September 18, 2013
Pharmacists: Expanded Scope of Practice Market Revolution?
At the first meeting of the 2013-2014 season, the guest speaker was Bertrand Bolduc. Bertrand is the chairman and a partner at Galenova, Gentes & Bolduc Pharmacists and is also a pharmacist, entrepreneur and former PMCQ president. He has also held marketing positions in pharma and currently sits on the boards of the Ordre des Pharmaciens du Québec, Urgences-Santé, Prevtec and Greenshield.
To get a feel for the audience, Bertrand started off the evening with a poll, asking how many were familiar with Bill 41. Only 29% were!
Bertrand explained that there is now a new pharmacy “model”, which is not about owning your own pharmacy store, but about managing a store that belongs to a chain. This means that pharmacists don’t have as much power as they did, but they still have to run profitable businesses. The new pharmacy reality is that the fees paid by the government have grown marginally, private payers are capping fees, new brand prices are higher (lower margins), generic prices are down (decreased mark-up) and professional allowances are gone or limited. All of this equals decreased profitability. In fact, big chain pharmacies in the United States have become a loss leader.
Bertrand’s first take-away message for the evening was that independent pharmacist profitability is under pressure; integration and competition from chains and banners is fierce, so pharmacists are looking for new ways to be profitable.
Within this new pharmacy "model", there are new ways that pharmacists have improved their distribution productivity, including certified pharmacy technicians, automated distribution technology and improved training. In most provinces, pharmacists can now offer more services. They can extend prescriptions, adapt prescriptions without contacting the physician, substitute medications when necessary, prescribe for minor ailments, initiate drug therapy for problems not requiring a diagnostic, order and interpret lab tests, and administer drug injections for demonstration purposes. Bertrand polled the audience again, asking them which new pharmacist role they felt will have the greatest impact on prescription products. 40% of the audience felt that renewing prescriptions would be the most impactful.
His second take-away message was that, because of these new services, patients will be driving change at the pharmacy level because they’re now expecting pharmacists to do more.
To illustrate his point, Bertrand mentioned a pharmacist in Alberta who prescribed over 8,000 times last year. He also charged for patient consultations to compensate for extra time consulting with physicians, but his patients pay for the convenience of this service. He increased product sales and was able to charge more fees for his services, but his customer loyalty is incredible.
Bertrand outlined the new pharmacy act in Quebec which allows pharmacists to offer many new services. They can renew or extend prescriptions for up to 12 months if the original prescription was for 12 months. The goal of this service is to avoid treatment interruption, as the patient is not required to visit their physician for prescription renewals. Since the patient will need to be followed and monitored, it means more work (and revenue) for the pharmacist. Pharmacists can also adjust prescriptions by changing the pharmaceutical form (e.g., capsules versus tablets) or dosage frequency (i.e., OD versus BID) or by increasing the dose to improve efficacy or decreasing it to prevent or reduce side effects. They can also prescribe treatments for minor ailments or when no diagnostic is needed; for example, smoking cessation, pregnancy-associated nausea or vomiting, travelers’ diarrhea, malaria prophylaxis, altitude sickness, cytoprotection for patients at risk, emergency contraception and birth control after emergency contraception. Bertrand then polled the audience again with two questions. The first was “How much are you willing to pay to get your prescription extended by your pharmacist for up to a year?” 47% of people said $10-15 and 31% said $20-30. He explained that the fee schedule proposed by the Association québécoise des pharmaciens propriétaires (AQPP) is $12.50 to extend a prescription for >30 days and free for <30 days. The second question was whether the audience thought that the pharmacist’s role in selecting drugs for patients will increase, stay the same or decrease. 77% answered that they felt their role would increase.
So, what does all this mean if you’re a pharmaceutical marketer? Bertrand advised that marketers should identify situations where pharmacists could impact their patients in terms of all the new services they can offer. He explained how marketers should approach clinical pharmacists: they are very patient-focused and typically very risk averse and focused on product safety. Pharmacists want safety concerns addressed, so pharmacist tools should be safety-focused. They need to know how to safely prescribe medications or increase dosages. Pharmacists are business owners as well, so marketers should also demonstrate the business advantages of their products or programs, such as improved patient retention or competitive edges.
Bertrand also explained that not all pharmacists are going to have an impact on brands, so it would not be in companies’ best interests to try to target all pharmacists. Only 5 to 10% of pharmacists are going to impact any one brand. He advised the audience to ask their physicians which pharmacists they like to work with and then target those pharmacists that are dynamic, risk-tolerant and have a direct communication style. He also suggested looking at IMS/Brogan data to target those pharmacies dispensing larger amounts of their medications.
Bertrand advised the audience to understand the process, thinking and culture of pharmacists. They need materials to sell their new responsibilities to patients, but they’re not used to marketing themselves, so they need help. For example, provide a tool that would communicate which monitoring tests pharmacists need to do with particular medications. Another idea would be patient counselling tools that explain why patients need to take their medications. If a pharmacist is renewing a prescription or prescribing a product, it presents an opportunity to reeducate the patient about compliance.
Bertrand’s last message of the night was this: pharmacy is not changing, it has changed and pharmacists can have an impact on brands.