, and ever so cautiously funding for cognitive functions is supporting change.

Is industry aware of the significance of these new pharmacy services? How should industry engage?

Should pharmacy seek a “fee for a service” model when other health care sectors are trying to escape that very model?

Should pharmacy seek fees for extending, prescribing, and therapeutic substitution, or should the profession pursue a fee strictly for patient assessment?

So many questions. A few things are certain: the role of the physician as prescriber is being diluted, not only by pharmacy but by nursing, midwifery, optometry, patients, and, most significantly, payers. Pharmacists remain the most accessible and most trusted of health care providers. So far, they are still the last touch point with the patient before they initiate a prescription. Are you engaged with this stakeholder?

Get in touch with us for more information on this topic.

Originally published in Canadian Pharmaceutical Marketing (CPM)/ February 2012