Recently, an advisory council has been established for the discussion of the National Pharmacare.  Many stakeholders including pharmacists are not pleased that they have not been part of the advisory council.  I understand the frustration. I agree, pharmacists should be part of this important discussion. But I am also disappointed with the CPhA statement on the Pharmacare Advisory Council.

CPhA Pharmacare

It seems that we have only identified ourselves as medication experts who help patients navigate their drug plans.  This is certainly true but as we begin the conversation on national pharmacare, the focus is to develop a pharmacare that is affordable and allow access to essential medicines, not so much on how it relates to the patients’ various drug plans.

Just looking at the experience we have with OHIP Plus, the Ontario Drug Benefits formulary was not modified to reflect the needs of the pediatric population.  Pediatrics often need medications made with special formulation (e.g. liquid formulation) and medications may be prescribed for off-label use. This has created a huge gap as  OHIP Plus is not set up to reimburse a list of “essential medicines” for pediatrics.

Ideally, I hope this does not repeat itself as we move forward with the National Pharmacare.

I hope when we start to implement the National Pharmcare in Canada, we will listen to all the various stakeholders, patient populations and health care providers. We need to start the conversation on how we define “essential medicines”.

The World Health Organization (WHO) defines essential medicines as follow:

… those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness.Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford.

Yet in reality, essential medicines may mean different things to different health care providers and patient population. We all come with different agendas and perspectives.

As we move forward with National Pharmacare, we need to come to common ground as to what essential medicines are for Canadians.  Recently, a preliminary list of essential medicines has been published by Persaud et al.  A provision list for children was also released. These are all great work to move forward with the conversation on National Pharmacare.

But where is the pharmacist’s voice in these conversations?

I keep hearing our own discussion on the impact of National Pharmacare on private insurance, how its role may supplement the public payor.  But the key to a national pharmacare. is on more effective negotiating power which can only be possible if the government becomes  the key stakeholder.

Defining essential medicines is also where I think pharmacists can engage in the conversation. We can focus on how we see Canadians across the country need their essential medicines in different shapes and forms, collect information on how pharmacists define essential medicines for Canadians based on their experience.

For example, I see that insulin is considered an essential medicine which is great for any patient with diabetes. But it is also important that patients have easy access to glucometer, lancets and glucose strips to be able to safely start and monitor insulin therapy.  Without these “essential” supplies, it is futile to think about insulin.

I recognize and understand how the implementation of national pharmacare may impact on pharmacy. Many feel the impact is negative on sales and revenues.

This is where we need to expand our horizon and look outside the box.

I see National Pharmacare as an opportunity for pharmacists to impact on prescribing, to develop reimbursement schemes for more efficient way to optimize prescribing, make timely recommendations for medication substitution and helping to collaborate with patient and prescriber on deprescribing initiatives.

I see possible opportunities  for pharmacists as independent reviewers to review patients’ claims to help decide whether a “non essential medicine” is indeed “essential” for that particular patient’s unique situation.

Indeed, I see many possibilities where pharmacists can engage in the National Pharmacare conversation.  Do you have any ideas where pharmacists can do to help move forward with the National Pharmacare?

Thank you for reading my post.