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The coronavirus pandemic is demonstrating that pharmacists are a key health-care provider, with one study finding nearly 75 per cent of pharmacists have had patients who sought care at the pharmacy because they were afraid of going to any other health-care setting.

A panel during Benefits Canada‘s Face to Face in Drug Plan Management Forum in December discussed how private plans can maximize pharmacists’ services to help manage their plan, save money and ensure sustainability.

Pharmacy has shifted from a product to a service orientation, said Ned Pojskic, vice-president of pharmacy benefits management at Green Shield Canada, which means looking at a person’s holistic health rather than simply ensuring they get their medication. He said pharmacy professional services, sometimes called cognitive services, should be distinguished from core medication dispensing services and are related to elements such as adherence support and chronic disease management.

Read: The benefits of digital pharmacy for plan sponsors, members

“Leadership on this has really been from the public sector,” said Pojskic, noting many provincial governments now pay for medication reviews, pharmaceutical opinions and other services.

Also speaking on the panel, Uchenwa Genus, senior director of drug plan solutions at Shoppers Drug Mart, suggested private drug plans maximize these provincially funded professional services and supplement them with additional programs. For example, some private plans have started to offer or reimburse pharmacist health coaching programs.

As the health-care landscape evolves, many different pharmacy models are emerging and plan sponsors should consider which options best suit their needs by assessing the value and services they each provide.

Community pharmacies are generalists like family doctors, caring for different conditions, while specialty pharmacies have expertise to manage more complex diseases and high-cost specialty medications required to treat them, said Genus. She believes “pharmacies need to adapt to merging those models” because more patients are using specialty medications, likely because they are being used to treat very common conditions like migraines, skin conditions or asthma.

“Pharmacists must be prepared to support patients wherever they are in their care,” she noted, because they often have multiple conditions, some that are straightforward and others that are more complex.

Read: Drug plan considerations during the coronavirus pandemic

“Specialty pharmacy can provide dedicated care and follow-up teams for the patients for these very expensive drugs,” said Joyce Wong, director of clinical services at Express Scripts Canada, during the session. For example, they have close relationships with patient support programs and have expertise in navigating funding options or infusion networks, if required. In addition, said Pojskic, pharmacies that dispense specialty drugs on an ongoing basis get to know some of the disease states very well and work closely with specialists that prescribe these treatments.

The availability of both storefront pharmacies and digital — or online — pharmacies offer convenience and can potentially generate savings. The emergence of digital pharmacy is consistent with the overall trends of virtual care and getting everything delivered to our homes, said Pojskic.

Typically, said Wong, digital pharmacies are associated with lower costs, which “implies cost savings to the plan sponsor” and potentially lower out-of-pocket costs for plan members. They can also be convenient for people who don’t want to be out due to the pandemic, she said, because it provides them with an option to receive their prescriptions at home.

In addition, said Genus, there are a variety of professional services that can be delivered virtually to patients, such as adherence programs and medication reviews. “I think there’s a space for both storefront and digital online pharmacy,” said Wong. “Some people find that the convenience of digital suits their lifestyle, whereas others prefer the face to face with their pharmacy.”

Preferred pharmacy networks can maximize the value of plan sponsors’ drug spend by reducing the medication acquisition cost. However, noted Pojskic, these networks can go beyond cost savings and deliver value-added services, such as case management, to ensure appropriate adherence and improved outcomes.

Read: Collaboration fundamental when managing, altering private drug plans

PPNs can be delivered in different ways, said Genus, noting some are sole providers, while others have a group of pharmacies. Some networks are geared specifically toward traditional medications, while others focus on specialty medications. Ultimately, the best PPN, according to Genus, “depends on the goals the plan sponsor wants to achieve with its drug plan.”

Pharmacy can offer additional services that can benefit private drug plans, such as point of care testing or diabetes management. “The private sector has a role to play in terms of incentivizing the provision of those services,” said Pojskic, through reimbursement and targeting patients with programs that are structured with clear deliverables and measurable outcomes. These services, said Wong, strive to get to a healthier patient and ultimately a healthier employee for plan sponsors.

Genus recommended that plan sponsors use data and insights from their plans to set up strategic drug plan objectives. They can then harness some of these pharmacy services, she said, and be “more intentional about how they include different programs to make sure they’re addressing a very real need for their population.”

Plan sponsors can also consider bundling these programs together to address the pain points for their plan and then measure the health outcomes against their strategy.

Read more coverage of the 2021 Face to Face in Drug Plan Management Forum.