2015

As we reach the mid-point of the decade, it’s an apt time to step back and review the state of pharmacy in Canada. There’s no question that we’ve witnessed a significant level of change in the profession in the past decade; many people call it historic. But with any significant change come both challenges and opportunities. Although the profession of pharmacy is continuing to evolve, the purpose of these comments is to provide a high-level “State of Pharmacy” overview to gauge where pharmacy stands as we enter 2015. Scope of service has expanded: When we compare the list of pharmacist-provided services today compared with 5 or 10 years ago, there is no question that the scope of pharmacists’ services has expanded dramatically. Governments have unquestionably embraced the concept that pharmacists can alleviate pressure on the health care system by shifting greater and greater responsibilities to the pharmacy sector. Although it’s true that there remains room for growth in some jurisdictions, it’s equally true that the trend lines have all moved in the same direction—a trend that most pharmacists would agree is positive. This also explains the rise in pharmacy technicians, a profession that has been coming into its own over the past several years. Compensation models are witnessing significant reforms: Whereas there has been significant progress regarding increased responsibilities for pharmacists, there is still a long way to go in recognizing the need for compensation reform. Over the past few years, in the face of generic drug price reductions, elimination of allowances in some jurisdictions, inappropriate (or in some cases, complete lack of) compensation for provision of new services and dispensing fees in most provinces that are not properly indexed, most pharmacists would agree that the pharmacy compensation model is in need of an overhaul. The pharmacy compensation models of just 10 years ago are not meeting the needs of the profession today. However, given the pressures that provincial budgets are facing, especially in the face of lower oil prices, it may be difficult to rely on provincial governments to address this issue, at least in the short term. Use of technology is growing, but not quickly enough: As demonstrated by the October 2014 Canada Health Infoway/CPhA survey “The National Survey of Canadian Community Pharmacists: Use of Digital Health Technologies in Practice,” the use and acceptance of technology in pharmacy is increasing, and technology is leading to productivity gains. However, the report also made clear that there remains a long road ahead before pharmacy in Canada can claim to have embraced the full benefits of technology. Electronic Drug Information Systems, e-health records and even social media are all areas where pharmacy has not kept up with other economic sectors. Private payers are understanding pharmacy better: Third-party payers are often overlooked as a key pharmacy stakeholder. However, they pay for roughly half of prescriptions in Canada and, as such, play an important role in the administration of pharmacy benefits. Increasingly, private payers are also being asked to cover the costs associated with services that pharmacists provide that are not covered by public plans. Compared with a few years ago, there is a deeper dialogue today between private payers and pharmacy in terms of the many facets of that complex relationship. In addition, I believe we are on the cusp of an increase in the number of privately administered plans that will cover pharmacy services; although it is still early days, private payer coverage may be a growth area for pharmacy. Of course, other commentators may have different ideas about the bigger issues affecting the state of pharmacy. But perhaps the key trend is that pharmacy is moving beyond seeking expanded responsibilities to a point where it needs to determine how to best manage the new responsibilities, what tools are required and how to be appropriately compensated. Pharmacy may also need to look at new and expanded quality assurance programs in the provision of these services. There is no question that these remain daunting goals; however, in historical context, it’s important to keep in mind how far pharmacists have come in such a short period of time. While challenges remain, there has been a great deal of positive evolution in pharmacy over the past decade.

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