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The Changing Healthcare Landscape: Setting the Stage for Private Payers Jeff May, Shoppers Drug Mart Peter Zawadzki, Pharmasave National Interim Co-Chairs,

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Presentation on theme: "The Changing Healthcare Landscape: Setting the Stage for Private Payers Jeff May, Shoppers Drug Mart Peter Zawadzki, Pharmasave National Interim Co-Chairs,"— Presentation transcript:

1 The Changing Healthcare Landscape: Setting the Stage for Private Payers Jeff May, Shoppers Drug Mart Peter Zawadzki, Pharmasave National Interim Co-Chairs, Stakeholder Steering Committee on Private Drug Plans Solutions in Drug Plan Management Conference Toronto, ON September 8, 2011

2 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

3 A “Perfect Storm”?

4 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

5  Reinvestment in Enhanced Pharmacy Services  Alternate Delivery Methods Remote dispensing Central fill Mail order pharmacy  Regulated Pharmacy Technicians The Perfect Storm

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

7 New Opportunity – New Reality

8 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

9 CANADIAN PHARMACY SERVICES FRAMEWORK CANADIAN PHARMACY SERVICES FRAMEWORK

10 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

11  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

12 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

13 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

14 Service Classification Core Dispensing Services Enhanced Medication Related Services Expanded Patient Care Services

15 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

16 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

17 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

18 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)

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20 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

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

22 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

23 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

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

25 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

26 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)

27 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

28 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

29 Patient Care Services: 2011 Medication Review Immunization Bill 60  Ability to adapt prescriptions MedsCheck Smoking Cessation Bill 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 substitution Immunization Prescribing Lab tests Anticoagulation Refusal to Fill Emergency prescribing of OCs Opinion Pharmaceuticque Medication Review Immunization Prescription Adaptation Therapeutic Substitution Minor Ailments

30 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

31 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

32 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

33 For More Information… Blueprint for Pharmacy Resources expanding-pharmacy-services-summary-of-evidence-in-published-literature Expanding Pharmacy Services – Summary of Evidence

34 For More Information… CPhA Environmental Scan -services-environmental-scan-of-canadian-and-international-services-updated-august-2011 Pharmacists’ Medication Management Services

35 The New World of Pharmacy Scope of Practice New Reimbursement Models Show value to Public & Private Payers Public Support & Awareness

36 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


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