Mona Fanous, Katz Group.
bh IN BRIEF For many years, pharmacists have worked to align their training and skills with the broader health needs of their customers. Diabetes presents many opportunities for pharmacists to help patients manage their health, whether adult or child. Many stores feature diabetes ‘clinic days’ that provide comprehensive education, sometimes including representatives from drug and equipment manufacturers. Two provincial initiatives – new legislation in Ontario, and an important scope-of-practice change in Alberta – will have important effects on the profession and on patients. These two changes also present employers with significant challenges. On the surface, both may increase costs, but they also present new opportunities to engage pharmacists to create more value in employer-sponsored drug plans. | The Katz (pronounced Kates) Group includes 1,800 drug stores in Canada and the US under the PharmaPlus, Rexall, IDA, Medicine Shoppe and MediTrust banners. Q: Each year, 60,000 people are told they have diabetes for the first time. Why does this matter to employers and the workplace in general? Apart from adults, Type 2 diabetes is also hitting more and more young people. Soon parents will need more time off to visit doctors and look after their unhealthy kids. But later, these unhealthy young adults will generate costs we don’t currently expect until much later in life. Q: Is there still interest in having pharmacists work with employers, insurers, or benefit advisors to manage diabetes in the workplace? Unlike a few years ago, there are few current examples in workplace settings. While continuity has been a problem, the current shortage of pharmacists also means there is less time for work outside the store. Still pharmacists can positively impact health outcomes. For example, we can help patients understand why they’re checking blood glucose and specifically what to do with their results. If they don’t understand or comply, long term complications arise, and none of them are good. Many pharmacists regularly offer diabetes programs at their store, which include educational materials and follow-up telephone calls focused on compliance. These “clinic days” could be promoted by employers among their employees. Q: Beyond diabetes, in your role at Katz, what issues have been consuming your time? We are paying close attention to two recent provincial changes. First, we have been heavily involved with Ontario’s new Transparent Drug System for Patients Act (“Bill 102”). The Act will cut drug mark-up on the provincial plan from 10% to 8% effective April 1, 2007. It is not yet clear whether private plans will match this. Employers should also be concerned about recent price changes on brand-name and generic products, enabled by this Act. For pharmacy, one piece of good news is that the Act allows pharmacists to earn cognitive (professional) service fees for drug regimen consultations. When three or more medications are reviewed, the government plan will pay $50 per patient. Apart from extra income, this will require measurement and therefore accountability. Other provinces are watching closely: Nova Scotia has already said it will follow the Ontario government’s revised drug pricing. Also on April 1, 2007, pharmacists in Alberta will have prescribing rights for “Schedule 1” products, and be able to administer injections such as vaccines. Pharmacists will not make diagnoses, but will be able to modify a prescription, that is, change the dose, form, or frequency after a thorough patient review. They will be able to issue an emergency supply of an initial prescription if there is no reasonably accessible alternative, such as a local hospital or physician clinic. Finally, with special authorization by the College (regulator), a pharmacist will be able to select the most appropriate drug products to address a patient’s drug needs, following a physician’s diagnosis. This will occur mostly in hospital or special clinic situations or collaborative community settings. Though training programs are in place, a compensation schedule has still not been issued by the government. While each issue reflects just one province’s legislation right now, we think these will indeed become national issues. Q: Some provincial health plans are or will soon be paying pharmacists for "cognitive services". How soon will this impact the market, and should employers follow suit? Assuming reasonable regulations are proposed, this change will take time to become professional practice. We are cautious. A few years ago, Québec introduced a fee for a “pharmaceutical opinion”, but the reimbursement process was so cumbersome, many pharmacists did not submit claims. Employers may try to avoid these new pharmacist costs. They make sense for government plan beneficiaries, so why not for certain employees or family members? I think interventions by pharmacists today will provide important savings in the future. "Cognitive Services" Include:
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