TORONTO — Community pharmacy sales are still lagging those of other retail sectors in Canada, where provincial reforms are squeezing prescription drug business.

According to Statistics Canada, pharmacy sales for the period to the end of February rose just 2.7%, despite an additional day during the month.

That level of growth is a far cry from the high single digits that were common in the early 2000s. Total retail sales, by contrast, were up 5.1% in the first two months of this year.

Such results were not unexpected, of course, since community pharmacy continues to struggle with the reductions in remuneration for prescription dispensing under public drug plans imposed by provincial governments. The provinces with the largest populations — Ontario, Quebec, British Columbia and Alberta — had implemented their new regimes either partially or wholly, and those that had not completed the implementation had announced what their future intentions were.

It was an unpleasant surprise, however, when British Columbia recently announced that in the light of the scale of other provinces’ actions to reduce dispensing income, it intended to revoke the agreement it had reached with the sector and introduce a new, lower set of rates.

Similarly, pharmacies were disappointed when Ontario in late April announced it planned to lower the price it intended to pay for the top 10 generic drugs to 20% of their brand name equivalents from the previously established 25%.

As provincial governments reduced their remuneration for dispensing, they began a parallel process of empowering pharmacists to deliver more cognitive services to patients and introduced payment schedules for at least some of these services. So far, however, the income stream from this source does not come close to matching the revenue that has been lost from the dispensary-related cutbacks.

Sandra Aylward, chairwoman of the Canadian Association of Chain Drug Stores (CACDS) and, in her full-time capacity, vice president of professional and regulatory affairs at Lawtons Drug Stores and Sobeys Pharmacy, has been actively involved in negotiations with provincial governments on the extension of pharmacists’ powers and responsibilities, and the establishment of new fee schedules for these activities.

“We have been making significant, incremental progress across Canada in the establishment of new powers for pharmacists and the setting of appropriate remuneration for their exercise,” Aylward points out. “It is an exciting new world, as we are virtually reengineering the role of community pharmacy.

“Sometimes it feels as if we are involved in the equivalent of playing a 3-D game of Scrabble, as we in CACDS work with governments and provincial professional pharmacy associations, keeping all the parties in touch with what is going on in other provinces. We try to ensure that best practices developed in one province are adopted in the others, a crucially important role for CACDS acting as the intermediary among all the parties.”

Aylward cites some examples of the benefits that society is enjoying as a result of the new, enhanced role of the pharmacist. Recently there was an outbreak of pertussis (whooping cough) in British Columbia, where pharmacists there are allowed to administer injections. They were able to exercise these powers, providing some 10,000 injections to patients in the affected areas. The stemming of this outbreak provides a precedent of what could be achieved if a flu or other pandemic were to occur.

In another example, New Brunswick patients appreciate the convenience of getting their travel vaccinations at a pharmacy, saving them time and reducing the pressure on medical clinics. Equally meaningful is the pharmacist’s new ability to adjust prescriptions — say for a child who is unable to swallow a pill and needs a liquid in substitution for it, or for one who has grown since he or she was last prescribed and for whom the original dose is no longer large enough to be effective.

For patients with minor ailments, the choice between continuing to suffer and going to the trouble of seeking a doctor’s appointment and then allocating the time to fulfill it often results in the patient choosing continued discomfort over an unknown expenditure of time.

If a pharmacist can provide needed medication and accompanying counseling on its use in a readily accessible location, say for a seasonal allergy, there is every likelihood the patient will choose that option. The downside of course, is that until governments agree to pay for such services, patients have to accept the concept of user-pay in the drug store.

In this process of expanding the pharmacist’s role, Aylward notes that the sector is advancing its position in a careful way: “In establishing standards of practice we have to set ourselves up for success,” she says. “We have to involve other health care professionals in the discussion. In exercising our new powers we are adding capacity — we are taking some burden off others in a stretched system, and we want to avoid overlap.

“The issue is: How best can we collaborate, what can we best do as part of a larger whole? The answer will likely vary somewhat, by province, but we are talking about how the pharmacy sector constructs the future. Unless we achieve good integration with other health care sectors, we shall not be serving the public well.”

Aylward says she is optimistic that the thoughtful people involved in the current discussion will arrive at a good conclusion, even if implementation must necessarily be achieved in stages.

When Aylward and her CACDS colleagues and the representatives of the provincial professional organizations reported that provincial governments seemed to be receptive to their urging that the provinces work to achieve uniformity in the way they established pharmacists’ scope of practice, individual clinical services, patient eligibility and pharmacists’ reimbursement structure, they did not know whether that receptivity would be translated into action. They recently received a very positive signal that their hopes are being realized.

The government of Ontario, acting on behalf of a body set up jointly by the provinces and territories, sent out a request for proposals to consultants to make recommendations on which a new Pharmacy Clinical Services Model would be based.

The requesting document included such encouraging wording as “explore efficient, effective and innovative patient care models by leveraging pharmacy workforce resources and optimizing education skills and experience in order to improve patient care and create efficiencies in the drug distribution ­system.”