The Changing Healthcare Landscape: Setting the Stage

for Private PayersJeff May, Shoppers Drug Mart

Peter Zawadzki, Pharmasave NationalInterim Co-Chairs, Stakeholder Steering Committee on

Private Drug Plans

Solutions in Drug Plan Management Conference Toronto, ON

September 8, 2011

Outline of Today’s Presentation

The Perfect Storm New Regulated Health Professions – Who is RPhT? What will Pharmacists do? Canadian Pharmacy Services Framework Expanded Scope of Practice for Pharmacists Modernizing the Funding Model Drug Reform – Focus on decreasing generic prices Funded Pharmacist Services Implications for Plan Sponsors Strategies for Drug Plan Management

A “Perfect Storm”?

The Perfect Storm

The Great Recession Drug Reform

• Decrease generic drug pricing• Reduce or control professional allowances

The Patent Cliff Expanded Scope of Practice Funded Pharmacist Services

Reinvestment in Enhanced Pharmacy Services

Alternate Delivery Methods• Remote dispensing• Central fill• Mail order pharmacy

Regulated Pharmacy Technicians

The Perfect Storm

Plan Sponsors

Recession Expanding Drug and Health Costs Employee Engagement Employee Retention Specialty Medications Stop Loss Coverage / Catastrophic Claims

New Opportunity – New Reality

Regulated Pharmacy Technicians

Optimize use of Pharmacy Human Resources Academic training > practical experience >

licence RPhT accountable for distributive functions:

− Dispensing role & final check− Inventory management− Billing issues with public and private payers

Pharmacists responsible for patient centred care and interaction with prescribers & HC providers

Reverse the workflow – Pharmacist RPhT

Canadian Pharmacy Services Framework (CPSF)

The new language of Pharmacy

Standardizes definitions and terminology

Delineates Standards Operating Procedures

Foundation to promote to internal and external stakeholders, including patients

Implementation project of the Blueprint for Pharmacy• CPhA, CACDS, and Provincial Pharmacy Associations

A roadmap to deliver increased patient-focused care• Includes provision of medication management services

by pharmacists

Highlights the value of professional services Predicated on a financially viable & sustainable

model

CPSF

CPSF Guiding Principles

…identifies pharmacy services that are cost-effective- Based on needs of patient & health system

…establishes a common approach to describing and understanding pharmacy services

…is adaptable to the jurisdiction- Recognizes unique scopes of practice, health priorities and resources between provinces

…sees pharmacists practicing according to their specified standards and scope

…represents a unified and consistent message for pharmacy services across Canada

…supports the development of financially-viable services- Scalable across jurisdictions

In the Ideal World, Pharmacy Services Will…

…Be adapted for each province…Funded by payors with an acceptable ROI…Demonstrate value to the health system

…Enhance health outcomes for Canadians…Be desired by patients…Be implemented by pharmacists

…Utilize integrated technological solutions…Be based on enhanced interprofessional collaboration…Coordinated with pharmacy researchers/educators

Patient-Centred Services

Harmonized – Scalable – Sustainable

Service Classification

Core Dispensing Services

Enhanced Medication Related Services

Expanded Patient Care Services

Core Dispensing Services

Provision of prescribed medications

Assess for ADRs, interactions, allergies, accessibility (coverage, cost, etc)

Patient dialogue Patient callback

Pharmacist services Rx-focused Fee per Rx Workflow driven

Enhanced Medication-Related Services

Rx interventions• Adapting Rx• Refusal to fill• Emergency prescribing

Personal medication record /medication reconciliation

Medication injections OTC consultations

Pharmacist services• May lead to referral to

other HCPs

Outcome-focused Workflow adjustment

needed

Expanded Patient Care Services

Comprehensive medication management (CMM)• Assessment, DRP

identification, care plan development, & follow up

Minor ailments• Management & treatment

Health promotion & disease prevention

Pharmacist services• May lead to referral to

other HCP Outcome-focused Workflow adjustment

needed

CPSF Template

Designed as a standardized tool to describe the services to be implemented in the particular jurisdiction

Time estimation Compensation Change management Technological needs Other factors

Service description Responsibility Eligibility Desired

benefits/value Standard operating

procedures (SOPs)

Prescriptive Authority

Pharmacists are able to initiate a medication for a patient following a diagnosis by a prescriber

Some jurisdictions allow for prescribing in an emergency situation

Adaptation

Pharmacists can adapt a prescription to change the dose, dosage form, or drug regimen of the prescription to enhance patient outcomes

Extension/Continuation

Pharmacists can renew a prescription to ensure continuity of care without prescriber consent so long as he/she provides an update to the prescriber

Management of Minor Ailments

Pharmacists can assess and diagnose specified conditions and prescribe prescription or non-prescription medication; supportive education and advice are provided

Examples of conditions include dysmenorrhea, irritable bowel syndrome, and urinary tract infections

Administration of Medications

Pharmacists can administer drugs or substances by injection or inhalation for preventative measures or for treatment of medication conditions

Medication Review / Reconciliation

Pharmacists can review and assess patients’ medication regimens for drug related problems, educates patients on the appropriate use of their medications, and provide a comprehensive list of the patients’ medications

Management of Chronic Disease

Pharmacists can provide single or ongoing cycle of assessment, management, and education on patients’ medical conditions and medication therapy to improve health outcomes (e.g., diabetes)

Smoking Cessation Coaching

Pharmacists can provide smoking cessation coaching that ranges from brief intervention to intensive ongoing education including assessing patients’ readiness to quit, supporting the quitting process and recommending medication therapy

Drug Reform

Last year was all about uncertainty

New agreements in public sector

Reductions in generic prices – savings achieved

Reinvestments:• Core dispensing services• Funds for patient care services

Patient Care Services: 2011Patient Care Services: 2011

Medication Review

Immunization

Bill 60 Ability to adapt

prescriptions

MedsCheck (Diabetes, @Home)

Smoking CessationBill 179 Extend, adapt or adjust

prescriptions Pierce or lance the skin

Adaptation Changing dose, formulation,

directions Renewing a prescription Therapeutic substitution

Immunization

MMP Pilot: MTM

Medication Reviews

Medication Review

Minor Aliment

Prescribing of continued care prescriptions

PPMI Pilot Finished: MTM• Adapting a prescription• Renewing a prescription• Therapeutic

substitutionImmunizationPrescribingLab tests

Anticoagulation

Refusal to Fill

Emergency prescribing of OCs

Opinion Pharmaceuticque

Medication Review

Immunization

Prescription Adaptation

Therapeutic Substitution

Minor Ailments

Implications for Plan Sponsors

How to link benefits of:• Link benefits of medication reviews• Therapeutic substitution• Prescription adaptation, etc...

To Plan Design and Employee Health Objectives

Strategies for Drug Plan Management

Current thinking is that now is the time to implement aggressive plan management

Collaboration across the provider community • To manage cost increases• Focus on employee health outcomes• Link wellness to health and drug spend

For consideration today

Is the environment finally right to make a fundamental leap?• Innovation in plan design• Collaborative cost management• Maximize contribution of providers to employee health

For More Information…Blueprint for Pharmacy Resources

www.blueprintforpharmacy.ca

http://blueprintforpharmacy.ca/resources/resource-article/2011/03/11/expanding-pharmacy-services-summary-of-evidence-in-published-literature

Expanding Pharmacy Services – Summary of Evidence

For More Information…CPhA Environmental Scan

www.blueprintforpharmacy.ca

http://blueprintforpharmacy.ca/resources/resource-article/2011/04/12/pharmacists'-medication-management-services-environmental-scan-of-canadian-and-international-services-updated-august-2011

Pharmacists’ Medication Management Services

The New World of Pharmacy

Scope of Practice

New

ReimbursementModels

Show value

toPublic & Private

Payers

Public Support& Awareness

Conclusion

The Perfect Storm New Regulated Health Professions – Who is RPhT? What will Pharmacists do? Canadian Pharmacy Services Framework Expanded Scope of Practice for Pharmacists Modernizing the Funding Model Drug Reform – Focus on decreasing generic prices Funded Pharmacist Services Implications for Plan Sponsors Strategies for Drug Plan Management