I am writing to you on behalf of New Brunswick pharmacists who are on the frontline of this dreadful COVID-19 global pandemic. Thank you for your leadership in difficult times, particularly via the all-party committee.
We understand you are dealing with a myriad of concerns from constituents, including the directive from the New Brunswick College of Pharmacists (the regulatory body for pharmacy in this province) which limits medication supply to 30 days during the COVID-19 pandemic. I am writing to provide you with some information to help you better understand the directive, and answer questions from your constituents.
Pharmacists are ethically bound to protect the supply of medication for their patients. We cannot and will not jeopardize that. In recent weeks, pharmacists in New Brunswick and across Canada have seen a significant surge in demand for medical supplies and medications as a result of the global COVID-19 pandemic (volumes driven up more than 200% over historical demand).
On March 16, 2020, the New Brunswick College of Pharmacists directed all pharmacists to limit the supply of medications to 30 days for all patients, with rare exceptions based on the pharmacist’s judgement. This is a temporary but necessary measure that will help pharmacists manage prescription inventory to reduce the risk of absolute shortages in the coming weeks. Even with that measure in place, suppliers are already telling pharmacists to expect delays and shortages of some medications.
New Brunswick was one of the first provinces to take this step proactively to protect medication supply, but almost all provinces quickly followed suit. Once the pharmacy regulatory authorities across the country are confident in the security of the drug supply, we will be able to return to normal practice.
We recognize this directive means some patients will pay more dispensing fees and/or copay, but the overall consequences of not acting now to protect the drug supply are simply too great to ignore. We commend the New Brunswick Prescription Drug Program for supporting New Brunswickers by covering the copay for second and third fills on medications that were usually filled on a 3-month basis. Unfortunately, this measure does not resolve the issue for New Brunswickers who have employer-sponsored or personal private third-party plans, or individuals who have no insurance coverage. The NBPA, with the support of the Canadian Pharmacists Association and the provincial government, have asked insurance providers to address these cost issues for patients.
We have heard calls for pharmacists to waive fees during this crisis. However, there are costs incurred and additional work required by pharmacists to dispense a prescription, and these are covered partly by the dispensing fee. It is not reasonable to expect pharmacies to absorb these costs or the copay of a third-party plan and continue to provide services, especially when many are already paying for services to deliver medications and installing safety precautions such as plexiglass barriers. In fact, in some cases, waiving a copay could require the pharmacy to supplement portions of the actual drug cost.
In addition to that extra work, community pharmacists are presently dealing with an unprecedented volume of interactions with members of the public because access to other healthcare providers is restricted. Because most prescribers have largely closed their offices and are available only virtually, pharmacists are assisting with reducing non-essential physician visits by extending expired prescription and providing emergency prescriptions, in addition to administering injections. None of these services are compensated by Medicare as they would for other healthcare professionals.
To be frank, we are concerned about the well-being of our pharmacy professionals and their support staff. New Brunswick has 233 community pharmacies, many of which are small business owners serving both urban and rural communities across the province. During this pandemic crisis, the risks to their sustainability is clear. Our pharmacies are remaining open, our pharmacists and their teams are continuing to care for patients, despite being at high risk of infection, as immediate frontline healthcare providers.
Many measures taken by Public Health and other healthcare partners at this time are having a significant impact on individuals. Those decisions - like this one that protects our drug supply - are taken for the protection of the public’s health and safety. Like other health care providers, pharmacists need to be supported as we work toward the same goals.
We look forward to being on the other side of this crisis. Until then, we ask for your patience and understanding with this temporary measure.
I have attached a short FAQ to help explain the issue further as well as a joint letter from the NBPA and the NB Medical Society on this matter. Also attached is an urgent call from the Canadian Association of Pharmacy Distribution Management for Canada to continue to stay the course on 30-day supply.
Please don’t hesitate to contact me if you have any questions about this matter or wish to discuss it further.
Interim Executive Director
New Brunswick Pharmacists Association