In the first of a two-part series, leaders of industry associations present their expectations for pharmacy operators for this year. The views of other organizations will appear in the next issue of Chain Drug Review.

Sandra Hanna

2023 was a momentous year for community pharmacy in Canada. All provinces further expanded pharmacists’ scope of practice and/or increased funding for services. Claims data testify to Canadians’ readiness for pharmacists’ expanding role, with double- or even triple-digit growth rates for some of the publicly funded services.

Neighbourhood Pharmacies also had a productive year. We are increasingly at government tables at both provincial and federal levels. Our new governance, to be implemented January 2024, enables us to grow and engage our membership more efficiently so we can be an even stronger voice for pharmacy business.

Guided by a strategic approach to “protect and pursue,” Neighbourhood Pharmacies is laser-focused on protecting against significant risks to the pharmacy business model and to pursue growth in the community pharmacy sector as pharmacies secure their roles as veritable community health hubs, while addressing health human resources challenges and enablers like reimbursement.

Patient-centered care is the guiding principle on both sides of the table. While this is not new, the pandemic laid bare how the current public system falls short.

As we work to remove the barriers to patient-centered care, another principle rises to the surface: freedom of choice. Again and again, Canadians stand by their desire to be able to choose their health care provider, including their pharmacy. Choice of health care provider is a fundamental value — in one province, Quebec, it is enshrined in law. Against this backdrop of patient choice, community pharmacies are a welcome, sensible option for patients and family caregivers, who continue to report high levels of trust in pharmacists.

The stars do indeed appear to be (slowly) aligning, with scope of practice in all provinces converging and moving ever closer to the sector’s North Star — that is, the full integration of community pharmacies into the health care team as the custodians of medication therapy. Our ultimate vision is that the system enables pharmacists to fully exercise and embrace their training as the author of prescribing decisions for the treatment of all conditions, working with patients and diagnosticians. Governments and regulators agree — and have not only accelerated efforts to expand scopes of practice for pharmacists, but they are also more willing to step outside the box with new models to increase capacity (for example, with pharmacist-led primary care clinics).

The sector is extremely well positioned for continued success in 2024, keeping in mind that for every step gained, equal effort must be made to enable and protect sustainability.

Protecting against significant business risks

A Pharmacare Act was expected by the end of 2023 but has been pushed to 2024 as negotiations between the New Democratic Party (NDP) and minority Liberal government continue, with the NDP pressuring the Liberals to move forward with a single-payer model.

The downstream negative impact of a single payer model to the community pharmacy sector has been estimated to be up to $1 billion annually through anticipated reductions in fees, markups and drug prices, the equivalent of approximately 20 million hours of direct pharmacist care, putting essential health care services at risk.

This unintended downstream financial impact on pharmacy services is also true for other drug-pricing policy changes in Canada, and we’re pleased that our efforts have helped delay implementation (in the case of new pricing guidelines from the Patented Medicine Prices Review Board) or considerably reduce the impact on pharmacy (in the case of the renewed generic pricing framework).

We’re also starting to see concerning trends around pharmacy benefits managers directing patient care and implementing unilateral fees on pharmacies — a trend that our neighbors to the south are far too familiar with. While more private plans are putting preferred-provider arrangements in place as part of efforts to control costs, they typically incentivize rather than mandate participation, though with a growing trend of vertically integrated PBMs with mail order pharmacies, payer-directed care remains a concerning trend in a health system that places significant value on freedom of choice.

With operating costs on the rise, and multiple significant financial risks looming, it is critical to continue to protect the business model but to look to where the sector is going to pursue future opportunities.

The North Star for community health hubs

Community pharmacy as a health hub is coalescing in three main areas: primary care, public health and wellness ­services.

As of June 2023, pharmacists in all provinces could assess and prescribe for minor ailments. The minor ailments program in Canada’s largest province, Ontario, saw strong uptake by both patients and pharmacies right out of the gate in January 2023. In Ontario and five other provinces, public funding for minor ailments is universal — that is, for all eligible conditions and residents (not just public-plan beneficiaries). Pilot projects in two other provinces seek to make the case for universal funding.

Community Pharmacy Primary Care Clinics in Nova Scotia, a government-funded pilot project launched in February 2023, is testing pharmacist-led primary care services.

In addition to funding to assess and prescribe for a broad range of minor ailments, the authority to order and interpret lab results and administer point-of-care tests to guide prescribing decisions — be it for strep throat or as part of chronic disease management — equip pharmacists to be part of the primary care team seamlessly. Data so far show these clinics are hugely successful. Nova Scotia Health, the province’s health authority, publicly described them as “a breakthrough solution to primary care.”

On the vaccination front, community pharmacy steadily strengthens its position as the preferred destination for vaccinations. Pharmacies are now administering most flu and COVID-19 vaccines, and the sector has begun to make its mark with other vaccines, including the new adult vaccine for respiratory syncytial virus (RSV) and the shingles vaccine. We anticipate regulatory, remuneration and supply barriers to continue to fall across provinces in 2024, and continue to advocate for pharmacies to be a destination to access all routine ­immunizations.

Authorities to access, order and interpret lab results, as well as conduct point-of-care tests vary across provinces and have long been critical enablers for optimal medication management. Data from Nova Scotia underscores their importance, and progress on this front is a key call to action for 2024.

Health human resources

It is impossible to talk about pharmacy’s future without addressing the wellness of our pharmacy teams. While pharmacy teams’ achievements during the pandemic were nothing short of Herculean, they took their toll in the form of higher reported rates of burnout and attrition. As a trade association, our priority is to ensure enablers are in place to support a resilient work environment for our pharmacy teams.

In 2024 Neighbourhood Pharmacies will advocate for quicker actions on workforce mobility between provinces and countries. To improve workplace efficiencies, we will push for modernized policies and programs to reduce administrative burdens, remove regulatory barriers and better leverage technology (for example, to enable cross-provincial central-fill facilities). We will continue to participate in the efforts of government agencies, educational institutes and health care organizations to plan for the health care workforce of the future.

New governance

As we continue to advocate for issues that impact the entire sector, our new governance better reflects our core value of inclusivity and improves efficiencies in engagement between our members (pharmacy operators) and partners (pharmacy suppliers). As providers of goods and services that contribute to the success of the pharmacy sector — and help take us closer to our North Star — we welcome their diverse perspectives and ideas and have formally included partners in our governance and ­committees.

That includes input and partnership with U.S. firms doing business in Canada or considering doing business in Canada. If you contribute to enabling services in public health (testing, screening, immunization), primary care (prescribing, chronic disease management, point-of-care testing) or wellness (preventive care, self-care), we would love to hear from you, and learn from you.

A big part of our job as an association is to connect the dots between all stakeholders and find consensus and a shared purpose upon the common ground of optimal patient care.

Sandra Hanna is the CEO of Neighbourhood Pharmacies.