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November 25, 2015

PHARMACY-PHARMA SYNERGIES: ADDRESSING LANDSCAPE CHANGES

How to Leverage Patient Programs and Create Winning Partnerships with Pharmacists

This month’s meeting featured two panellists who provided their perspectives on pharmacy-pharma synergies and the role of pharmacists in today’s landscape. The first speaker was Bertrand Bolduc, President of l’Ordre des pharmaciens du Québec. He emphasized that the role of the pharmacist has evolved and their main goal is to protect their patients by working for them, and not for the pharmaceutical companies. He said that this mission is achieved by only admitting competent pharmacists into the profession and ensuring that l’Ordre des pharmaciens remains intact. L’Ordre des pharmaciens has standards of practice and they monitor pharmacy practices on an ongoing basis to ensure that they meet the required standards.

Bertrand proposed that pharmacists are now like medication “coaches”. “Like a personal coach, a pharmacist will help prevent side effects and improve treatment efficacy.” He pointed out that one of the main problems in Quebec is that many patients don’t have access to a general practitioner. As a result, they come to the pharmacy and ask for advice and support because they don’t want to go to the clinic or the emergency room to get treatment. The pharmacist offers easy access, expertise/competence, reputation and trust. In fact, the pharmacist is often the healthcare professional that patients see most.

Due to Bill 41, the role of pharmacists is expanding even more, as they are now allowed to perform more services, including:

• Prescribing medications for minor ailments
• Prescription and interpretation of laboratory results
• Medication administration for demonstration purposes
• Medication substitution
  • Products on back order or within the same class with comparable dosage
• Extending prescriptions
  • For patients waiting for an appointment or stable patients who become “physician-orphaned”
• Prescription adjustments
  • Dosage form (solid, liquid), dosage, timing/frequency, quantity (synchronization), and dosage strength (prevent adverse events)

So what do pharmacists need from pharma companies? Bertrand said that they need training and selling skills. Pharmacists are told to sell their services, but they’re not good sales people. He said that they also need CHE to keep them up to date with products and diseases. Pharmacists also need point-of-care education and screening programs, such as pharmacy days. What don’t pharmacists need from pharma? Bertrand said they don’t need:

• Direct involvement with the patient
• Speciality distribution
• Direct payment from industry to pharmacist
• Preferred provider networks (not possible in QC)
• Loyalty programs

Bertrand concluded his talk by saying that pharma companies and pharmacists need to work together more closely and not separately. He said, “Drugs without pharmacist supervision are like a plane on auto-pilot. It can work for a while, but it is very dangerous. It seems expensive, but the value is there. Pilots are expensive, but they’re worth the expense.”

The next speaker was Ken Saldanha, Business Development Manager for Shoppers Drug Mart Specialty Health Network, who discussed the specialty side of the pharmacy business. He began by showing some statistics on the Canadian drug market: overall the market grew by 4.4%, but biologics grew by 10.4% and oncology by 12.3%. By 2020, 30% of the market will be biologics and, by 2018, it is predicted that 50% of sales from the top 100 pharma products are expected to come from biologics.

Ken pointed out that most specialty drugs are for rare diseases with small populations. They are drugs that have their own set of special features, including high cost, ongoing monitoring, patient training, special handling, etc. So who is the ideal group to provide these services? These products require specialty service providers and specialty pharmacies. These pharmacies employ pharmacists with advanced knowledge to provide appropriate patient services, such as:

• Patient counselling on administration, storage, adverse events and drug interactions
• Refill reminders to ensure compliance and optimal outcomes
• Cold chain and ambient temperature control to ensure medication reaches patients promptly and in optimal condition
• Certified aseptic clean rooms for IV sterile preparation of both cytotoxic and non-cytotoxic drugs

But will specialty drugs be limited to specialty pharmacies? Ken answered no, because many community pharmacies are also now specializing in these drugs. As such, Ken emphasized that the pharma industry has a large opportunity to collaborate and engage with pharmacists in this area. He said that community pharmacy networks should be leveraged to get medications to patients in the easiest way possible.

Ken concluded with the following points:

• Opportunities: knowledge and expertise is #1
  • These are complex molecules and diseases, so education and expertise with pharmacists is needed for them to become competent partners
  • Pharma can be part of the solution by providing the necessary support and tools
• Network: ability to accommodate patient choice; develop the most appropriate model to best serve each patient
• Patient’s point of view: deal with one pharmacy of choice; community pharmacy needs to step up to make that happen to the benefit of the patient; provide consistency of care, especially with specialty products
• Manufacturers: treat specialty drugs as a healthcare service rather than a sale, and include community pharmacies as part of the total patient care
  • Want to give patients a seamless, pleasant experience at the pharmacy level to encourage compliance

The panellists then fielded some questions from the audience, which included:

Q: We’re aiming towards value-based medicine, and everyone would like to do value-based pricing and allocation, but it’s more complicated because it needs to be measured and we can’t measure the healthcare system. How do you think pharmacists can have a part of that?

A: It’s not easy to measure outcomes. The measure is important, but we need to make patients more educated and become partners in their own care. Studies show that, when there is patient coaching, medication costs are reduced because of better control.

Q: Regarding specialty and community pharmacy, patients want to go where they want and where they have a relationship with their local pharmacist. However, the local community pharmacist may not have the required knowledge. How is it going to work with liability if the patient is ordering his specialized product at the local “shop”?

A: There is a code of conduct that says that pharmacists should not do anything they’re not comfortable doing. They should direct the patient to a colleague that is comfortable and the pharmacist needs to make sure that they have the complete patient file or they’re liable.

 

Lara Holmes
Medical Writer
Email: lholmes@videotron.ca
Cell: 514-425-4977

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