Community pharmacies weigh financial impacts of COVID-19 vaccination campaign

Community pharmacies remain significant contributors to getting Canadians vaccinated against COVID-19. Now that vaccine supply is more predictable and changes to vaccine eligibility have slowed, pharmacists can examine the impact of the program on their finances. Tangible costs In order to administer COVID-19 vaccines, community pharmacies had to invest in a number of areas. One was buying appointment booking software and paying for associated charges. Jaspreet Chager, senior manager of pharmacy innovation for Pharmasave in Ontario, noted that for some software, pharmacies were charged to process each appointment, which adds up during a mass immunization campaign. The software also needed to be set up and managed in a way that worked for the pharmacy and its patients, said Marco Casagrande, vice president of operations for Sandstone Pharmacies in Alberta. “We’ve had an enormous amount of resources put in to just managing the ebbs and flows of the software system, making sure people are there for the right time, for the right appointments, for the right type of vaccine,” he said. Other set-up costs included refrigerators, thermometers, furniture, signage and extra computers. As the campaign continues, so do the bills. Whether a pharmacy pays for PPE depends on whether or not it is provided by the province. There’s also an amount to pay for sharps disposal. There are increased marketing costs as well, making sure the correct messages are being communicated to patients. Pharmacies had to hire additional staff and compensate those putting in extra hours, from the front-line immunizers to the administration teams. Chager said that there are few pharmacists, pharmacy technicians, students or interns currently available in Ontario: everyone is working. In some provinces, pharmacies were able to hire allied healthcare professionals, including nurses, to help with immunization. Reimbursement Did the service fees from provincial governments cover the costs, or was delivering COVID-19 vaccines a largely altruistic exercise for pharmacies? It may depend on the province. Reimbursement ranged from $25 per dose in Alberta to $13 per dose in Ontario, New Brunswick and Newfoundland and Labrador. In Ontario, Angeline Ng said the Ontario Pharmacists Association has been hearing from members that the reimbursement was not enough to cover operating costs. Ng, the OPA’s vice president of professional affairs, said that the OPA is currently examining the average costs borne by community pharmacies to offer COVID-19 vaccines. A final report is expected in the fall. Casagrande said the renumeration from the Alberta government has been fair. He said that how much was take-home profit from the pharmacy depends on the size and scope of the pharmacy. For example, some smaller pharmacies may not have hired additional staff and were able to do it all themselves. Once the final numbers are calculated, “I’m thinking that we’ll be fortunate if we have broken even on the fee,” he said. Billy Cheung of Pharmasave Canada said it was difficult to answer if the renumeration was appropriate for the amount of work involved, but pointed out that pharmacies didn’t participate in the COVID-19 vaccination campaign for profit. “Pharmacies were involved because they wanted to help their patients,” he said. Cheung is the executive director of pharmacy, marketing and professional affairs at Pharmasave Drugs in Eastern Canada. Hidden costs A cost that many might not consider is what Casagrande calls “the cost of people.” “There’s been pressure wrapped around the vaccination process,” he said. This constant pressure has all taken a toll on pharmacy staff. Casagrande said that Sandstone Pharmacies has been trying to determine how staff are doing mentally and physically, and if there is anything the company can do to alleviate the pressure. This includes "assessing what are people having to use to help themselves get through the process," he said. "For many of our pharmacists, they are accessing the benefit plan.” This covers massage therapy or counseling services. Many staff members haven’t taken a holiday for a long time, and the company is trying to figure out how to give them a significant holiday. “Even a week away is not significant enough to take away the wear and tear that’s occurred to them,” Casagrande said. There are also the opportunity costs, or what has been lost while the pharmacies focused on the vaccination push. “In many of our retail stores we’ve had to pull people from all sorts of departments of the store – retail, administration, head office – and we’ve had to really use them to get enough front-facing capacity to the patient,” he said. The result is that all of their work and responsibilities have been curtailed, with measurable results. For example, certain departments have performed differently financially. Clinical opportunities such as care plans, follow-ups and writing prescriptions, have also been missed as shots were put in arms, Casagrande said. Cheung said that management teams have been providing support to pharmacies throughout, including making sure vaccination statistics were sent to the COVaxON system and ensuring staff training was up to date. All levels of pharmacy staff have sacrificed their weekends, their evenings and the pharmacy's normal operation to ensure success, he said. The vaccination campaign even affected pharmacies who weren't delivering vaccines, because they were also actively answering vaccine questions from patients, Cheung said. Casagrande said that the full impact of people costs and opportunity costs has yet to be revealed. He advised pharmacies to take a step back from the COVID-19 vaccination and examine the entire pharmacy’s operation to make sure it can resume normal pharmacy operations once the COVID-19 vaccination push subsides. Benefits Cheung and Chager said that pharmacies have been seeing new faces since the vaccine campaign started. How that translates into profit has yet to be seen, but Casagrande reported many who got COVID-19 vaccines at the pharmacy have become customers. There’s another impact too, one that is not easy to capture on the ledger. Casagrande said he reminds pharmacy staff that “for the life of these patients, they will drive by your store, and they will recognize that your store gave them the opportunity to resume life as normal.” “That is an emotion and a feeling that can never go away,” he said. The public also has a new view of pharmacies thanks to the COVID-19 vaccine rollout, which will perhaps make them rely on pharmacies more in the future. “I would strongly suggest that the perception and respect for the role of the pharmacist and pharmacy technician has been elevated like never before,” Cheung said. With a renewed appreciation of pharmacies by the public, the COVID-19 vaccination campaign may have long-term financial effects beyond the initial cost versus revenue analysis.

Community pharmacies weigh financial impacts of COVID-19 vaccination campaign

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