The practice of pharmacy is evolving quickly. Change has always been part of the landscape, the adjustments made in the last decade have led to the most significant disruption in the pharmacy business model in the history of the profession.
By Mike Boivin, BSc.Phm.
Part of the reason is that recent changes have largely been driven by external stakeholders rather than emanating from within the profession. This has significantly affected both the delivery of pharmacy services and the scope of services being offered.
Healthcare now focuses on cost-effective delivery of optimal patient care, which has led to rapid change in scope of many healthcare practices. Nurse practitioners are an excellent example, with their very limited scope of practice several years ago broadening to their ability to offer a robust array of options to their patients today.
As pharmacists adjust to the new pharmacy business model, many will wonder:
- What will the future of pharmacy look like?
- What are the steps required to get there?
- What partners should pharmacy seek to reach this future practice?
We posed these questions to some innovative pharmacy leaders in a variety of practice settings:
– Billy Cheung (Ontario Region Director, Pharmacy & Strategic Initiatives, Pharmasave, and past chair of the Ontario Pharmacists Association)
– Peter Zawadzki (Pharmacist consultant, CPhA board member)
– Nadine Saby (Kalim consultants, former CEO of CACDS)
– Iris Krawchenko (Pharmacist consultant in Hamilton, board of directors member at CPhA and a former owner of Dell Pharmacies)
– Jane Farnham (Pharmacist consultant )
– Carlene Oleksyn (Pharmacy owner/Clinical Prescribing Pharmacist at Meridian Pharmacy and Pharmacist/consultant at colekPharm Consulting)
– Rita Winn (Chief Operating Officer, General Manager at Lovell Drugs)
– Jeff May (Director, Healthcare Operations, Target Canada)
– Mike Sullivan (Pharmacist, Co-founder and President of Cubic Health)
– Tom Smiley (President at Pharmavision Health Consulting Inc., Director of Professional Education, Pear Healthcare Solutions Inc.)
PHU.ca: What role will medication dispensing play?
Billy Cheung: “A portion of pharmacies will have a strong focus on dispensing, and they will be need to be highly efficient in their operations and can dispense high volumes. These stores will increase the pressure on other pharmacy providers due to their lower cost per script model.”
Peter Zawadzki: “I have seen the impact of technology on pharmacy dispensing. Devices that fill an incredible volume of prescriptions with 100 per cent accuracy have transformed the pharmacy market in the United States.”
Nadine Saby: “The amount of time pharmacists dedicate to dispensing will be reduced significantly as the role for pharmacy technicians increases in the overall distribution of medications.”
Iris Krawchenko: “Pharmacists are going to have to accept and efficiently integrate the role of regulated technicians because in the new world of pharmacy we need a greater team approach in order to evolve.”
Jane Farnham: “Technicians can effectively manage dispensing, liberating the pharmacist to perform their expanded role.”
Carlene Oleksyn: “The current model of dispensing will be flipped. Generally, pharmacists see the prescription at the end of the process, but I approach my patients at intake and assess the patient and the prescription, determine if the therapy is appropriate, and look for opportunities for expanded pharmacy services. My technician manages the entire dispensing process.”
PHU.ca: What is the role of expanded scope?
Rita Winn: “Enhanced services are the future of pharmacy. I don’t think we know exactly what the end point is right now. The bulk of what the patient still needs now is dispensing (they still need to have their drugs dispensed) – you can’t separate the dispensing and the services”
Jeff May: “I look at expanded scope services as being additive to the value that is already provided from the professional functions of dispensing and patient education. Services that are derived from expanded scope lead to a more comprehensive approach to the patient’s care. If done appropriately, it can bring the pharmacist into the patient’s caregiver network to a much greater degree.”
Jane: “Patients are comfortable with the expanded pharmacy scope and have heightened expectations of their pharmacists. I view pharmacies as ‘health hubs’ where patients will have access to many healthcare services.”
Mike Sullivan: “I visualize pharmacists working more proactively with patients and payers to provide the most cost-effective and appropriate therapy for each patient, while driving better health outcomes. Pharmacists need use their knowledge to influence plan sustainability to ensure the ability of payers to afford to treat common chronic diseases, while balancing the ability to afford innovative specialty therapies. Plans will pay pharmacy to ensure they get the biggest return for their investment in employee health.”
Carlene: “Currently, most pharmacists assume the prescribed medication is the best choice for the patient. Through expanded scope, a prescribing pharmacist looks at each prescription and determines if it is, in fact, the best choice; if it isn’t, they adapt or change the prescription, to a more suitable drug therapy.”
PHU.ca: What do pharmacists need to do to provide the services of the future?
Tom Smiley: “Pharmacists will need to improve their current level of education to provide the services of the future. Certification programs can be transformational, providing pharmacists with the knowledge and the confidence to influence and modify a patient’s care. Certification also enhances the credibility of the pharmacist in the eyes of other healthcare professionals. These pharmacists are more comfortable recommending changes, educating patients, and adapting a patient’s current care.”
Jeff: “It is natural that when you get into advanced services it is essential to ensure that the knowledge is current with clinical practice guidelines. Pharmacists have the professional responsibility to ensure they have the right training to deliver the services they provide to their patients.”
Rita: “All pharmacists need to continue to learn. For the most part, pharmacists should have a base knowledge of everything.”
Carlene: “Continuing education must support the role of the pharmacist. It must be highly practical and encourage pharmacists to utilize their expanded scope.”
PHU.ca: What are the steps to get there?
Iris: “Widespread consistency in payment (reimbursement models for expanded services) is crucial for the profession. It is ridiculous that pharmacists are encouraged and expected to implement expanded practice services and in many cases are only reimbursed for one subset of patients (public payers) and not for others.”
Mike: “I am not surprised, as all the focus to date has been on public plans, not on private payers. Pharmacy has to quantify the value of its services in context that is relevant to private plans.”
– Technology and documentation
Billy: “Pharmacy will require new technology to accommodate its expanded scope, because current technology does not provide the required support. Future systems will effectively identify, document, and bill expanded services. Intuitive technology will revolutionize the current model of practice.”
Nadine: “Electronic health records will have an enormous impact on practice. Pharmacists will have enhanced access to all of the pertinent patient information, which will aid them in making appropriate therapeutic choices.”
– Partnerships with public and private payers
Peter: “Pharmacists can become point-of-care drug plan managers.”
Mike: “There is a tremendous opportunity between pharmacy and private payers, because payment for optimizing therapy, improving adherence, and impacting absence and disability can lead to lower long-term costs to payers that can be quantified. Pharmacists need to listen to the needs of payers before suggesting solutions.”
Billy: “Standing alone in the tidal wave of change is not likely the wisest plan for a pharmacist. Partnering with people does not take away autonomy but allows everyone to share from each other’s experience and avoids duplication of efforts.”
Iris: “Strong advocacy is important. The profession requires one voice, one agenda and one set of goals.”
Peter: “Over the past year, forward-thinking pharmaceutical companies have started to realize how a strong relationship with pharmacists can improve their overall growth.”
Carlene: “With pharmacists becoming more involved in initiating therapy, industry can play a role in providing pharmacists with the information and the tools needed for patient care.”
Nadine: “Among other things, industry can provide opportunities for interprofessional education. By partnering with pharmacy, the pharmaceutical industry can explore programs, tools, and education that promote pharmacy practice and enhance quality of care.”
Rita: “As an industry, if we work together we can shape health policy. If we keep the discussion around price, it comes across as self-serving and reduces impact. We need to all speak with one voice.”
Jeff: “Ideally, we would collaborate around the needs of the patient. The business needs of all can best be served when there is agreement and alignment around the needs of the patients.”
Rita: “Drugs save lives, I think people forget about that sometimes and they only think about drugs as a cost driver. Drugs plus pharmacists save lives.”
– Other healthcare professionals
Jane: “With expanded scope and enhanced patient care, pharmacists will have to work more collaboratively with other healthcare professionals. Pharmacists will need optimal communication skills to be able to manage potential resistance from other clinicians.”
Tom: “Education and certification play an important role. Successful completion of properly developed and practical continuing education provides pharmacists with the confidence to make therapeutic changes and the ability to justify why the changes are needed. Other professionals will be better able to appreciate pharmacists’ role in patient care, when the profession consistently delivers individualized patient care services that are within its expanded scope.”
Although each leader visualized more changes on the dispensing side of the business, most were excited about the future opportunities for pharmacists in improving patient outcomes through their increasing ability to modify therapy.
Peter: “It’s time for pharmacists to ask themselves:
- What is the perfect job for me in the future?
- Where do I see myself in the next five years?
- How do I get there from here?
Answering these three questions is the perfect start to having more control over the profession’s destiny.”