TORONTO — Speakers at the Canadian Foundation for Pharmacy’s recent forum here weighed in on whether the recent shift in the Canadian pharmacy paradigm was merely a tremor or a seismic shift.

The question that the speakers were asked to address grew out of changes in the way some provincial governments’ public drug plans compensate pharmacies and similar changes under consideration in other provinces.

The representatives of the academic, government, professional, retail and manufacturing industries who addressed the delegates tended to feel the changes were on the seismic side of the equation.

Six months ago Ontario enacted the first new pharmacy reimbursement regimen. The province’s action set something of a pattern, with other provinces following its example and still others about to take action that is different in detail, but similar in intent.

Ontario Public Drug Programs assistant deputy minister Diane McArthur outlined what had moved the province to act as it had and the elements of the new regimen. Ontario has one of the most generous prescription drug programs in Canada, she said, with 3.4 million of the province’s 13 million people eligible for coverage in one of the seven drug programs the province supports.

The annual cost has been running at $4.3 billion, representing 10% of the province’s total health care spending and close to 50% of the province’s entire budget, McArthur said.

The reforms lowered the price of generic drugs for the public plan to 25% of the brand price. A reduction to the same level is to be phased in over three years for private plans and private citizens. Professional allowances paid by generic drug manufacturers to retail pharmacy were eliminated immediately under the public plan and are to be phased out for private payers, again over three years.

Modest increases in dispensing fees were introduced, as was a transition fee starting at $1 a prescription, phasing out over three years. The province is planning a shift in the reimbursement model to focus on remunerating pharmacists for clinical pharmacy services.

The intent, McArthur explained, is not to confine reimbursement simply to the dispensing of drugs but to treat pharmacy services as integral to a comprehensive health care system and to remunerate appropriately in that context.

On June 7 Ontario established the Expanding Professional Pharmacy Services Working Group as a subcommittee of its Pharmacy Council. The group has provided the province’s health ministry recommendations on the types of patient-focused clinical pharmacy services that may be implemented immediately in community pharmacies as well as the principles of reimbursement for these services.

McArthur said Ontario is looking for “innovative ways” to manage growing drug expenditures and focusing on support, education and collaborative action with the pharmacy community to find opportunities its members can make use of as health care providers.

British Columbia Pharmacy Association chief executive officer Marnie Mitchell described how a collaborative process between the province’s health ministry and the association led to an interim agreement in 2008 that provides cost reductions through a new schedule for generic drugs and a new approach to fees for frequent dispensing. The parties are now working on a demonstration medication management project that is to continue until January 2012.

The project involves working with patients in close collaboration with physicians and other health care providers to optimize safe and effective medication use and improve health outcomes. So far 118 pharmacies across British Columbia are involved in the project.

The retailers at the conference said they realize that pharmacy has to continue to evolve in order to meet the way government sees the industry’s role in the health care system.

Shoppers Drug Mart senior vice president for pharmacy innovation Susanne Priest told the audience that the Canadian Pharmacy Services Initiative’s “Blueprint for Pharmacy” seeks to define a new and expanded role for the pharmacist.