A pharmacist’s secret is simple: The more time to spend with patients, one on one, the better. “It allows us to pick up the person who falls through the cracks,” he says.
Mr. Poon is precisely the type of pharmacist that provinces across Canada hope to empower, with the goal of freeing up a doctor’s time from routine visits. Pharmacists can now renew routine medications, such as those for blood pressure, but not narcotics, such as codeine. Such routine prescription visits will only increase in frequency as baby boomers age.
… WHO IS CAUGHT IN A CLASH OF IDEALS …
Only three provinces, however, actually pay pharmacists to take on the new roles. Alberta will, beginning this year, pay a $20 fee each time a pharmacist does a routine prescription renewal, compared with $36 it pays a doctor for the same service. B.C. pays pharmacists $10 per renewal, while Saskatchewan pays $6 per consultation.
That difference – renewals versus consultations – is the crux of the ideological conflict in the field, torn between its pill-producing past and its ambitions of being broad health-care providers. They want to be paid for consultations instead of piecing together lucrative incomes with drug-company subsidies, dispensing fees and prescription-renewal fees.
“The renewal is still based on, ‘Here, there’s drugs. We’ll put it into a little bottle and here you go.’ It doesn’t talk about, ‘Hey, go to your pharmacist and get assessed,’ ” Mr. Poon says.
Pharmacy is a four-year program at the University of Alberta, and students can apply after just one earlier year of post-secondary schooling. Though far less schooling than doctors, pharmacists argue their education is sufficient to handle basic cases. But doctors across the country have balked at handing over certain powers.
“I guess I wonder what criteria pharmacists will use to renew prescriptions when they were not the original prescriber. How will they know it’s reasonable to do so?” Alberta College of Physician and Surgeons registrar Dr. Trevor Theman said in an e-mail.
Alberta isn’t the only province lowering the cap on what drug companies can charge for generic drugs -- 20 million prescriptions a year in Alberta alone. The system of drug-company subsidies, meanwhile, is considered ethically dicey by some pharmacists. “No one likes this, but it’s the only way that pharmacies have been able to provide services,” Mr. Poon says.
Cutting the rebates will put many pharmacies into the red, forcing them to lay off staff or close.
“Over the years, generic drug pricing has changed in a way that it actually supplemented the ways pharmacies were able to provide services,” said Anjli Acharya, president of the Alberta College of Pharmacists. Pharmacists used to make money only by a dispensing fee, but those have stayed mostly stable as costs grew – opening the door to drug-company money.
“If you pull that funding out, it’s not like it was just going anywhere,” Ms. Acharya says.
… THAT YOUR LOCAL PHARMACIST WILL LIKELY FACE SOON …
Alberta says the changes are just one piece of the puzzle, and pharmacists indeed hope that’s the case. “If this [a renewal]is the only thing I’m being reimbursed for, it’s actually bad for patients. It’s counterproductive,” said Edmonton-area pharmacist Hugo Leung, who also attended Mr. Horne’s announcement.
Each province takes a different approach. For instance, Quebec allows pharmacists to bill for being on call, while Saskatchewan has a minor-ailments program that allows pharmacists to be paid for treating minor ailments, such as rash.
In Ontario, talks are under way over how to overhaul the funding method after a similar cut in generic-drug pricing. Pharmacists there can renew prescriptions but have to try to ask a doctor first, and aren’t paid.
“We should have been doing this years ago,” says Dennis Darby, CEO of the Ontario Pharmacists’ Association. He frames the broader powers as a way to ease up the health-system congestion caused by routine prescription renewals.
“It’s not uncommon to see someone lined up in an emergency department trying to get their prescription to be renewed,” he notes, a scenario that’s “very, very cost inefficient.”
Each province is watching the others closely as the changes roll forward. The students at Alberta’s news conference have banked on the industry remaining lucrative, but there’s no clear sign of where the changes – in roles and in funding – will take Canadian pharmacists.
“The real key message is pharmacists need to be able to provide care,” Ms. Acharya says. “And the care they provide should be funded.”
Editor's Note: In Saskatchewan, both physicians and pharmacists can treat certain minor ailments. Incorrect information appeared in an earlier version of this article.