Sandra Hanna

Looking ahead to 2020, the Neighbourhood Pharmacy Association of Canada (Neighbourhood Pharmacies) continues to be recognized as the leading pharmacy advocate for our members across the country. A solutions-oriented partner, we focus on working collaboratively for a sustainable, competitive pharmacy industry that serves the best interests of patients.

Neighbourhood Pharmacies represents Canada’s leading pharmacy organizations that deliver high-value, quality care to Canadians in all models including chain, banner, long-term care, specialty and independent pharmacies, as well as grocery chains and mass merchandisers with pharmacies. Our members are home to the most trusted providers of drug therapies, pharmacy-based patient services and innovative health care solutions.

A recent series of reports by the Conference Board of Canada concluded that the pharmacy sector generated more than $16 billion in economic activity and supported nearly 250,000 high-quality jobs in 2016.

Neighbourhood Pharmacies advocates for community-based care through our members’ high accessibility and proven track record of providing optimal patient care closer to where patients live, work and play. By leveraging close to 10,500 points of care with pharmacies conveniently located in every neighborhood across Canada, our aim is to advance sustainable health care for all.

New leadership

Over the last year, we had two significant changes to our management team. Karl Frank has taken on the role of Neighbourhood Pharmacies board chair, and I have transitioned from the role of vice president of pharmacy affairs, since 2017, to take on the role of chief executive officer of the association. In addition to the enthusiasm I have regarding the endeavors that lie ahead for Neighbourhood Pharmacies, I’m equally pleased to be contributing to an increase in the number of women represented on industry boards.

Karl and I are highly familiar with the pharmacy industry and practice. Karl is divisional director of Bayshore Specialty Rx and a licensed pharmacist in British Columbia, Alberta, Saskatchewan and Ontario. I am a practicing pharmacist; a consultant in areas of pharmacy practice, strategy and marketing; and a pharmacy owner in Guelph, Ontario. Together, along with our board of directors, we have a well-developed understanding of the pharmacy sector, and a deep appreciation of its complexities. With our new leadership in place, Neighbourhood Pharmacies is working hard for our members, shaping health policy and identifying growth opportunities, while mitigating impacts of pricing and reimbursement-related pressures.

Following the 2019 federal election, we also have a new political landscape in Canada. In their second term, Prime Minister Justin Trudeau’s Liberal Party won the most seats in the election, but not enough to secure a majority government this time around. The Liberal Party will be governing with a minority government, with Andrew Scheer’s Progressive Conservatives as the official opposition. The Bloc Quebecois’ particularly strong performance surprised many, and Jagmeet Singh’s New Democratic Party (NDP), while not winning the anticipated number of seats, remains committed to establishing a universal, single-payer pharmacare program. The unique dynamics of this minority government mean an increased role for provinces and grassroots advocacy, owing to the federal government’s need to negotiate and build consensus. In a federated model like the one in Canada, a minority government calls for a multipronged approach to advocacy on every file. Similarly, the potential for more meaningful and impactful advocacy increases — an opportunity our association will certainly be pursuing in the year ahead.

Areas of focus in 2020

Neighbourhood Pharmacies begins this year by ensuring we are strategically positioned for advancement on all fronts and, most importantly, positioned to meet the needs of patients. At this time, there are six areas of focus for the association in 2020:

• Pharmacare.

•Pricing and pharmacy ­reimbursement.

• Expanded scope.

• Opioid crisis.

• Medical cannabis.

• U.S. importation and drug shortages.

Pharmacare

Canada is often looked towards as the gold standard for health care, yet no system is without its challenges; we are also the only country with universal health care that does not have universal drug coverage. After decades in and out of the spotlight, pharmacare has risen to the surface again, and it is currently among the most talked-about issues in Canadian health care. Proactively acknowledging this possibility, several months ago Neighbourhood Pharmacies launched a pharmacare campaign titled Complete the Plan as the focal point of our federal election advocacy (www.completetheplan.ca).

As part of the 2019 election, the Liberal government expressed interest in pharmacare, and there has been much consideration and speculation on what their approach might look like. We are also following closely the possibility of their collaboration with the NDP to define a national program.

In fact, Canada has recent experience with this kind of drug coverage model. For example in 2017, the province of Ontario, the largest single public drug payor in North America, implemented a single payor universal pharmacare-type model for children and youth. Little over a year after its launch, the program was redesigned and reverted to a mixed payor system, to allow Ontario patients to maintain choice in their drug plan.

Our pharmacare advocacy is founded on research and public opinion polling. We focus federally, provincially and regionally on directly supporting our members, providing grassroots training and orientation, customizable tool kits, and assistance in mobilizing pharmacists across Canada on this issue. Through Complete the Plan, our association helped coordinate nearly 100 in-person meetings with political candidates in the 2019 pre-election period. Additional meetings with elected officials from both the federal and provincial governments are planned for 2020, along with the establishment of a permanent grassroots advocacy program rolling out later this year.

In our 2020 pharmacare discussions, we will continue to encourage government to keep patients at the heart of decision making and, based on public opinion polls, this means giving patients the choice to remain on their current drug plans. When it comes to accessing medication, we firmly believe that our finite financial resources should be focused on Canadians who are most in need — the uninsured and underinsured. Our model will save billions in unnecessary spending, conserving funds that can be used for other health care priorities including mental health, the opioid crisis, home and seniors care, and better access to primary care services — all government priorities.

Pricing and pharmacy ­reimbursement

For the past couple of years, Health Canada has been engaged in a process to change the way that prices for patented drugs are regulated in Canada. The Patented Medicines Prices Review Board (PMPRB) is responsible for establishing the maximum price a company may charge for a patented drug in Canada. They have done this by comparing the Canadian price against the prices in a group of seven other countries. New regulations are expected to come into effect in 2020 which would expand the basket of countries from seven to 11. This change is expected to result in a 20% decrease to the maximum prices that may be charged in Canada. Additionally, manufacturers must submit pharmacoeconomic studies to PMPRB.

Neighbourhood Pharmacies is concerned that these changes will have unintended consequences for pharmacy, making it more difficult to provide services for patients. We will be following the issue closely in 2020, and will take every opportunity to provide feedback to Health Canada.

Expanded scope

In addition to being recognized as experts in medication management, in recent years pharmacists are playing an expanded role in the delivery of quality, patient-focused care. In most provinces, pharmacists are now providing the majority of flu shots, along with a number of other vaccines. Pharmacists can also prescribe drug therapy for smoking cessation in almost every province. There is increasing opportunity for pharmacists to play a role in diagnosing and prescribing for minor ailments such as eye infections, skin rashes and urinary tract infections. Last year, Manitoba’s government made it easier for people suffering uncomplicated UTIs to get prescriptions from a pharmacist, instead of having to visit their doctor, urgent care center or walk-in clinic. This UTI initiative is also in place in Saskatchewan, Alberta, Quebec and New Brunswick.

When adequately funded, we have seen the positive impact pharmacists have on delivering patient care in every community they serve. Based on the success of several Canadian jurisdictions, the opportunity for pharmacists to diagnose and prescribe for minor ailments is likely to be an area of growth in 2020 and beyond.

Knowing this potential, we will work with governments and stakeholders this year, moving the needle to advance patient care and support opportunities to expand scope in provinces across Canada.

Equally important and in lockstep with scope expansion is government’s willingness to compensate pharmacists for delivering this wider range of services. By paying pharmacists for additional services, government can incentivize better utilization of a more cost-effective provider and help to create capacity in physicians’ offices, hospitals and emergency departments.

Opioid crisis

Between January 2016 and March 2019, there were more than 12,800 apparent opioid-related deaths in Canada. From 2016 to 2018, the number of deaths actually increased year over year, with 3,023 in 2016, followed by 4,120 in 2017 and 4,588 in 2018, which means that one life was lost every two hours related to opioids.

Naloxone continues to be the most commonly used drug to temporarily reverse the effects of opioid overdoses. Tens of thousands of take-home naloxone (THN) kits are dispensed annually at pharmacies across Canada — simply by asking a pharmacist and with no prescription required. Some provinces offer THNs free of charge.

Pharmacies are well positioned to help patients manage opioids in a responsible and effective way. In order to do this, we firmly believe that authorizing pharmacists to prescribe and deprescribe controlled drugs and substances by including them as practitioners under the Controlled Drugs and Substances Act (CDSA) is a meaningful step government can take to more effectively support patients with opioid dependency.

Medical cannabis

Pharmacy is most effectively situated to play a leadership role managing medical cannabis in Canada in 2020 and beyond. With 2020 under way, we emphasize the need for authorizing pharmacists to dispense, distribute and counsel on medical cannabis and cannabis health products. For example, we know that, when used appropriately, cannabis can be an effective secondary or tertiary treatment for several conditions, and there is a growing evidence base that it may be used to reduce the number and dose of opioid prescriptions.

Pharmacists’ expertise in medication management allows them to effectively advise and educate patients on the use of cannabis for medical purposes and supports patient care.

U.S. importation and drug shortages

In 2019, in the face of U.S. proposals that would permit mass importation of Health Canada-approved medicines for U.S. patients, Neighbourhood Pharmacies has expressed our concerns and asked that the federal government commit to seek ways to avoid disruption to our pharmaceutical supply. In August, we met with then-Health Minister Ginette Petitpas-Taylor on the issue. After the election, we joined a group of stakeholders in a letter to Trudeau to request swift and urgent action to protect Canada’s drug supply in response to U.S. proposals.

In the past several years, drug shortages have become an increasingly serious concern in the Canadian health care system. While we recognize the priority that American governments have placed on reducing the costs of prescription medicines in the U.S., we are concerned that the legal and policy frameworks that they have adopted may not address the root cause of their domestic concerns and will likely result in increased drug shortages in Canada.

An increase in drug shortages may force Canadians to find medicine through unconventional sources, such as illegal online sellers. The Canadian medicine supply is not sufficient to support both Canadian and U.S. consumers.

We anticipate the U.S. government will propose a rule in early 2020 that will allow U.S. states, pharmacies and wholesalers to import medicines from Canada. In 2020, we will continue to engage the federal government and stakeholders to communicate the importance of ensuring predictability in the supply of medications.

New year, new leadership and new opportunities

With new leadership at the association, a different political landscape, and constant shifts in the policy and regulatory environment, Neighbourhood Pharmacies approaches 2020 with a clear understanding of the importance of delivering a precise message and insightful perspective to decision makers on behalf of our members.

We will continue to place emphasis on the six priorities identified here, while acknowledging the need to be nimble and responsive as issues inevitably evolve — often at a rapid pace.

We thank our members for placing their confidence in Neighbourhood Pharmacies and look forward to working together.

Sandra Hanna is the CEO at Neighbourhood Pharmacy Association of Canada.