The Changing Healthcare
Landscape: Setting the Stage
for Private Payers
Jeff May, Shoppers Drug Mart
Peter Zawadzki, Pharmasave National
Interim Co-Chairs, Stakeholder Steering Committee on
Private Drug Plans
Solutions in Drug Plan Management Conference
Toronto, ON
September 8, 2011
Outline of Today’s Presentation
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The Perfect Storm
New Regulated Health Professions – Who is RPhT?
What will Pharmacists do?
Canadian Pharmacy Services Framework
Expanded Scope of Practice for Pharmacists
Modernizing the Funding Model
Drug Reform – Focus on decreasing generic prices
Funded Pharmacist Services
Implications for Plan Sponsors
Strategies for Drug Plan Management
A “Perfect Storm”?
The Perfect Storm
 The Great Recession
 Drug Reform
• Decrease generic drug pricing
• Reduce or control professional allowances
 The Patent Cliff
 Expanded Scope of Practice
 Funded Pharmacist Services
The Perfect Storm
 Reinvestment in Enhanced Pharmacy Services
 Alternate Delivery Methods
• Remote dispensing
• Central fill
• Mail order pharmacy
 Regulated Pharmacy Technicians
Plan Sponsors
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Recession
Expanding Drug and Health Costs
Employee Engagement
Employee Retention
Specialty Medications
Stop Loss Coverage / Catastrophic Claims
New Opportunity – New Reality
Regulated Pharmacy Technicians
 Optimize use of Pharmacy Human Resources
 Academic training > practical experience >
licence
 RPhT accountable for distributive functions:
− Dispensing role & final check
− Inventory management
− Billing issues with public and private payers
 Pharmacists responsible for patient centred care
and interaction with prescribers & HC providers
 Reverse the workflow – Pharmacist
RPhT
CANADIAN PHARMACY
SERVICES FRAMEWORK
Canadian Pharmacy Services
Framework (CPSF)
 The new language of Pharmacy
 Standardizes definitions and terminology
 Delineates Standards Operating Procedures
 Foundation to promote to internal and external
stakeholders, including patients
CPSF
 Implementation project of the Blueprint for
Pharmacy
• CPhA, CACDS, and Provincial Pharmacy Associations
 A roadmap to deliver increased patient-focused
care
• Includes provision of medication management services
by pharmacists
 Highlights the value of professional services
 Predicated on a financially viable & sustainable
model
CPSF Guiding Principles
…identifies pharmacy services that are cost-effective
- Based on needs of patient & health system
…establishes a common approach to describing and
understanding pharmacy services
…is adaptable to the jurisdiction
- Recognizes unique scopes of practice, health priorities and resources between
provinces
…sees pharmacists practicing according to their specified
standards and scope
…represents a unified and consistent message for pharmacy
services across Canada
…supports the development of financially-viable services
- Scalable across jurisdictions
In the Ideal World,
Pharmacy Services Will…
…Be adapted for each province
…Funded by payors with an acceptable ROI
…Demonstrate value to the health system
Patient-Centred Services
…Enhance health outcomes for Canadians
…Be desired by patients
…Be implemented by pharmacists
Harmonized – Scalable – Sustainable
…Utilize integrated technological solutions
…Be based on enhanced interprofessional collaboration
…Coordinated with pharmacy researchers/educators
Service Classification
Expanded Patient Care
Services
Enhanced Medication
Related Services
Core Dispensing
Services
Core Dispensing Services
 Provision of prescribed
medications
 Assess for ADRs,
interactions, allergies,
accessibility (coverage,
cost, etc)
 Patient dialogue
 Patient callback
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Pharmacist services
Rx-focused
Fee per Rx
Workflow driven
Enhanced Medication-Related Services
 Rx interventions
• Adapting Rx
• Refusal to fill
• Emergency prescribing
 Personal medication
record /medication
reconciliation
 Medication injections
 OTC consultations
 Pharmacist services
• May lead to referral to
other HCPs
 Outcome-focused
 Workflow adjustment
needed
Expanded Patient Care Services
 Comprehensive
medication
management (CMM)
• Assessment, DRP
identification, care plan
development, & follow up
 Minor ailments
• Management & treatment
 Health promotion &
disease prevention
 Pharmacist services
• May lead to referral to
other HCP
 Outcome-focused
 Workflow adjustment
needed
CPSF Template
Designed as a standardized tool to describe the services to
be implemented in the particular jurisdiction
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Service description
Responsibility
Eligibility
Desired
benefits/value
 Standard operating
procedures (SOPs)
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Time estimation
Compensation
Change management
Technological needs
Other factors
Prescriptive Authority
 Pharmacists are able to initiate a medication for
a patient following a diagnosis by a prescriber
 Some jurisdictions allow for prescribing in an
emergency situation
Adaptation
 Pharmacists can adapt a prescription to change
the dose, dosage form, or drug regimen of the
prescription to enhance patient outcomes
Extension/Continuation
 Pharmacists can renew a prescription to ensure
continuity of care without prescriber consent so
long as he/she provides an update to the
prescriber
Management of Minor Ailments
 Pharmacists can assess and diagnose specified
conditions and prescribe prescription or nonprescription medication; supportive education
and advice are provided
 Examples of conditions include dysmenorrhea,
irritable bowel syndrome, and urinary tract
infections
Administration of Medications
 Pharmacists can administer drugs or substances
by injection or inhalation for preventative
measures or for treatment of medication
conditions
Medication Review / Reconciliation
 Pharmacists can review and assess patients’
medication regimens for drug related problems,
educates patients on the appropriate use of their
medications, and provide a comprehensive list
of the patients’ medications
Management of Chronic Disease
 Pharmacists can provide single or ongoing cycle
of assessment, management, and education on
patients’ medical conditions and medication
therapy to improve health outcomes (e.g.,
diabetes)
Smoking Cessation Coaching
 Pharmacists can provide smoking cessation
coaching that ranges from brief intervention to
intensive ongoing education including assessing
patients’ readiness to quit, supporting the
quitting process and recommending medication
therapy
Drug Reform
 Last year was all about uncertainty
 New agreements in public sector
 Reductions in generic prices – savings achieved
 Reinvestments:
• Core dispensing services
• Funds for patient care services
Patient Care Services: 2011
Adaptation
 Changing dose, formulation,
directions
 Renewing a prescription
 Therapeutic substitution
Immunization
MMP Pilot: MTM
Medication Reviews
PPMI Pilot Finished: MTM
• Adapting a prescription
• Renewing a prescription
• Therapeutic
substitution
Immunization
Prescribing
Lab tests
Medication Review
Immunization
Bill 60
 Ability to adapt
prescriptions
Medication Review
Immunization
Prescription Adaptation
Therapeutic Substitution
Minor Ailments
Medication Review
Minor Aliment
Prescribing of continued
care prescriptions
MedsCheck (Diabetes, @Home)
Smoking Cessation
Bill 179
 Extend, adapt or adjust
prescriptions
 Pierce or lance the skin
Anticoagulation
Refusal to Fill
Emergency prescribing of OCs
Opinion Pharmaceuticque
Implications for Plan Sponsors
 How to link benefits of:
• Link benefits of medication reviews
• Therapeutic substitution
• Prescription adaptation, etc...
To Plan Design and Employee Health
Objectives
Strategies for Drug Plan Management
 Current thinking is that now is the time to
implement aggressive plan management
 Collaboration across the provider community
• To manage cost increases
• Focus on employee health outcomes
• Link wellness to health and drug spend
For consideration today
 Is the environment finally right to make a
fundamental leap?
• Innovation in plan design
• Collaborative cost management
• Maximize contribution of providers to employee health
For More Information…
Blueprint for Pharmacy Resources
www.blueprintforpharmacy.ca
Expanding Pharmacy Services – Summary of Evidence
http://blueprintforpharmacy.ca/resources/resource-article/2011/03/11/
expanding-pharmacy-services-summary-of-evidence-in-published-literature
For More Information…
CPhA Environmental Scan
www.blueprintforpharmacy.ca
Pharmacists’ Medication Management Services
http://blueprintforpharmacy.ca/resources/resource-article/2011/04/12/pharmacists'-medication-management
-services-environmental-scan-of-canadian-and-international-services-updated-august-2011
The New World of Pharmacy
New
Reimbursement
Models
Scope of Practice
Show value
to
Public & Private
Payers
Public Support
& Awareness
Conclusion
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The Perfect Storm
New Regulated Health Professions – Who is RPhT?
What will Pharmacists do?
Canadian Pharmacy Services Framework
Expanded Scope of Practice for Pharmacists
Modernizing the Funding Model
Drug Reform – Focus on decreasing generic prices
Funded Pharmacist Services
Implications for Plan Sponsors
Strategies for Drug Plan Management