US Pharm. 2010;35:1. 

For pharmacists who want to get a sneak preview of what pharmacy in the U.S. might look like under any new health care reform, maybe they should set their sights on our neighbors to the north in Ontario, Canada.

As everyone in the U.S. knows, Canada’s citizens have been living with government-provided health care for many years. And while it probably isn’t fair to compare our current or future health care system with that of Canada’s, there are arguably pros and cons to both. There are also some similarities between the countries’ programs, particularly as they relate to retail pharmacy. Unlike most drugstores in Europe and other continents, the pharmacies in Canada more closely resemble the kinds of stores we have in the U.S. Aside from some different products or the same products sporting different names, for the most part when you walk into a drugstore in Canada, you’d be hard-pressed to realize you are in a different country. And as in the U.S., Canada’s pharmacists and pharmacy owners struggle with many of the same professional issues.

A recent article that appeared in the The Globe and Mail, a well-respected Canadian newspaper, spoke about many pharmacists in the province of Ontario complaining of being treated like clerks instead of pharmacists. Sound familiar? And while other Canadian provinces such as British Columbia, Quebec, Alberta, and New Brunswick have been more progressive in allowing pharmacists to step beyond their current professional responsibility of filling prescriptions, Ontario had not…until now.

According to the article, Ontario pharmacists had been making most of their profits through rebates paid by generic drug manufacturers in return for stocking their products. Recognizing that the practice might be perceived as unethical or questionable, the government tried to ban the rebates altogether, but it quickly figured out that following that route would just drive costs up. A number of other alternatives were investigated, but in the end Canadian government officials turned their attention to the possibility of paying pharmacists for performing new professional counseling services, like medication therapy management. As Yankee hero Yogi Berra is fond of saying, “It’s déjà vu all over again.”

One interesting twist in Canada’s medication management plan is also to pay pharmacists for not filling prescriptions in cases where the pharmacist feels it would be unsafe to do so. But as in the U.S., the government is going to have to do some heavy selling to physician groups on this concept, as doctors see pharmacist consultation infringing on their turf. And pharmaceutical companies can’t be happy about pharmacists refusing to fill, or refill, prescriptions; after all, the companies are in business to sell more drugs, not less. Despite this, there are already signs that Ontario pharmacists have embraced their new-found professional freedom, and pharmacy schools are scrambling to reinvent their curriculums to include courses that will help pharmacists succeed in the more communicative world of retail pharmacy in Ontario after they graduate.

Our government will be facing much of the same uphill battle should it adopt a similar consultative role for pharmacists in which they would get paid for their valuable consultative services. In many ways, the U.S. is ahead of Canada in that it has already proven in many therapeutic areas that medication therapy management actually works to lower the nation’s overall health care bill by keeping patients more compliant, out of emergency rooms, and in hospitals for fewer days. Only time will tell whether pharmacists get that opportunity, because even Yogi would agree, “It ain’t over till it’s over.”

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