Ask Your Pharmacist

April 11, 2018
Q:

I read that generic drugs in New Brunswick are going to be cheaper starting in April. Does this have any impact on community pharmacies?

A:

In January, the pan-Canadian Pharmaceutical Alliance announced that it had reached an agreement with the Canadian Generic Pharmaceutical Association to lower the prices of the 70 most commonly prescribed generic drugs in Canada by 25-40 per cent. This change goes into effect April 1st. While pharmacists applaud changes that improve the access of needed medications to their patients, we ask that policy makers consider the impact that changes such as these have on the sustainability of community pharmacies.

Pharmacists provide numerous services at no charge here in New Brunswick. In other provinces, the government reimburses pharmacists for many of those services. Have you ever called your pharmacy for a prescription renewal to find that you have no refills remaining? This is a common occurrence and usually, the patient’s physician won’t renew by fax or over the phone without seeing the patient in person. In our province, pharmacists may assess the patient to determine if an extension of the prescription is medically necessary and renew a supply accordingly. The pharmacist has ensured the patient’s health has not been compromised by stopping a necessary medication and the province has not assumed the cost of an ER or after hour clinic visit from a patient who is either requesting a simple refill or experiencing an adverse health event from stopping a drug. Pharmacists in most other provinces are reimbursed for this service but not in New Brunswick.

Four years ago, New Brunswick pharmacists were given the authority to assess and prescribe for certain minor ailments. We undertook additional training to provide this service and take time away from the pharmacy’s workflow to accommodate those who are seeking an assessment. Most provinces reimburse pharmacists for this service but not New Brunswick. Pharmacies charge an out-of-pocket fee to patients requesting this service, but it often creates confusion amongst our patients who are accustomed to having their medical assessments covered by Medicare. A pharmacist who works at my pharmacy told me she often apologizes to patients when explaining the fee but feels that she is devaluing the profession in doing so. She is a highly-trained healthcare professional providing a healthcare service. We don’t expect doctors, dentists or physiotherapists to apologize for being reimbursed for providing their services.

There are instances when a pharmacist receives a prescription for a pain medication for a patient and realizes through the Drug Information System that he or she is getting the same medication filled by another doctor at a different pharmacy. The pharmacist then takes the time to speak to both physicians about the abuse, is told to shred the prescription and then spends time with the patient to explain why. The interventions made in refusing to fill the prescription have occupied a lot of the pharmacist’s time and identifying the abuse will save the healthcare system money. This service is reimbursable in many provinces but not New Brunswick. 

Pharmacists in New Brunswick are presently reimbursed for two services, PharmaCheck (medication reviews for patients on publicly funded drug plans to ensure compliance and medical necessity) and flu shots (for patients who are either high risk themselves or close contacts of those at high for complications of influenza). In Alberta, there are 16 services available for reimbursement and there are 14 in Quebec.

My point is that the revenues from generic drug sales have, for decades, helped in subsidizing the numerous services that community pharmacists of New Brunswick have provided at no charge. In order for New Brunswickers to continue to access these services, which are vital to their health and cost-effective for the province, our government needs to reinvest a portion of the millions of dollars that will be saved under this new agreement back into the pharmacies that provide them. Failing to do so will compromise the sustainability of New Brunswick’s community pharmacies and further deteriorate access to care.

It is my hope that the provincial Department of Health will engage in a much-needed formal agreement with its pharmacists. Working together, pharmacists and the government can find sustainable, cost-effective solutions to the provision of pharmaceutical care in New Brunswick.

Ryan Kennedy (BSc., Doctorate of Pharmacy, MBA) is a pharmacist/owner at Jean Coutu in Saint John. His opinions expressed in this newspaper are published for educational and informational purposes only and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. Send your questions to AskYourNBPharmacist@gmail.com.