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A key takeaway for our federal and provincial governments in Canada throughout the pandemic was that no matter how daunting, community pharmacy rose to the challenge and delivered. From triage to testing, education to vaccination, our capability to serve as community health hubs, touted before the pandemic, was validated.
Sandra Hanna
Our governments are finally realizing that community pharmacy’s unique attributes as part of both the public healthcare system and the private retail sector — the latter delivering a deep community presence, an efficient distribution network and multipurpose frontline teams — result in an unparalleled degree of responsiveness and adaptability. Public-private partnerships between government and pharmacy are not only possible, but they often provide vital solutions to add much-needed capacity to the system.
Beyond COVID-19
Continued expansions in scope and new government programs are further evidence of community pharmacy’s integration in the health system in response to a growing primary care crisis. The coming months will see the long-awaited implementation of programs to assess and prescribe for minor ailments in Ontario and British Columbia, the last of our 10 provinces to do so.
We anticipate that the mobilization of pharmacy as an immunization hub for all publicly funded and recommended vaccines will feature large on the horizon. Over the past decade community pharmacy has become the primary destination for flu shots, and now in many cases COVID-19 vaccinations too. Surveys, commissioned by Neighbourhood Pharmacies, in partnership with 19toZero — a coalition of physicians, public health experts and related stakeholders — consistently show that Canadians are very willing to go to their pharmacies for more routine immunizations, and governments are responding. Early this year, Prince Edward Island launched a shingles vaccination campaign promoting pharmacy, and thousands flocked to pharmacies to get their “free” shot.
While this is all good news, it brings me to the crux of our priorities for 2023: sustainability.
Additional enablers must be in place so that community pharmacies can resource appropriately to provide high-quality, reliable and scalable services for the long term. Governments are turning to us to do more, and we have proven we can do more, but to do it sustainably — so that pharmacy teams remain healthy and resilient — we in turn need more from governments.
More than ever, we are advocating for the “how” as much as the “what” and the “why” of pharmacy solutions that are brought to the table.
Remuneration, regulation and technology
The key enablers for which we advocate are remuneration, regulation and technology. We advocate for broadening the “pharmacy team” to extend to pharmacy technicians, assistants, students, nurses and other regulated health professionals; to reduce pressures on pharmacists; and consistently look for ways to reduce administrative burden through automation, digitization and policy modernization.
Funding for pharmacy services is still far from universal. Equitable remuneration enables pharmacies to staff up and removes the need for patients to pay out of pocket, to offer universal access to these much needed services for all Canadians, inevitably driving better uptake.
Regulation and technology often intertwine. We are educating regulators and policy makers on the need to remove barriers that slow the adoption of technology solutions such as virtual care, automation, central fill, e-prescribing and a growing array of other digital health tools. As health care strategist Will Falk put so succinctly at our recent Specialty Pharmacy Summit, paper records, fax machines and obsolete rules and regulations “put people’s lives at risk.”
Specialty pharmacy practice
Medication management, of course, is at the core of pharmacy services. But pharmacies are offering so much more, extending from medication management to disease management more broadly. In the past decade we’ve seen a rapid acceleration of the role of pharmacists in disease management for patients taking high-cost, high-value specialty pharmaceuticals. Just 1.7% of Canadians take these medications, yet their share of the cost of all prescriptions has reached 44%. With such a large share of the drug budget, the sustainability of specialty care has become a focus for both public and private payers.
Advocating for an inclusive, competitive and sustainable specialty care model in community is also a key objective for Neighbourhood Pharmacies. We’ve partnered with IQVIA to quantify the value of specialty pharmacy services to the health care system. We will forge a path to intraprofessional collaboration in order to uphold the highest level of patient care, and to advocate with a united voice.
National pharmacare and drug pricing policies
Canada’s universal health care system does not extend to prescription drugs or dental care, though their inclusion has long been debated. We expect to finally see some action in 2023.
In accordance with the March 2022 Supply and Confidence Agreement between our minority Liberal government and the New Democratic Party, the federal government has begun the process to implement the Canadian Dental Care Program by the end of 2025 and has agreed to put a Pharmacare Act in place by the end of 2023.
All indications so far suggest that the dental plan will build upon the existing mixed-payor system of private and public dental plans, which suggests that pharmacare may also take a “fill-the-gaps” approach for drug coverage. This aligns with Neighbourhood Pharmacies’ position that pharmacare should focus on the uninsured and underinsured, and not disrupt the current system of public and private coverage. More than 85% of Canadians have some form of coverage, and surveys have found that private drug plans are highly valued.
New drug pricing guidelines from the Patented Medicine Prices Review Board (PMPRB) have been delayed yet again. It has now been almost six years since the federal agency began to reform its pricing review process. While the delays are partly due to the pandemic, they are also due to numerous revisions in response to stakeholders’ concerns.
The mandate of the PMPRB is to prevent excessive pricing; however, the reforms would reduce prices for patented medicines across the board. Another agency, the pan-Canadian Pharmaceutical Alliance, negotiates generic drug pricing. Its five-year Generic Pricing Framework, negotiated in 2018, expires in March 2023, and renewal negotiations are under way.
Pharmaceutical price compression is a key file for Neighbourhood Pharmacies. As long as the bulk of funding for pharmacy services is tied to drug prices by way of markups, we will continuously raise awareness that lower drug prices, especially at a time of increased operating costs across the entire supply chain, put a strain on the sector’s ability to deliver timely and accessible medicines and services — at a time when governments and the public need and value these services more than ever.
The challenges ahead are daunting, to say the least. Yet when I look back and consider the tremendous inroads made, I firmly believe that community pharmacy has never been better positioned to sustainably fulfil its role as an integrated community health hub.
Sandra Hanna is chief executive officer of Neighbourhood Pharmacies.
