In her first days as president and chief executive officer of the Canadian Association of Chain Drug Stores, Denise Carpenter has started to instill a renewed sense of purpose in the organization.

Canadian Association of Chain Drug Stores, CACDS, Denise Carpenter, chief executive officer, retail pharmacy, Canada, health care, pharmacists, community pharmacies, pharmacists' professional practice, 9,000 Points of Care: Broader Pharmacy’s Plan for Better Care, pharmacy industry, generic drug prices, pharmaceutical supply chain, health care costs

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Carpenter puts her stamp on CACDS

April 8th, 2013
Denise Carpenter

TORONTO – In her first days as president and chief executive officer of the Canadian Association of Chain Drug Stores, Denise Carpenter has started to instill a renewed sense of purpose in the organization.

Consistent with a strategic review completed by the CACDS board of directors last year, she has placed the emphasis squarely on carving out a bigger role for retail pharmacy in Canada’s changing health care system and, in the process, is helping the country provide quality health care for its citizens in a sustainable way.

At first glance, Carpenter, who was appointed in early January, seems an unlikely choice for the assignment. While her professional credentials are impressive, her previous experience, including work as a consultant, an executive at the power company EPCOR and, most recently, president and CEO of the Canadian Nuclear Association, falls outside the health care sector. Carpenter is confident, however, that much of what she has learned over the years is applicable to the issues that confront CACDS and its members.

“Throughout my career I’ve been privileged to work with a lot of great Canadians on a lot of big public policy files,” she said during her first interview as head of CACDS. “It’s an exciting time in this industry. Our goal at CACDS is figuring out how we can help Canadians get access to the right patient care from the right professional at the right cost, when and where they need it. I believe in community and I understand the value that pharmacists bring to it.

“I’m a focused strategist and understand the value of communicating with and listening to stakeholders and partners. As an industry association our goal is becoming a respected interlocuter, especially by government. That’s a great responsibility. You have to have good economics, good research and a good understanding of the political landscape. Just as important is building a great team that can respond to it. We bring a really clear understanding of how that works to the table and, over the next few months, will develop a very defined long-term strategy.”

The need for CACDS to assert itself has never been greater. The demand for health care services is rising as the population ages. That, in turn, has prompted federal and provincial governments, which guarantee coverage for all Canadians, to explore new ways to limit expenditures. As a result, community pharmacies find themselves in an environment where their traditional revenue stream is changing at the same time the scope of pharmacists' professional practice is expanding.

“Our market and service environment is increasingly dynamic,” said Carpenter. “As health care providers we are rethinking where and how we can most appropriately intervene to support governments as they contain costs, while at the same time ensuring the continuity of care that our patients and customers have come to expect. It all goes back to who’s the right professional to deliver a given service.”

Immunizations are one area where a paradigm shift is under way. Ontario allowed retail pharmacists to deliver flu shots for the first time in the 2012-2013 season, and more than 200,000 of them were administered by CACDS members. Working with stakeholders, CACDS is evaluating the program’s success with an eye to enhancing the current program and exploring the opportunity to provide other types of professional services.

Carpenter and her colleagues at CACDS will make the case for pharmacy in a political system where, in contrast to the recent situation in the United States, cooperation and consensus are the preferred way of doing things.

“My philosophy is simple — it takes a village,” she said. “We’re working closely with our partners in health care to find common ground where we can contribute and build a better system. If, as an association that represents pharmacy, CACDS can create a village collaboratively with manufacturers, distributors, pharmacies and government to serve Canadians who walk into pharmacies every day, then we’ll have mutual trust and can all work together effectively.”

A significant milestone along that path will be reached later this month with the publication and launch of “9,000 Points of Care: Broader Pharmacy’s Plan for Better Care,” which proposes five creative initiatives to improve the health care system while delivering greater value and improving the patient experience. Developed by the broader pharmacy industry, including community pharmacy, generic pharmaceutical manufacturers and pharmaceutical distributors, the document identifies areas where changes in current practice can make health care more accessible and affordable as governments struggle to deliver cost-effective services to Canadians.

“We know we can do more. The broader pharmacy community has human, physical and technological infrastructure that is underutilized. Used more strategically, we can improve patient outcomes and reduce system costs. These five initiatives provide the road map to better care.”

The preference for collaborative solutions has not blinded Carpenter to the fact that a good deal of wrangling lies ahead.

“In society we’ve created this whole concept of social friction, which is there in just about every platform and every issue,” she said. “We have to deal with it within our industry and within the broader health care system. The threats faced by pharmacy have galvanized everybody. That’s when there’s change in the ecosystem.”

Provincial governments’ shifting approach to paying for prescription drugs is a case in point. Working through the Council of the Federation, a body composed of the premiers of Canada’s 13 provinces and territories, officials considered a number of schemes designed to restrain expenditures, including competitive bidding. Although the efforts of CACDS and its allies forestalled the national competitive bidding process and other measures that they asserted could exacerbate shortages of certain medications and add instability to the pharmaceutical supply chain, the council early this year moved to set prices for six frequently prescribed generics.

In what was characterized as “the first step toward a more strategic, comprehensive and coordinated approach to pharmaceutical management in Canada,” the participating ministers (Quebec is not taking part in the initiative, although the law in that province mandates that generic drug prices be equivalent to the lowest anywhere else in Canada) established the price point for the six medications at 18% of their branded counterparts.

The council projects annual savings of $100 million (Canadian) for provincial and territorial drug plans when the program is fully implemented.

In the wake of the council’s decision, the Alberta provincial government last month took more aggressive action, voting to cut payments for all generic medications to 18% of the cost of the equivalent brand name product. The reduction from the current 35% level is set to take effect on May 1.

While cognizant of the need of government, which in Canada accounts for 55% of spending on prescription drugs, to control costs, Carpenter warned of unintended consequences that may adversely affect retail pharmacies and the patients they serve.

“We can’t lose sight of the fact that prescription drugs provide the greatest value to improving the health of Canadians and reducing future health care costs,” she said. “Cutting reimbursement for generics may save money in the short term but, done in isolation, it impedes the ability of pharmacy to generate the substantial long-term savings that will really make a difference.

“We can overcome present challenges by working with stakeholders and government toward the common objective of improved patient care. Prescription drugs are just one of the contributing costs to health care delivery, and we call on provincial governments to consider the system holistically.”

Backed by the fruits of an intensified research program that she says will quantify the positive impact of community pharmacy, Carpenter intends to make CACDS a prominent voice in the intensifying debate about the evolution of health care.

“We must be fully engaged and treat everyone with respect,” she said. “There will be friction along the way, but sometimes that leads to creative solutions. It’s not necessarily a negative thing.”