Pharmacists are now uniquely positioned to support Canadians at a time when the public health-care system is stretched thin, creating significant barriers for people looking to access care, said Dr. Jennifer Poh, senior director of drug plan solutions at Health Solutions by Shoppers, during Benefits Canada’s 2023 Face to Face Drug Plan Management Forum in December.
“We’re stepping out from behind the counter and providing patient-centric, evidence-based care that looks at the whole individual, and not just the medications they take.”
Read: How plan sponsors, insurers are considering coverage of weight-loss drugs amid rising use of Ozempic
Pharmacists can now assess and prescribe for minor ailments, adapt and personalize medication prescriptions to suit someone’s health journey and disease condition and offer healthy lifestyle advice. In a growing number of jurisdictions, pharmacists can also order and interpret lab tests.
The evolution of the pharmacy practice also comes alongside a change in the specialty medication landscape. In 2013, just 30 per cent of top-selling drugs by cost were specialty drugs, while in 2022 that figure had risen to 60 per cent.
But specialty means something new today, Poh said. The specialty drugs that were claimed by plan members in 2013 were used in the treatment of complex and rare conditions, required special handling, tended to cost more than $10,000 annually and could involve injection or intravenous delivery, such as Remicade and Humira for the treatment of ulcerative colitis and rheumatoid arthritis, respectively. While biologics still made up a decent proportion of plan sponsors’ specialty medication spend in 2022, that list also now includes scientific evolutions in the treatment of common chronic diseases that don’t often exceed $10,000 in annual patient costs and require less or no special handling — such as Ozempic for diabetes.
Read: A closer look at how chronic conditions are impacting benefits plans
More than nine in 10 (93 per cent) specialty drugs can now be dispensed at a retail pharmacy, which can translate to reduced wait times and less time off work for plan members. For plan sponsors, partnering with a preferred pharmacy network can also reduce drug delivery costs, allowing them to manage the cost of their drug plan without having to limit coverage for members, said Poh.
A preferred pharmacy network can also improve plan members’ access to care generally, as well as to pharmacist-led chronic disease management programs — complete with information on exercise and healthy eating, medication prescriptions and monitoring — for those who need it.
“Incorporating a disease management plan into your drug plan will help manage the costs of your plan in the long term, because you are managing the disease before it gets too burdensome,” she said, noting plan members with type 2 diabetes have three times’ the annual drug and benefits spend of plan members without the condition. “Pharmacist-led disease management programs lead to better health outcomes, a healthier workforce and less time off work.”
Read more coverage of the 2023 Face to Face Drug Plan Management Forum.