Pharmacy can play a greater role in benefits programs, supporting employees and plan sponsors alike
Retail pharmacies are stating their case to become major players in drug plan management—a role that, they say, goes far beyond capped dispensing fees and lowest-priced pharmaceuticals. How can today’s plan designs evolve to incorporate pharmacists’ unique services? What level of investment must sponsors make for this partnership to be worthwhile for both sides?
The Pharmacy Solutions in Drug Plan Management conference, hosted by Benefits Canada and Drugstore Canada in Toronto this fall, presented a forum for more than 100 stakeholders to ask these types of questions. While it’s too early yet to have all of the answers, one message is clear: pharmacists in Canada are in a position to do more than just count pills, and a growing number regard the workplace as an ideal environment in which to prove—and be compensated for—their value.
Laying the Groundwork
“Pharmacists are turning a corner with expanded scopes of practice,” said opening keynote speaker David Gardner, professor of psychiatry and pharmacy at Dalhousie University. All provinces in Canada have increased, or are in the process of increasing, pharmacists’ authority so that they can independently adapt prescriptions (e.g., renew a longterm medication). Some provinces have enabled pharmacists to undergo training to administer injections (for vaccines including flu shots, as well as injected medications), write prescriptions for minor ailments and view lab results.
For example, pharmacists in Alberta can prescribe and manage prescriptions for ongoing conditions such as diabetes. Since that legislation took effect in 2007, just over 300 of the province’s 2,600 community pharmacists have obtained that advanced level of prescribing authority, and uptake really gained momentum after the government began paying for pharmacists’ expanded services in July 2012.
Some provinces are also funding pharmacists’ medication reviews or management services, such as MedsCheck in Ontario. In the past two years, the number of MedsChecks has almost doubled, to more than 1.1 million annually, according to the Ontario Ministry of Health and Long-Term Care, as pharmacy head offices allocate the resources to include this service in their daily workflow.
It’s no coincidence that pickup at both the corporate and store levels is accelerating as traditional revenue streams for pharmacies shrink. “It is both the best of times and the worst of times for pharmacists,” said Karen Welds, a pharmacy and health benefits journalist, during her presentation. Across Canada, generic pricing cuts, as well as the attendant reduction or elimination of professional allowances, are forcing pharmacies to adjust a business model that, until now, has depended mainly on the distribution of products rather than the delivery of services. “While the new public funding is not nearly enough to make up for the revenue lost, it’s a start,” Welds added.
Pharmacy owners and executives are also pursuing a greater role in chronic disease management, particularly for diabetes. A number of pharmacy head offices have made it their goal to have at least one certified diabetes educator (CDE) per store, and data from the Canadian Diabetes Educator Certification Board show that the number of pharmacist CDEs has quadrupled in the past five years, now accounting for 37% of all CDEs across the country.
Ideally, benefits providers will come to see pharmacists as a type of paramedical services provider for medication management, disease management and health risk screenings—one with the added benefit of being able to work on-site. Pharmacists can also serve as case managers for higher-cost or complex drug claims, Welds suggested.
Putting Pharmacy to Work
Shoppers Drug Mart, Costco Pharmacy and MHCSI (Managed Health Care Services Inc., the pharmacy benefit management division of Sobeys and Lawtons pharmacies) were among the sponsors of the conference, and representatives for each organization presented their company’s initiatives with benefits providers. Shoppers Drug Mart, for example, has partnered with Great-West Life to offer eligible plan members a diabetes support program that includes a blood sugar-level test (usually done by a lab) and one-onone education on adherence and followup appointments, if required. The national franchise is also developing workplace disease management support services, which it is currently testing with its own head office employees.
Costco’s partnership with Manulife Financial has resulted in preferred provider arrangements with plan sponsors, beginning with cost containment measures such as therapeutic substitution (using pharmacists’ new authority to adapt prescriptions) and moving into wellness offerings such as flu shots and consultations for chronic conditions.
Since 2010, MHCSI has launched a number of pilot projects with plan sponsors through its preferred provider network of Sobeys and Lawtons pharmacies. Plan members with three or more chronic medications and/or at least one chronic condition are eligible to receive medication reviews and disease management services. About one-third of the basic reviews uncovered drug-related problems. In followup surveys, 80% of members agreed that they have a better understanding of their medications, and 98% would recommend this pharmacist service to others.
Preliminary results for a one-year pilot project (now concluded) that focused on pharmacists’ services to support the proper use of antidepressants are also very positive, added Gardner, who helped develop the program for MHCSI. The rate of adherence improved significantly, to 80% from a baseline of 50%.
Focus on Adherence
A panel discussion on adherence to therapy also addressed the untapped role of the pharmacist. While some employers may balk at the possibility of increased drug claims, the fact is that “plan sponsors are spending millions on drugs that aren’t being used properly,” said Connie Wong, director of pharmacy benefits with Manulife Financial.
While automated refill reminders, smartphone apps and even small financial incentives can all play a role in improving adherence, “pharmacists are the ones to really see this through, because nonadherence can be very personal,” said Ruth Ackerman, a pharmacist and director of professional affairs with Shoppers Drug Mart. “Patients sometimes don’t even know they are non-adherent. The only way to work through this is with face-to-face conversation.”
One immediate step that plan sponsors can take, added Wong, is to promote or integrate provincially funded medication review programs as part of their benefits plans. While criteria vary by province, these programs target those with chronic conditions and are currently available in B.C., Alberta, Saskatchewan, Ontario and all Atlantic provinces.
The role of pharmacy in Canadian healthcare is changing rapidly. Raising awareness in the workplace is a simple way for employers to connect plan members with pharmacists—at no direct cost to the employer.
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