A patient’s journey: Shedding light on the value of pharmacy services for Canadians taking high-cost specialty drugs

This article was originally published in Neighbourhood Pharmacy Gazette, August 2023. Specialty medications treat chronic, complex, rare or genetic conditions. They are revolutionizing treatments and may even be a cure for debilitating diseases such as cancer, hepatis C and autoimmune disorders. And they are complicated. And costly. Specialty medications represent just 1.7% of medications dispensed yet 44% of costs, reports IQVIA Canada.[1] Pharmacies dispensed 13.1 million prescriptions for specialty drugs in 2022, valued at $13.3 billion.[1,2] They are “specialty” drugs because they often require specialized handling (such as compounding and cold chain protection), administration (by injection or infusion), reimbursement navigation and enhanced clinical services (for adherence, to prevent adverse events, to monitor outcomes, etc.). All community pharmacies dispense specialty medications. Some have dedicated their operations to these medications, investing millions in an infrastructure that includes distribution sites and infusion clinics. A formal funding mechanism does not exist for most of the services associated with specialty medications. Pharmacies and pharmacy distributors rely mostly on revenue from markups that are tied to the cost of the medication. The reliance on markups is problematic. “There is a misconception that the higher price points of specialty drugs generate markups that are enough to cover costs and help keep pharmacy sustainable,” says Shelita Dattani, Senior Vice President, Pharmacy Affairs and Strategic Engagement, Neighbourhood Pharmacies. “In reality, this type of funding model is precarious for both pharmacy operators and patients. Payors are looking to contain costs by lowering prices and markups and don’t realize these actions jeopardize sustainability and compromise the ability of pharmacies to provide the level of care needed for these patients.” To help build the understanding of all stakeholders, Neighbourhood Pharmacies decided to produce an evidence-based report to capture and communicate what’s involved in the services provided by pharmacy teams to Canadians taking specialty medications—and how pharmacies are filling gaps in care that would otherwise have to be provided, and funded, by the public healthcare system. In March 2023, the Association commissioned IQVIA to conduct an analysis of several key specialty services offered by pharmacies, drawing from IQVIA’s internal databases, the experiences of Neighbourhood Pharmacies’ members and partners, and published clinical research. “Up until now the value of the interaction between specialty patients and pharmacy teams has not been well documented,” says Brad Millson, General Manager, Real World Solutions, IQVIA Canada. “Being able to demonstrate that in a cohesive, evidence-based manner is very important to advance discussion among all stakeholders on where we need to go from here.” The resulting report, The Value of Specialty Pharmacy Services to the Healthcare System, became available in August. “We anticipate the report will help inform policy change on pharmacy practice for patients taking specialty drugs in Canada,” says Dattani. “We are also excited to leverage this report as we start to think about pharmacy as a partner in the national strategy for drugs to treat rare diseases.” The Gazette shares excerpts from the report here, supplemented with commentary from Karl Frank, Managing Director, Bayshore Specialty Rx, and Alicia Wood, Senior Manager, Specialty Pharmacy, Walmart Canada, members of Neighbourhood Pharmacies and the task force that guided the report’s development. The report focusses on six categories of service associated with specialty medications: Infrastructure and inventory management Reimbursement navigation Intravenous infusion administration and coordination Enhanced dispensing-related services Enhanced medication management Enhanced clinical monitoring 1. Infrastructure and inventory management EXECUTIVE SUMMARY EXCERPT While all pharmacies dispense medications that meet the definition of a specialty medication, some have invested millions of dollars to upgrade their facilities to meet all possible requirements for the distribution, storage, handling and administration of complex, high-cost, fragile medications. Cold chain protection is a huge component of costs. Close to half of the 13 million specialty prescriptions dispensed annually require cold chain protection. The maintenance of on-site cold chain integrity costs between $400,000 and $2 million per pharmacy per year, or between $27.2 million and $136 million annually for the sector.[3,4] Cold chain shipments go to infusion clinics, other medical facilities or directly to patients’ homes. “Inventory management is really about getting patients on their medication as quickly as possible,” says Frank. “The pharmacy needs to strike a balance between having enough inventory on hand and the inventory capital costs, which can be very high.” This takes on added significance for specialty medications since prior authorization and the securing of reimbursement can delay dispensing by days or even weeks. While those requirements are met, the pharmacy makes sure that product availability does not further delay the start of treatment. In fact, once pharmacies get the green light to dispense, the patient will usually have the medication within 24 hours. “Canada’s pharmaceutical distribution system is top-notch, with state-of-the-art measures for cold chain protection and same-day or next-day delivery for most orders,” says Dattani. The 24-hour turnaround is standard whether patients get their medications from pharmacies dedicated to caring for patients taking specialty medications, which have their own wholesale facilities and ship directly to patients or healthcare institutions, or from their local community pharmacy, which orders specialty medications from either their usual distributor or a specialty distributor. Cold chain protection is a huge, and costly, factor in inventory management. “It’s really a skill set that requires significant training, infrastructure investment and follow-up to ensure shipments maintain their required storage temperature throughout the supply chain,” notes Frank. The process can be incredibly complex, as was the case for an autologous stem cell transplant that recently took place for an oncology patient in New Brunswick. “The medication needs to be administered to the patient at exactly the right time during the procedure, and in this case the oncology centre could give very little advance notice. We flew the drug to the patient within hours. The rapid response and constant coordination with the oncology team were critical,” says Frank. For less complex specialty medications, such as self-injectable biologics that can be stored in household refrigerators, cold chain protection revolves around education and continued dialogue with the patient. “We ensure that patients have the means and the understanding to maintain the cold chain. Many patients choose to come with their own cooler and are confident with their ability to store their medication,” says Alicia Wood, Senior Manager, Specialty Pharmacy, Walmart Canada. High medication costs and small patient populations are two other factors that influence inventory management—and the evolution of pharmacy practice for patients taking specialty drugs. For medications to treat rare diseases, the patient population can be less than a few dozen in Canada. “The working capital alone would be prohibitive for broad distribution across every community pharmacy, which is why centralizing through specialty pharmacies works really well to ensure adequate inventory is on hand for quick and safe delivery,” says Frank. Inventory management in traditional community pharmacies more commonly involves specialty medications used by relatively larger patient populations, where perpetual inventory management can occur. Patients can also benefit from community pharmacies’ “just-in-time” practices for special orders needed by specific patients. “Typically, our wholesalers operate on a next-day basis. This provides our teams with the ability to order products well in advance of when a patient needs their medication, so that the patient can pick it up or we deliver it the same day as part of our usual delivery service,” says Wood. 2. Reimbursement navigation EXECUTIVE SUMMARY EXCERPT An average annual cost of $10,000 is not unusual for a specialty drug and a growing number cost more than $100,000 annually. It is imperative that the out-of-pocket financial burden for patients does not prevent, curtail or interrupt access to these life-changing therapies. Accessing insurance coverage can be complicated and time-consuming due to the process of prior authorization. Reimbursement navigation support is essential, and a key offering of Canadian pharmacies that provide specialty services. Canadian studies with oncology patients found that reimbursement navigation services reduced the time to initiation of treatment by six to 25 days.[5,6] Reimbursement navigators connect patients to public and private sources of coverage they may not know they already have. They demystify industry jargon and guide patients through enrollment, options, applications and appeals. They coordinate with patient support programs for additional financial assistance, if warranted. Reimbursement demands consistent and ongoing effort. Canadian pharmacies providing specialty services estimate that reimbursement navigation requires 30 to 120 minutes per patient per encounter.[7] Reimbursement navigation is about more than the money. It’s about removing a huge source of stress so that patients can focus on their health. “Patients are usually already struggling with their physical health, and often their mental health. Having to sort through reimbursement from private or public drug plans can easily overwhelm them. The initiation of treatment is delayed, and symptoms can worsen because of the stress,” says Dattani. Reimbursement navigation is also about jump-starting patients’ access to a drug that could be life-changing, even life-saving. “Because of the work we do obtaining early coverage, we feel we’re actually a key part of the launch of the drug into Canada,” says Frank. That’s because coverage by public drug plans is typically not available for more than a year after a specialty drug is approved by Health Canada, whereas private funding—from private drug plans and the manufacturers themselves, through their compassionate coverage programs—can usually be put in place within weeks or even days, often thanks to navigation support from the dispensing pharmacy. Payors and providers also benefit. First, an earlier start to treatment generates savings through reduced visits to hospitals and physicians’ offices. Second, “pharmacies get a lot of exciting real-world data starting from the launch of a product. It gives good insights on patient outcomes and can aid prescribers in making decisions based on data that wasn’t collected during the clinical trials,” says Frank. For example, in some areas in oncology, “we are finding that outcomes differ in the broader population and when we look at combinations with other drugs that wouldn’t be considered during the trials. This level of insight for the prescriber can result in improved clinical outcomes,” says Frank. Manufacturers’ patient support programs (PSPs) often serve as the starting point for reimbursement navigation. “Where a patient support program exists, our teams work with them to get our patients set up for success in terms of their coverage,” says Wood. PSP personnel often rely on the pharmacy team to clarify the details of a health benefits plan and provide real-time adjudication data on copayments and deductibles to ensure patients avoid delays in therapy due to financial circumstances. “In one example, our team supported an Ontario patient who had been paying over $70,000 out-of-pocket every year for two specialty medications that were being dispensed by competitor pharmacies. The patient was submitting claims manually to a public program. Now this patient avoids these financial and administrative burdens and has all their medications consolidated and digitally reimbursed through one of our pharmacies,” says Wood. 3. Intravenous infusion administration and coordination EXECUTIVE SUMMARY EXCERPT More than a third of specialty medications require administration by intravenous (IV) infusion, administered at infusion clinics.[8] Pharmacies dedicated to specialty medications have established more than 420 infusion clinics across Canada, which represents 98% of all infusion clinics. Clinic staff administered more than 500,000 specialty IV infusions worth more than $2.2 billion to more than 130,000 patients in 2022.[8,9] This network of clinics is especially important for the one-in-three patients who live in rural or remote areas, who would otherwise face hours of additional time per infusion to travel to a clinic in a major city. This extra time, as well as the added transportation costs, can negatively impact adherence as well as physical and mental well-being. Specialty pharmacy-run infusion clinics fill a gap in timely and equitable access to care. They increase healthcare capacity by operating during weekends and outside of work hours, adding an estimated 1 to 2.5 million hours of essential infusion capacity to the healthcare system.[10,11] They do not receive government funding; however, without them, the public healthcare system would have to take on significant costs to match their volume and level of service. Specialty pharmacy infusion clinics add capacity to the public healthcare system on multiple levels, the most obvious being the availability of hundreds of brick-and-mortar clinics throughout Canada. Of equal value is the “collaboration and coordination between our pharmacy teams and our nursing teams to fully manage the patient. In addition to injections and infusions, there are blood draws required for lab tests, companion diagnostics, EKGs and other services. The clinics provide whatever is required for that patient and their medication,” says Frank. The infrastructure of these infusion clinics also includes mobilizing to meet the needs of vulnerable patients in the comfort of their own home. “Patients may not be ambulatory. They may be struggling with a rare or other debilitating disease or, in some unfortunate cases, palliative care. We make it easier for these patients to receive home-based infusions or injections,” says Frank. And competition does not get in the way of patient-centred care. For example, soon after the start of the COVID-19 pandemic Canada’s largest specialty pharmacies collaborated to ensure zero interruptions to therapy. “If any clinic had to shut down because of staffing issues or an outbreak, other competitor clinics would take on their patient loads until the original clinic was safe to resume. That only happened once or twice during the pandemic, but it was very important to have that set up ahead of time, to share our infrastructure and to make sure that patients didn’t go without their therapy,” explains Frank. In the absence of an established infusion clinic infrastructure, community pharmacies coordinate with many specialty pharmacy infusion clinics to administer IV products. And as the scope of practice for pharmacists continues to expand, patients are increasingly able to turn to their usual community pharmacists for support with the administration of other injectable specialty medications. “Our patients rely on the convenience and accessibility of their community pharmacists to administer these medications on their behalf. The prevalence of this service will continue to grow as more provinces expand their scope of practice to complement the growing number of self-injected products in Canada,” says Wood. Canada’s network of private infusion clinics is also evolving in response to the growing availability of biosimilar biologics. “In many cases, biosimilars have really opened things up from a patient selection perspective,” says Frank. That said, certain higher-risk medications require infusions to be administered in highly specialized clinics. “You may have to have a physician on site, for example,” notes Frank. “Or there may be a need for EKG monitoring or post-dose monitoring. We have become very innovative and open to provide community health services that were previously available only in hospitals.” With all that in mind, Frank has found that most external stakeholders don’t understand the economics of infusion clinics. “One big misconception is that manufacturers pay for the full cost of the services. That’s not the case. The infrastructure, the lease, staff management—including frequent schedule changes to expand hours to meet patients’ needs—and the working capital to manage lab coordination and all the services are not covered at all by manufacturers.” 4. Enhanced dispensing-related services EXECUTIVE SUMMARY EXCERPT The fragile and potentially sensitive nature of specialty medications, as well as their unique administration requirements (e.g., infusion), necessitate enhanced dispensing-related services. Compounding Pharmacists may need to alter the strength or formulation of a medication, or combine medications. Ten to 20% of all specialty medications involve compounding.[1,4] A “clean room” is mandatory to compound and work safely, with an upfront investment of at least $680,000 on average and $300,000 annually for maintenance, including training.[4] Coordination of deliveries Many pharmacies deliver specialty medications directly to patients’ homes to remove the risks associated with vulnerable, frail or immunocompromised patients leaving their homes. A large number of specialty medications must be administered in combination with IV infusions. Pharmacies ensure that these medications are delivered on time to infusion clinics. Specialty medications can be described as the vanguard of personalized therapeutics. They may involve the use of biomarkers, the patient’s DNA or immune cells to deliver extremely targeted treatment, in many cases for diseases that were previously untreatable, including certain cancers. The more complex the medications, the more they must be handled with care—and administered quickly. “There is a big pipeline of monoclonal antibodies and cytotoxic medications that must be mixed in a sterile environment. Then they may be only stable for only 24 hours or less, so you’ve got to make sure you prepare and deliver them on time to the infusion clinic,” says Frank. This requires coordination not only with the clinic but also with the patient, to ensure they get to their appointment on time. If all the pieces do not fall into place, the medication must be discarded and the pharmacy absorbs the cost of the spoilage, which could exceed $10,000. 5. Enhanced medication management EXECUTIVE SUMMARY EXCERPT The complexity of medication management derives from one or more of the following factors: the nature of drug itself, the way it must be administered, the management of adverse events or the nature of the disease or condition treated. Standard clinical services such as patient education, counselling and medication assessment are often more frequent and involve more time and expertise than is typical for non-specialty medications. The pharmacy team may need to provide unique clinical services for testing and monitoring. Without these services, the risk is much higher for avoidable healthcare costs due to sub-optimal therapeutic effect, treatment delays and disease progression. Education and counselling General education for patients taking specialty medications can take up to one hour per consultation. Counselling on disease states and related health concerns, or answering patients’ own questions, can take up to another one hour. Injection training is another important service. In 2022, Canadian pharmacies dispensed more than 1.9 million prescriptions for self-injectable medications.[8] Medication assessment Specialty medications carry risks of serious adverse events. Pharmacists’ assessments of safety, effectiveness and appropriateness, which includes checking for interactions with other medications, are generally more time-consuming than assessments for traditional therapies. A medication history alone can take 30 minutes to 2.5 hours. The full assessment may require consultations with other members of the healthcare team. All told, each assessment takes one to four hours and occurs at least several times a year per patient, or with each refill of their medication. Medication adherence Many factors can negatively impact adherence. Patients often live with multiple chronic conditions or co-morbidities, such as pain and depression, which can affect mood, functionality and energy levels. Multiple medications, each with its own regimen, can be difficult to coordinate. Non-adherence not only jeopardizes health outcomes and may speed the progression of disease, but also wastes valuable medications and healthcare services. In Canada, nonadherence is the cause of 5% of hospital admissions and 5% of physician visits, resulting in $4 billion in avoidable annual costs to the healthcare system.[12] Canadian pharmacies providing specialty services support adherence in multiple ways and spend, on average, 30 minutes per adherence activity.[7] One study found that adherence support for patients taking specialty medications reduced the risk of discontinuations by 72% and increased the likelihood of adherence by 83%.[13] Services for biosimilars Biologics constitute approximately two-thirds of the specialty market.[3] In recent years, as patents for originator biologics expire, biosimilar versions of these biologics have come to market and have become a focus for cost-containment efforts by public and private payors. In Canada, from March 2021 to March 2022, sales of biosimilars increased by 51%.[3] Higher uptake of biosimilars will continue apace as “biosimilar switch” initiatives roll out across provincial drug programs and are subsequently adopted by some private payors. Biosimilars require the same level of services as the originator biologic. As well, pharmacies assist patients in transitioning from the originator biologic to a biosimilar. The coordination of services around many specialty medications naturally boosts adherence rates. “There’s a built-in adherence model with delivery where pharmacy staff are reaching out to the patient with every fill, as opposed to the traditional model where the patient comes to you,” says Frank. “We proactively reach out and address any issues or questions they may have before they become problems. Adherence rates are very high as a result of that coordinated effort.” Throughout the community pharmacy sector and from coast to coast, expanded scopes of practice also help drive new approaches in the provision of medication management. “New authorities, patients’ expectations, technologies and registered pharmacy technicians—so much is coming together to enable our profession to evolve like never before,” says Wood. “We are transitioning our teams away from a lot of the traditional dispensing services by bringing in tools and processes to free up their time for clinical care.” Wood agrees with Frank that proactive outreach is a critical component of new service models—for non-specialty as well as specialty medications. “A proactive approach helps to keep our patients on track and inherently frees up time for clinical care provisions and patient monitoring. It’s exciting to think of the impact we can make on people’s lives by acting proactively,” says Wood. On the specialty drug front, self-injectables are a good example of the benefits of proactive adherence support. “There is often a need for additional support when it comes to self-administered products—we see it every day at our pharmacies. Patients may not be comfortable or confident in their abilities to self-administer, and some may hesitate to say anything,” says Wood. On another front, proactive care combined with PSPs and new technologies translate into “some pretty amazing real-world data that’s critical when you’ve got small patient volumes,” says Frank. “It’s exciting when you think about what we can do with the data—like predictive and prescriptive analytics to help understand when patients are at higher risk of adverse events, to allow you to take action in advance. It’s also a goldmine for researchers.” For example, data from the PSP and a global database made it possible to study the safety of ocrelizumab, for multiple sclerosis, before and during pregnancy.[14] Traditional clinical studies would not be feasible for such a small patient group. (For more on real-world data from Canadian PSPs, get the April 2023 edition of The 20Sense Report.) 6. Enhanced clinical monitoring EXECUTIVE SUMMARY EXCERPT Unlike most other drugs, specialty medications often have a much smaller “window” between the dose needed for therapeutic effect and the dose that can lead to adverse effects. Specialty pharmacies and infusion clinics provide or support a range of monitoring services. Therapeutic drug monitoring (TDM) is a laboratory-based service that measures drug concentrations in the patient’s blood and enables healthcare providers to adjust doses with a high degree of precision for the individual patient. Therapy adjustments are very common due to the progression of the disease, other health issues and life events. Pharmacists become experts in the pathophysiology and progression of complex diseases and use evidence-based treatment decision-making algorithms to determine when adjustments are required. The prevention of adverse drug events (ADEs) involves services that can require 2.5 hours per patient on average.[4,7] Some patients require these services several times a year. ADEs are responsible for almost 3% of hospital admissions in Canada.[15] Early this year, Frank received a thank-you message from a patient—whose treatment began more than a decade ago. “She’s been cancer-free for 11 years. It was a beautiful email thanking our team for everything we’ve done over more than a decade of therapy.” The treatment was one of the first immuno-oncology therapies in Canada, he recalls. “It was ground-breaking, for melanoma, and we designed a whole new service model. It required adverse event monitoring, clinic coordination and constant coordination with the oncologist and specialist.” Such enhanced clinical monitoring is standard operating procedure for a growing number of specialty medications. “The physicians and everyone else on the healthcare team are trusting you as a pharmacist to have the knowledge and the education to reach out to their patient to monitor for adverse events and, if necessary, suggest or adjust dosages so that the patient remains on therapy,” says Frank, adding that remote monitoring, so patients do not need to leave their home, is increasingly possible. These services reach their apex for drugs with a risk management plan required by Health Canada as a condition of approval. “Twenty years ago, many of the products that are on the market today may not have been launched because of their high-risk profile. Health Canada’s risk management program requires our industry to have an infrastructure for these drugs to be much more closely monitored. The pharmacy is at the heart of that,” notes Frank. While the risks are higher with most specialty medications, so are the rewards, summarizes Frank. “It is such a great experience working with these patients, especially when there have been no really effective therapies until now. When we see the results and hear back from the patients, that’s what provides so much meaning to the work that we do.” Conclusion EXECUTIVE SUMMARY EXCERPT Canadian pharmacists and pharmacy teams safeguard the distribution and preserve the integrity of $13 billion worth of specialty drugs every year, a figure that grows at an approximate rate of 10% annually.[1,3] Without the enhanced services of pharmacies that dispense specialty medications, patients would be vulnerable to limited access to the medications as well as reduced access to professional advice. They would likely face increased out-of-pocket costs. Their risk of adverse drug events, interruptions in therapy and poorer health outcomes would be higher. Drug spoilage and wastage would increase. Canadian pharmacies that provide specialty services fill gaps in the public healthcare system in the areas of reimbursement navigation, infusion, patient education, monitoring and adherence support and, more recently, the transition of patients from originator biologics to biosimilar biologics. The current public system simply does not have the capacity to provide these services. Overall, pharmacies providing specialty services contribute an estimated 8.9 million hours of clinical services annually.[2,4,7] Such clinical support alleviates a substantial burden on the public health system, potentially offsetting up to $790 million in incremental costs if these services were provided by physicians [2,4,7,16] In total, pharmacies that provide specialty services directly invest and offset an estimated $1 billion, at minimum, in economic value for the 1.9 million patients who are otherwise unsupported by the current public health system. Despite the value of these services, a formal funding mechanism does not exist. Pharmacies must rely mostly on revenue from markups that are tied to the price of the medication. As medication prices and markups are cut back as part of payors’ cost-containment efforts, the sustainability of these services is in jeopardy. At the same time, the pipeline for specialty medications continuously evolves, with increasingly complex medications for small numbers of patients on the one hand and more readily available, self-administered medications for relatively large patient populations on the other hand. Additional models of remuneration, based on the complexity of the service, are essential for pharmacies to resource appropriately so that patients, and the healthcare system, can benefit fully from these life-changing, and at times revolutionary, medications. Pharmacies that provide services to patients taking specialty medications represent a continuum of community-based settings, from bustling neighbourhood pharmacies to office-based specialty pharmacies where pharmacy teams mainly connect virtually (by phone) with patients. That continuum will continue to evolve and mature in response to medical advances and the complexities of patient care—and to protect sustainability. “There may always be a need for specialty pharmacies since it may not be feasible for traditional community pharmacies to establish infusion networks or invest in the highly specialized infrastructure required for the most complex therapies,” explains Wood. For lower-touch, lower-complexity specialty molecules, she anticipates a growing shift to the neighbourhood community pharmacy. In fact, she notes it’s essential to help safeguard the sustainability of the specialty sector. “The collective goal is to be most cost-effective in how we supply and steward these medications,” she says, adding that expanded scopes of practice, improved operational efficiencies and new technologies in recent years have bolstered traditional community pharmacies’ state of readiness. Wood, Frank and Dattani emphasize that the service model must revolve around the patient. “The key here is patient choice. Some patients really want to stay with their regular community pharmacy, others prefer a pharmacy that’s dedicated to specialty medications. As a sector we want to seamlessly offer up what fits best for the patient based on their needs, the complexity of their disease and the requirements of the medication,” says Dattani. All three also agree that a funding model that hinges on markups hampers efforts to build an environment that is inclusive for patients while allowing for healthy competition between pharmacies. Markups also devalue the care provided by all pharmacies because they do not effectively recognize the complexity of services tied to these medications. “There needs to be a healthy balance between markups and service remuneration,” states Wood. Markups have long served to recoup the costs of services that are not directly remunerated, both for specialty and non-specialty drugs, remarks Dattani. “But markups are eroding due to price compression and direct cuts. The balance needs to be reset through additional funding models tied to services. We’re ready to come to the table to help payors do that, with solutions that are reasonable for both sides.” Frank recalls what happened several years ago when some provinces reduced the markup for hepatitis C drugs. Before the cutback, pharmacies and clinics proactively went into the community to conduct liver scans and get patients on therapy. “That stopped after the cutback and individuals who were homeless or less privileged went without treatment because there wasn’t a funding model to aid in the diagnostics,” he says. Conceptually, funding models that are tiered based on the complexity of care make sense to better enable the wraparound care required for more vulnerable patients, suggests Dattani. “We have the tools and the evidence to start to shape what this should look like.” In the bigger picture, Neighbourhood Pharmacies is asking for a seat at government tables to help guide decisions on service models as well as funding models for the many exciting yet complicated new therapies available for patients. Raising awareness, through initiatives such as The Value of Specialty Pharmacy Services to the Healthcare System report, is a priority. “We know we need to provide visibility into the great work pharmacies do for Canadians taking specialty drugs,” says Dattani. “And we don’t want payors to just hear it from us—we want them to listen to the patients and specialists involved in their care. We can’t emphasize enough our desire, and our ability, to be part of the solution for all stakeholders.” Karen Welds is a healthcare journalist and has written about community pharmacy for more than 25 years. References: IQVIA Rx Premium. IQVIA, Editor. 2022; IQVIA Claims Database. IQVIA, Editor. 2022; PharmaFocus 2026. IQVIA. 2022; Estimated from data provided by members of Neighbourhood Pharmacies that provide services to patients taking specialty medications. 2022; Baptist G, et al. PCN252 Time-to-treatment initiation (tti) in community infusion clinics: decreasing wait times for Canadian oncology patients. Value in Health 23. 2020:S6; Harvey N. Impact of a drug access facilitator in a chemotherapy clinic. CPJ. 2012;145.4:S41; A primer on the value of specialty pharmacy services for patients and healthcare systems in Canada. Neighbourhood Pharmacy Association of Canada. 2020; IQVIA Canadian CompuScript. IQVIA. 2022 Sep; IQVIA claims database. IQVIA. 2022 Sep; Ong WC, et al. A quality improvement project reduces time spent at an inflammatory bowel disease infusion center with accelerated infliximab infusion protocol. JGH Open. 2022;6(7):470-476; Medication Guides. Rituximab. American College of Rheumatology. 2023; Non-adherence costs employers. Benefits Canada. 2014 Oct; Marshall JK, et al. Impact of the adalimumab patient support program’s care coach calls on persistence and adherence in Canada: an observational retrospective cohort study. Clinical Therapeutics. 2018;40.3:415-429; Gitman V, et al. Pregnancy outcomes of women with multiple sclerosis treated with ocrelizumab in Canada: A descriptive analysis of real-world data. Must Scler Relatability Disordering. 2022 Jun;62:103792; Reducing Adverse Events and Hospitalizations Associated with Drug Interactions. ISMP Canada. ISMP Canada Safety Bulletin. 2013; Job Bank - Medical Doctor in Canada. Government of Canada. 2023.

A patient’s journey: Shedding light on the value of pharmacy services for Canadians taking high-cost specialty drugs

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