As pharmacists’ scope of practice evolves across the country, their expanded role in drug plan management can improve plan member health and positively impact plan sponsors’ bottom lines.
Challenges in the Canadian health-care system — such as the millions of people who don’t have access to a family doctor, extended emergency rooms wait times or medication shortages — result in plan members’ inability to access the care they need, said Uchenwa Genus, former senior director of drug plan solutions at Shoppers Drug Mart Inc. at Benefits Canada’s 2022 Face to Face Drug Plan Management Forum in Toronto in December.
Pharmacists are the most accessible health-care professional in Canada, with around 10,000 pharmacies and 42,000 pharmacists representing the front door to health care. In fact, people may visit their pharmacist about 10- to 12-times more than their family doctor, she said.
Pharmacists’ scope of practice is regulated provincially and varies by province. Some examples of this provided scope, according to Genus, is assessing patients and prescribing a necessary drug, renewing an expired prescription, adapting a prescription when medication isn’t optimized, chronic disease management and ordering lab tests and interpreting their results.
With an increased use of managed formularies to manage drug plan costs, pharmacists are uniquely positioned to “have conversations at a point of sale to educate patients on their formulary choices,” she said. “The formulary comes alive at the point of interaction.”
A pharmacist-led walk-in clinic pilot in Lethbridge, Alta. maximizes the province’s broadest pharmacist scope of practice in Canada. Due to reduced access to physicians, some patients have to commute several hours to receive care, which can lead to loss of workplace productivity.
Pharmacists see patients to diagnose and prescribe for minor ailments such as allergies, dermatitis, reflux disease and oral thrush; assess and prescribe for infections such as conjunctivitis and ear infections; and offer chronic disease management for conditions such as diabetes, hypertension and high cholesterol. In the nearly six months the Alberta clinic has been open, it has seen close to 6,000 patients who saw a pharmacist and received a prescription within 20 minutes. “We can see how that expanded scope in Alberta is really being put to use in a real and practical way,” said Genus.
In terms of benefits plans, diabetes tends to land in the top three conditions, she said, noting a pharmacist-led diabetes care pilot program allows pharmacists to assess patients, interpret test results and potentially make therapy changes. Assessment begins with a quick, point-of-care finger prick blood test, which allows the pharmacist to assess the patient’s hemoglobin A1C, a measure of diabetes control, and cholesterol levels. “Through the pilot program, we’ve done close to 20,000 point-of-care tests.” said Genus.
Some early results show close to 42 per cent of patients had high cholesterol values, while 22 per cent had high hemoglobin A1C, which indicated poor diabetes control, she noted. About a quarter (26 per cent) of patients received a new prescription for diabetes care management and 27 per cent had their existing prescription adjusted. In the pre-diabetic population, about 30 per cent had improved hemoglobin A1C when it was measured three months later.
“Having that interaction and being aware helped change behaviours that led to an improvement three months later,” said Genus.
Pharmacists can play a critical role in supporting Canadians’ health care, she added. “The key is the expanded scope of practice for pharmacists, which opens the doorway for members to get care and have better outcomes.”
Read more coverage of the 2022 Face to Face Drug Plan Management Forum.