Over the past few weeks, we have started to discuss community pharmacy practice. Our conversations always start off with us discussing the core of community pharmacy which involves an assembly line where pharmacy technicians and pharmacists work together to effectively and safely fill a prescription. Once said prescription is filled, the patient is counselled and sent on their way. This is the basis of community pharmacy practice, as we know. However, current technology has allowed for this process to become increasingly automated, leading to companies like Amazon entering the pharmacy market. After acquiring PillPack, a company that has mastered the pharmacy assembly line, Amazon has high hopes to revolutionize the pharmacy market. Many pharmacy owners are worried about this new player, and the plummeting of Walgreens and CVS stocks after Amazon supposedly entered the market reflect this. Another shakeup to the current community pharmacy landscape is the generic medication price cuts. As outlined in the rxownership.ca blog, 70 generic molecules are experiencing price cuts over the next 5 years, which may result in the loss of ~ $100,000 annually for a pharmacy. Does this mean doom for community pharmacies? Or is there a light at the end of the tunnel?
The assembly line can be automated, however, the patient-centric knowledge, care, and compassion pharmacists provide cannot be automated. Independent pharmacies may not be able to compete with companies such as Amazon in a per script based business, however, they may be able to identify and exploit niche markets to provide unique services. We have been observing a cultural shift in the pharmacy industry where specialized services are offered to patients in order to benefit their specific health care needs. Some of the early adopters of this ideology have already started such an escapade and are providing novel services which are benefiting their patients in unique ways.
Dr. Melanie McLeod, a community pharmacist who has board certification in mental health, is leading the trend in mental health specialty pharmacy. McLeod cares for patients suffering from a wide variety of mental health problems and provides unique services. McLeod’s services have been noted throughout her community and a local psychiatrist had this to say: “a community pharmacy that provides services specifically for patients with psychological disorders has been needed for a long time. It is honestly a dream come true”. McLeod hopes to train and mentor other pharmacists to increase specialization in this field and continue the pursuit to help those suffering from mental health illnesses.
Dr. Alan Low, a community pharmacist and pharmacy lead for BioPro Biologics Pharmacy, established a novel practice which has embodied what it means to operate as a specialty pharmacy. BioPro offers a tailored pharmacy experience to those individuals living with conditions such as rheumatoid arthritis. BioPro collaborates with rheumatologists and their collective patients to achieve the best health outcomes, by aiding patients with the navigation of the biologics market, resolving medication-related issues, providing medical devices these patients may require, and offering evidence-based supplementation for their health conditions. On top of this, BioPro also offers educational sessions by either one-on-one consultations with patients or in-house educational sessions where Dr. Low, his staff pharmacists or other health care professionals present healthcare related seminars to patients and their families. The pharmacists at BioPro also coordinate educational discussions with nearby healthcare providers to discuss health and drug-related topics as a group.
Pier Health Resource Center is a great example of a pharmacy that identified a niche population, which gravely requires the intervention of pharmacists. Pier Health addresses the needs of the homeless and at-risk population in Vancouver’s downtown eastside. They work closely with this population and provide mental health, chronic disease, and social supports in order to resolve drug therapy problems within the pharmacy and the community. Pier Health’s manager Craig Plain took it upon himself to aid in the fight against the increased opioid-related deaths occurring in our community. Working with the BC Center of Disease Control, Plain was able to secure Pier Health as the first provider for the free naloxone kits in British Columbia, which has benefited many of their patients and the community as a whole.
Over the past few years, we have noticed an increasing proportion of pharmacists playing an expanded role in the health care system. A number of noted key drivers influencing that trend include limited health care resources, the shortage of primary care physicians and the drive for greater efficiencies in the healthcare system. According to a report (Needs Assessment of Specialization in Pharmacy in Canada, 2015) published by the Canadian Pharmacists Association, many experts in the profession envision specialization (whether in the form of services or pharmacist qualifications) as the next step in the evolution of pharmaceutical care. There seems to be a number of key factors driving that movement forward including the number of drug therapies, an ageing but more knowledgeable and demanding population, and deficiencies in other areas of the healthcare system.
There may be a light at the end of the tunnel, and our intuition suggests that the light is to specialize. Pharmacies are already pursuing specialties in men’s health, women’s health, medicinal cannabis, home health care, travel health, diabetic education, veterinary drugs, compounding, renal, pharmacogenomics, and potentially many more. Anything that can be done on the back of technology is going to be fundamentally vulnerable; the history has shown us that over and over again… what Amazon did to bookstores, what e-commerce did to Toy-R-Us, what Netflix did to Blockbuster, what Uber did to the taxi industry, and so on. Community pharmacy may not be doomed, however, it may require industry leaders to take it upon themselves in order to identify niche markets and areas where pharmacist intervention will benefit the health care needs of a select population by providing specialized and personalized care.
Thank you for reading and feel free to share your thoughts below! 🙂
Amol Chahal, CEO & Arjun Randhawa, COO