Just last week, I was asked to review a patient’s medications because she was overly sedated. So I met with the physician; we chatted for few minutes and we both agreed it was the baclofen that was most likely contributing to the sedation. So he decided to stop the medication. While I had the opportunity, I also suggested make other changes to simplify the patient’s medication regimen. We were able to get rid of few other pills. So I thought that was a great accomplishment. Then I got an unexpected comment: “How is this good? You will run out of business soon?”. The comment didn’t sit well with me. I really don’t see myself as a pill pusher. Less is better. In fact the latest craze in pharmacy is on de-prescribing initiatives – how to discontinue medication with an evidence based approach. But is this a sustainable concept in pharmacy where we still depend on prescription sales to survive?
Costo is now under investigation for allegedly demanding illegal drug rebates from Ranbaxy, a generic company. Their defending explanation is that the funding is used to support clinic activities and educational campaign which is considered appropriate and legal. With budget cut and less projected revenue, many pharmacies are turning to pharmaceutical companies to support educational activities. But is this a healthy business relationship? The case with Costco illustrates how far and messy this relationship can evolve into.
The profession of pharmacy has been trying to distant itself from the image of a pill pusher, attempting to instill the philosophy of pharmaceutical care to new graduates. But the challenge has been on the reimbursement of these services – patient counseling, medication review, provision and follow up of pharmacy care plan. Some of these services are now reimbursed in Ontario via the Medscheck and Pharmaceutical Opinion Program. But it remains that many people don’t see the sustainability of a viable business model from solely offering these services.
That’s because we don’t have a system to measure the cost savings with these services. I have been conducting medication reviews for the last 5 years. Have I helped the system to save money? Perhaps but we are not measuring. I have “diagnosed” few cases of Type II diabetes; I have questioned an unexplained tachycardia which turned out to be atrial fibrillation. I have helped nursing home facilities to decrease their usage of antipsychotics, provided education on risk of falls with medications and I have many times prevented the inappropriate use of antibiotics. I don’t see myself as a pill pusher but we also need to write a better business case for what we do now, specifically how much cost savings we are contributing to the health care system. Because it obvious is not clear when I am still being seen as a pill pusher.