Public funding for pharmacists’ services truly is a double-edged sword.
By Dayle Acorn
On the one hand we know that without the public purse, many of these services would not be happening. Consider Alberta in particular: it’s had the broadest scope of practice since 2007, yet little was known about the degree of uptake until 2012, when publicly funded services were enabled. The level of publicly funded services is also the broadest in Canada, contributing to the provision of professional services that steadily outpaces all other provinces.
And as pharmacists provide services more often, they become more efficient, more confident and more motivated. “There is a huge cultural shift going on now in Alberta,” noted Margaret Wing, CEO of Alberta Pharmacists’ Association, at the Canadian Foundation for Pharmacy’s (CFP) Pharmacy Forum in November 2016. “Pharmacists are telling us their practice is so much better today.”
It’s fair to say, therefore, that public funding can be a catalyst for the adoption of expanded services. On the other hand, can it also be like a crutch, giving support while also limiting actions that are vital for sustainability? What would happen if public funding were reduced or even eliminated?
We need to keep in mind that public funding for pharmacy services comes out of the same budget as funding for drugs, and provincial drug plans today are seriously grappling with coverage for high-cost specialty drugs. According to IMS Brogan, biologic drugs accounted for 23 per cent of all prescription purchases in 2015, but just two per cent of prescriptions dispensed. Public and private payers alike are struggling to help fund these life-changing drugs — and all other budget items, including fees for pharmacists’ services, are under increased scrutiny.
Which brings me to perhaps the most critical “payer” of all: patients. Without their demand and vocal support for these services, as well as a readiness to pay from their own pockets if need be, can there really be a future for funding from public or private plans? I’m reminded of a quote by Denise Balch, a benefits advisor for private drug plans, in the “Private Eye” blog on CanadianHealthcareNetwork.ca:
“Pharmacists cannot do a service for free if the patient says they don’t have coverage. If they don’t charge every patient, coverage or not, then insurers and employers who want their employees to have access to these services will have no incentive to pay.”
At our Pharmacy Forum, we spoke of the need for pharmacies to be more assertive about the benefits of their services. That includes being upfront about fees, even when public funding is available. The bottom-line message that needs to be conveyed: pharmacists’ services are never “free,” because they provide value.
As the saying goes, we can’t put all our eggs in one basket, particularly when that basket is hard-pressed to carry all that’s demanded of it. Public funding can be an incredibly important catalyst, but patient support is the foundation upon which pharmacists can confidently build expanded pharmacy practices.
Research that works
Through our Innovation Fund, the Canadian Foundation for Pharmacy is dedicated to funding research projects that revolve around practical tools (for example, to support adherence) or scalable new services (for example, in pharmacogenomics) that support the advancement of community pharmacy practice. Check out our website (www.cfpnet.ca) and join us on Facebook or LinkedIn — we welcome your feedback!
Dayle Acorn is Executive Director of the Canadian Foundation for Pharmacy (www.cfpnet.ca), a registered charity dedicated to supporting innovation and leadership to advance the profession of pharmacy.