If Canadian pharmacists played a larger role in dispensing flu shots, reviewing cardiovascular disease medication and providing help with smoking cessation, the health-care system could save between $2.5 billion and $25.7 billion over the next 20 years, according to a study from the Conference Board of Canada.
Co-sponsored by the Canadian Pharmacists Association and the Canadian Alliance for Sustainable Health Care, the study showed the exact amount of savings depends on the level of uptake.
“Based on literature and research, we feel that a pharmacy being involved in primary care in these instances will lead to fewer hospitalizations . . .,” says Greg Sutherland, principal economist at the Conference Board of Canada. “Populations tend to have easier access to their pharmacists as opposed to a physician, so I think the timeliness, as well as the better chance of quicker followup, visits will lead to averting some hospitalizations and early deaths that we don’t really need.”
The study calculated that for every dollar spent on flu shots, the direct return could be as high as $72 by 2035. For smoking cessation, the return could reach $9.10 for every dollar spent, and for cardiovascular disease intervention and drug management, it could reach $2.30 for every dollar spent.
The savings calculation includes both disease prevention and immediate savings when it comes to paying for services, which may be cheaper to buy from pharmacists than from physicians. In Ontario, for example, pharmacists receive $7.50 for each flu shot they administer, according to a fact sheet for pharmacists from the Ministry of Health and Long-Term Care. Physicians receive $4.50 per vaccination, but if that’s the only reason for the patient’s visit, they bill an additional $5.10, according to the provincial schedule of benefits for physician services.
Another concern is who ends up paying for pharmacists’ services, says Suzanne Lepage, a private health plan strategist in Kitchener, Ont. “Who’s going to pay the pharmacist for these services?” she says. “Is it the patient? Is it the private payer? Could it be a cost-shifting model? That’s the big unknown that I’ve seen, anyways.”
The study presumes the public health-care system would pick up the costs, says Sutherland. But Lepage notes that wouldn’t necessarily be the case. And if private payers end up funding the pharmacists’ services, plan sponsors won’t likely be happy.
“If we think about the traditional plan sponsor who’s making widgets in his factory, he would probably see it in his mind as an additional cost: ‘I now have to pay a pharmacist for something that the government used to pay for?'” says Lepage.