Justin J. Bates joined the Ontario Pharmacists Association as Chief Executive Officer effective September 3, 2019 after spending the last 14 years advocating on behalf of the pharmacy industry in various capacities at the Neighbourhood Pharmacy Association, including as Chief Executive Officer since 2016. Here he talks to PharmacyU.ca about the challenges and opportunities he sees in pharmacy:
PHU.ca. In your years in pharmacy, what have been the biggest changes you’ve witnessed?
Bates. Pharmacy has undergone significant changes since I began working at what was then known as the Canadian Association of Chain Drug Stores in 2006. Repeated cycles of drug reform across the country combined with increased regulation and scrutiny of the financial model have led to margin erosion. There are constant headwinds forcing pharmacy to rethink service delivery and to reconsider pharmacists’ role in the broader healthcare system. With the deflationary pressures, now a race to the bottom with diminishing returns on decreasing the cost of goods, we are entering an era of transformation as the demographic shift places a burden on the delivery of health services. The opportunity is to pivot from an era of cost cutting to one of investing in delivering cost-effective care to patients in the community, and at home, by enabling pharmacists to practise at their maximum scope. The retail pharmacy ecosystem is evolving to provide an exceptional patient experience to drive toward better health outcomes and create capacity in the healthcare system. Patients visit their pharmacist on average 10 times more annually when compared to a physician and are the only ungated healthcare provider. We need to do more to tap into pharmacists’ expertise if we are to improve access and create a more sustainable healthcare system.
PHU.ca. What are the big changes you see on the horizon?
Bates. The pharmacy ecosystem is complex with a sophisticated supply chain and requires a thoughtful approach that considers the unique health needs of Canadians. It is here that we need to ensure fair compensation for pharmacy services and measure the value of everything we do to demonstrate the return on investment from a payor perspective. On the horizon is the threat of increasing drug shortages which potentially puts patients at risk and we must be part of this solution to ensure equitable access to medicines for all Canadians. As key partners in healthcare delivery, pharmacy and pharmacists need to be at the table with government to help shape health policy and avoid unintended consequences. Pharmacists are on the front lines and can help provide insight on how things get implemented. This is often a gap in considering the operational elements of taking a government initiative and achieving a successful implementation. I believe we are in a race to the bottom on drug prices that poses a significant threat to the stability and safety of our drug supply. We are seeing the risk of drug shortages and the recently political push in the USA to import less costly drugs from Canada. There is also the challenge of ensuring that there is not pharmacist burnout and adequate compensation recognizing the value pharmacists deliver in drug plan management. The next federal election will determine the direction on national pharmacare, whether it is a single or multiple payor model, and how the various federal regulatory regimes will operate with the introduction of a Canadian Drug Agency. As we can see from the recently announced PMPRB reform there continues to be an emphasis on drug cost and yet the federal government still has not put medical cannabis where it belongs – with trained pharmacists who can help patients reduce the risk and ensure appropriate use.
I think the store experience will evolve and pharmacists will be more integral partners in the patient’s healthcare team. We are ideally position to create capacity and provide greater convenience to patients in every neighbourhood in Canada. When it comes to discussions with government we need to take more innovative approaches like entering into risk sharing agreements and leverage the value we offer payors.
PHU.ca. What are the biggest challenges for pharmacy?
Bates. Demonstrating the value to payors and ensuring viability and sustainability of pharmacies during a time when we continue to be a soft target for government reductions in spending. To this end, we need to tell our story from a patient’s perspective and bring solutions to the broader healthcare challenges. We have to mobilize the grassroots: pharmacists and patients to tell our story on the impact and importance of pharmacy. We have the infrastructure and expertise to be part of the solution and not viewed as just a cost centre. With the constant threats and changes facing pharmacy we can’t ignore the disruptors in the market. How patients and consumers access services is changing in all markets. Pharmacy must keep pace with the omni-channel and offer an evolving customer experience. This starts with incorporating new service models and integrating automation and innovation with how we deliver the health services. The way a pharmacist interacts with a patient is changing and we need to embrace new technologies to increase efficiencies and deliver the best possible outcomes. This is all happening at a time when margins are eroding so the question is are we going to lead the evolution toward new and sustainable reimbursement models that create value for patients and payors or stay in an antiquated model that is inevitably deflating. All of this is happening in an era of increasing drug shortages, so we need to find that right balance of value for money while not undermining the ability to deliver on the sophisticated supply chain. Our goal should be to ensure all Canadians have equitable access to affordable medications and we cannot ignore the obvious correlation with government pricing policies and the increasing challenges of drug shortages.
PHU.ca. What are your hopes coming to OPA?
Bates. OPA has a rich history serving pharmacists and the pharmacy community in the province. The OPA team has delivered several key programs and services to pharmacists while helping to navigate turbulent times during the drug reform days. There are many opportunities to showcase the value of pharmacists and how we can contribute solutions to help patients better manage and improve their health. We have over 4,400 points of care in the province that act as healthcare hubs with convenient access for patients to medication management services. We have developed a trusted relationship with the Ontario government and there are strong positive signals and initiatives currently underway to expand pharmacists’ scope of practice in the province.
The healthcare system needs to ensure that the right person, at the right time, occupies the hospital bed and doctor’s office, and pharmacy is a critical partner in making this happen. Pharmacy is well positioned to offer cost-effective care closer to where people work and live. The question is how we convince policy makers that they should invest in pharmacy services to create capacity and deliver better care. As an association we need to better tell our story of how we can deliver on the commitment of cost-effective care in the community so that it resonates with patients, the general public and government stakeholders. My goal is to ensure all pharmacists are enabled to maximize their expertise with the corresponding fair compensation. We want engaged and highly motivated pharmacists. Our objective is to provide them with the tools and appropriate infrastructure to do their jobs. At OPA, we need to have a vision and inspire the profession by ensuring there are opportunities and growth for all pharmacists. This is what leadership is all about – providing hope to enable those around you to advance and be at their best. OPA can and will advocate for advancing the profession, thereby lifting the morale of the profession. The healthcare system needs highly engaged and motivated pharmacists to help create capacity and ensure a sustainable system otherwise the challenges will only worsen.