Canada's changing pharmacy landscape

Canada’s community pharmacies may seem, at first glance, to exist collectively in a stagnant space. A 2016 report from Ryerson University’s Centre for the Study of Commercial Activity tallied the total number of community pharmacies at 10,272. Today, according to the National Association of Pharmacy Regulatory Authorities, that number stands at 10,860. At the same time, the industry continues to be dominated by two big national players—Loblaw and McKesson—who own a combined total of close to 2,000 of those pharmacies. McKesson also supplies more than 2,100 independent pharmacies, including IDA, Guardian, Medicine Shoppe and Uniprix. But numbers tell only part of Canada’s pharmacy story, and it’s a story that’s definitely not characterized by stagnation but rather by rapid progression and dramatic changes over the decade. “Pharmacy has evolved a lot more in the last 10 years than in the 10 years preceding,” says Chris Gardner, CEO of Neighbourly Pharmacies, one of the country’s newest and fastest-growing pharmacy networks with about 145 locations. “I’ve worked in pharmacy for virtually my entire career and have worked coast to coast from Newfoundland to B.C., and I can tell you that these are exciting times for the industry.” Expanding scopes of practice—with Alberta leading the way as the only province that ticks off all the boxes in the country’s table of pharmacy practices—is a key factor and attribute in pharmacy’s evolution over the last decade, says Gardner. Who would have imagined 10 years ago, for example, that they’d be getting their annual flu shot from a pharmacist, let alone their COVID-19 vaccine, of which more than 9.2 million have been administered by pharmacists. Who knew back then that the community pharmacist who handed them their diabetes medication would also be helping them monitor and manage their disease. Read Neighbourly poised to become second-largest chain in Alberta “Different changes are driven by different factors,” observes Sherif Guorgui, co-CEO of OnPharm-United, one of the largest buying groups for independent pharmacists, with almost 600 members in Ontario and more in B.C. and Nova Scotia. “However, the main change is being driven by the continuously increasing constraints on the healthcare system. With an aging population that is living longer, often with co-morbidities requiring multiple medications and needing special care, our healthcare system is facing unparalleled stress.” The COVID-19 pandemic has only exacerbated these pressures on our healthcare resources, adds Guorgui. “When you take into consideration the additional effect of the pandemic in general, and more specifically, the urgent need from public health to expand testing and vaccinations to as many people as possible, and when you further add to that the impact caused by many primary care providers closing their clinics, shortening their hours or choosing to work remotely, it is evident why pharmacy had to step up to fill those gaps and help ease the pressure on the healthcare system,” he says. Pharmacy’s evolution goes beyond expanded scopes of practice. The last several years has seen a diversification of business models in the industry. There’s the emergence of companies such as Neighbourly, which acquires independent pharmacies, usually from pharmacists looking to exit their business soon. There are also buying groups such as OnPharm-United, and banners such as Whole Health Pharmacy Partners, which marries group buying with access to programs that enable pharmacists to expand or enhance clinical services. While each represents a different business model, these and other similar organizations help ensure continued diversity in the country’s pharmacy landscape by enabling independent pharmacies to exist and grow alongside the big drugstore chains and banners. “I believe that the existence—and emergence—of different groups and banners is necessary to maintain a healthy ecosystem and to help level the playing field, as many buying groups and banners offer their members access to a wide range of professional, operational and practice support programs,” says Guorgui. This growing breadth and diversity also gives independent pharmacists the power of choice in their supply chain. “It’s good to have different options for buying groups and banners to choose from, since each independent pharmacy has a unique practice setting and business model, which may be better served by one group over the other,” says Guorgui. Dean Miller, president and CEO of Toronto-based Whole Health, with 143 member pharmacies in seven provinces, says this choice-filled environment may be responsible in large part for the innovations in pharmacy in recent years. “I used to be a corporate guy and I can tell you that I’ve seen more innovation coming out of independent pharmacies than I’ve seen at the big companies,” he says. “When you let a pharmacist take your program and run with it—instead of dictating that they execute according to a specific sequential order—it’s pretty amazing what they can do.” As an example, he points to Harrisville Pharmacy, which opened in mid-September in Moncton, N.B. A distinguishing feature of the new pharmacy is its mastectomy service, which it delivers in a consulting room designed for mastectomy prosthesis fittings. Whole Health also has a new model that brings together pharmacies and recreational cannabis shops. The first iteration of this model, which was launched in late September in Welland, ON, put an Insalata Cannabis Market right beside a Whole Health pharmacy. “We’ve included in this model the education provided by two PharmD pharmacists to create adjacencies where the cannabis shop will open right next to the pharmacy so they can share information.” he says. “Perhaps they can encourage patients who have never really found good relief from certain medications dispensed to them to add a new regimen to the mix,” explains Miller. “Of course, pharmacists can’t make claims that are unsubstantiated, and they need to be careful about how far they can go with making recommendations. That’s why we hired the two pharmacists to offer that kind of expertise.” hrough the new program, pharmacists can invest partly or wholly in an adjoining recreational cannabis business, with a license owned by Insalata and support and due diligence provided by Whole Health. “Insalata has 75 of these licences, of which probably six or seven are already spoken for,” says Miller. “The plan is to expand that and make it available to more pharmacists through a flexible investing model.” New pharmacy models mushrooming All across Canada, independent community pharmacists are venturing into new, innovative territories. In Manitoba, Tim Smith and Josée-Anne Le Dorze recently hung their shingle on a pharmacy model that focuses entirely on health coaching and disease management. In fact, their Winnipeg business, Simplicity Wellness, does not dispense medication at all. In Nova Scotia, thanks to a support program led by the Pharmacy Association of Nova Scotia (PANS), some pharmacists run consulting practices from their homes and never set foot in a dispensary. “One pharmacist does this and she goes and meets with patients in their homes,” says Allison Bodnar, PANS executive director. “The service is billed to the pharmacy, although she doesn’t actually work physically in a pharmacy.” While pharmacists can innovate only to the extent that their approved scopes of practice allow, these examples demonstrate their general willingness—one might even say eagerness—to do more, much more than they’ve been doing in past years. Technology is helping. In addition to the emergence in recent years of virtual pharmacies, innovations like remote medication dispensing, central fill pharmacies and robotic packaging are creating efficiencies and allowing pharmacists to focus more on clinical services. “We’re starting to see the separation of services versus technical functions, with more pharmacies, for example, starting to take advantage of centralized dispensing services,” says Sandra Hanna, CEO of the Neighbourhood Pharmacy Association of Canada. “Services like this will help relieve some of the administrative and technical strain on pharmacists. Karim Nassar, CEO of Mednow, a firm that provides dispensing technology services as well as virtual pharmacy and medical services, sees pharmacy evolving into more than a provider of medications and clinical services but also as a healthcare navigator who can direct patients to the appropriate services in their community and follow patients through their healthcare journey. “Our approach recognizes the value of community care and what we’re doing is creating capacity in community care,” says Nassar, whose company recently added house calls and virtual health to its offerings. “Right now, patients know that if they can’t see their doctor, they can see their pharmacist. But we envision the pharmacy as the first step in the healthcare journey, where a patient with a healthcare issue goes to their pharmacist first—whether that’s through a virtual pharmacy like ours or through a pharmacy in their neighbourhood—and after going through triage, the pharmacist can either prescribe something or direct them to a doctor.” Taken altogether, these innovations by organizations and pharmacists have driven an industry that stands transformed and is ready for even more transformation. For many pharmacists, the most significant—and desired—change will be in their ability to get more deeply into clinical services. Gardner at Neighbourly notes that even in provinces with broad scopes of practice, a lot of pharmacists are still too busy dispensing to provide consulting services. Not surprisingly, many pharmacies acquired by Neighbourly boost their clinical services significantly after the transaction. “In the past five years our clinical services as compared to dispensing has grown five-fold,” says Gardner. “Every time we go into a pharmacy where the owner is selling, when we talk to their team it’s unanimous that they want to do more clinical services. This is what pharmacists want and as scope of services continue to expand in Canada, we’re going to see more pharmacists going in this direction in the future.

Canada's changing pharmacy landscape

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