By Louise Cooney

1. Role of the Pharmacist in Canada By Louise Cooney By Louise Cooney

2. What is a Pharmacist? • Medication administration, maximize benefits, minimize adverse effects, and drug interactions • Primary role is to ensure that medications are taken effectively and appropriately • Can recommend an over-the-counter (OTC) product for pain relief, demonstrate the proper use of an asthma inhaler, and help patients manage their diabetes. • Advise on medication storage, missed doses, and what foods or activities to avoid.

3. What Do Pharmacists Do? Pharmacists contribute to the health care system by: • Compounding, preparing and dispensing drugs • Medication histories and maintaining patient drug profiles • Safety counselling to patients and caregivers • Making recommendations to prescribers and other health care professionals for adjustments to patients’ drug therapies

4. Providing non-prescription drugs, natural health products, prenatal products, health care aids and devices • Managing minor illnesses • Providing referrals and advice on health promotion and wellness • Home visits

5. Increasingly, Canadian pharmacists are delivering a range of innovative services including: • Educating and supporting patients and caregivers about home administration of IV drugs • Education on self-management of diseases • Hosting disease management and immunization clinics • Palliative care to improve symptom control • Monitoring and adjusting doses of drugs such as blood thinners (anticoagulants) and cholesterol-lowering medications

6. Prescribing by Pharmacist • Expanded role for pharmacists • Certain provinces have approved pharmacist prescribing with varying scopes of authority • Not meant to replace physician care • Expanded roles for pharmacists: • Prescribing OTC drugs to treat minor, self-diagnosed disease conditions such as a rash, a cough or diarrhea • Start, adjust, continue or discontinue a medication in collaboration with a doctorthus increasing time efficiency for physicians

8. Community • Neighbourhood pharmacies, clinics, supermarkets, chain pharmacies and department stores. • Requires both professional capability and business management skills • Requires broad range of medication knowledge including prescribing and non-prescribing products • Offer additional professional services such as surgical, home care and athletic supplies, and self-diagnostic machines and kits. • Also practice on primary health care teams, in long-term personal care homes, or specialize in such areas as geriatric pharmacy.

9. Hospitals and Related Health Institutions • Work in specialize fields such as oncology, cardiology, psychiatry, dialysis, infectious disease, critical care, paediatrics and geriatrics. • Working with the hospital team • Monitoring/evaluating patients’ drug therapy while in the hospital • Counselling patients about their medication before discharge • Educating physicians and other health care workers • Overseeing the selection, purchase and distribution of drugs used in the hospital • Ensuring safe and efficient distribution of drugs • Development of best practice protocols

10. Pharmaceutical Industry • Work with researchers to develop, manufacture, & market prescription & non-prescription meds • Provide quality control • Act as liaison with government, or provide drug information, technical correspondence or educational materials to the public and health care professionals • May also work as pharmaceutical sales representatives.

11. Government • Employed in the federal and provincial governments • Monitor the distribution of scheduled drugs (poisons, narcotics) • Administer various drug plans and health care programs; develop pharmaceutical policy, or work in a laboratory. • The armed forces also employ pharmacists in military health care facilities in Canada and overseas.

12. Health, Education, Research and Administration • Many work at Canadian universities in the areas of teaching and research, or in health advocacy and professional organizations. • Also work for the provincial licensing and regulatory organizations responsible for ensuring that pharmacists practice according to the provincial laws and regulations.

13. Statistics • There are approximately 31,000 pharmacists in Canada working in 8,394 licensed pharmacies. • In 2007, pharmacists filled 422.6 billion retail prescriptions costing $20.7 million

14. Education and Licensingof Pharmacists • Bachelor of Science in Pharmacy: 4 year program (preceded by at least a year in science) • Biomedical sciences (anatomy, histology, biochemistry, specific diseases and disorders, health issues, organic chemistry, microbiology, pharmacology, physiology) • Pharmaceutical sciences (bio pharmaceutics, pharmacokinetics, medicinal chemistry, drug metabolism, toxicology, pharmaceutics) • Therapeutics • Pharmacoepidemiology • Pharmacoeconomics • Pharmaceutical care • Statistics • Communication and interprofessional relations • Law and ethics • Social and administrative pharmacy issues • Role of pharmacy in the health care system • Masters or Doctorate in Pharmacy: usually go into research or teaching • Ten Canadian universities offer degrees in pharmacy.

15. Pharmacists are licensed and regulated by Pharmacy Regulatory Authority (PRA) • Must have provincial accreditation • Licensing: • Hold a degree in pharmacy from a Canadian university (or the recognized equivalent) • Successfully have passed a national board exam by the Pharmacy Examining Board of Canada (PEBC) • have practical experience through an apprenticeship/internship program • Fill language requirements related to fluency in English or French • Meet all licensing requirements and renew license annually

16. The approval process and distribution of medications • Drugs are the fastest growing component of health care in Canada and have had a huge impact on improving the health of Canadians. • Approximately 22,000 drug products are on the market today. • In 2006, pharmacists filled 422 million retail Rxs • Drugs are now the second largest health-spending category after hospitals • Forecast to make up 17% ($25 billion) of total health expenditures in 2006, compared to 13% ($10 billion) 10 years ago.

17. Health Canada Review • All drugs sold in Canada (both manufactured & imported) mustbe authorized by Health Canada. • About 4,400 drug submissions are made to Health Canada each year but only about 80 are for new drugs. • A Priority Review Process for life threatening or severely debilitating conditions (e.g., cancer, AIDS, Parkinson’s disease) when there is no effective drug on the Canadian market.

18. Special Access Program (SAP) • Access to drugs not currently available in Canada for conditions with serious or life threatening • Conditions where conventional therapies have failed, are unavailable or not suitable. • Pharmaceutical companies have the right to decide whether, and under what conditions, to provide the drug to the patient

19. Controlled Drugs & Substances • Drug Strategy & Controlled Substance Program (DSCP) • Controlled Drugs & Substances Act (1997) • Controls import, export, distribution and possession of narcotics & controlled substances

20. Drug Scheduling • National Canadian drug scheduling model ensure consistent conditions of sale across the country. • National Drug Scheduling Advisory Committee (NDSAC) responsible for provincial scheduling. • Determining factors for scheduling: • Potential for dependency, adverse reactions, interaction, etc.

21. 4 Canadian scheduling categories: • Schedule I — available only by prescription and provided by a pharmacist • Schedule II — available only from a pharmacist; must be retained in an area with no public access • Schedule III — available via open access in a • pharmacy (over-the-counter) • Unscheduled — can be sold in any store without professional supervision

22. Distribution • Community pharmacies: • Purchase either from the manufacturer itself or from drug wholesalers • Hospital pharmacies: • Generally use group-purchasing organizations to buy drugs at negotiated rates.

23. Price Review • Patented Drugs: The Patented Medicine Prices Review Board (PMPRB) regulates the prices • Operates under the Patent Act and is independent of Health Canada. • Patentees are required to file price and sales information twice a year for each dosage strength form of all patented medicine. • PMPRB has right to reduce excessive prices • PMPRB collects comparative price data from the U.S. and six European countries.

24. Listing on Provincial Formularies • Individualized provincial drug plan for reimbursement • Public drug plans account for 45% of expenditures on Rx drugs. • Drug accessibility varies widely between the provinces, • Some drugs receive a restricted listing if special monitoring is required or their cost is high.

25. Common Drug Review • The Common Drug Review (CDR) (2002) • A rigorous process for reviewing and recommending new, approved drugs for listing on F/P/T formularies. • Consists of an appraisal of the best clinical evidence and a listing recommendation from the Canadian Expert Drug Advisory Committee (CEDAC). • The drug plans continue to make the final formulary listing decision. • A target timeframe of 20-26 weeks has been set for the review process. • Private drug plans have access to the recommendations when making their own listing decisions.

26. Manitoba Pharmacare Program • Provides drug cost assistance to eligible Manitobans who do not have coverage under a federal or other provincial program.   • Is income based • Deductible is calculated based on the total adjusted family income

27. DPIN • DPIN (Drug Programs Information NETWORK) – started in 1994 • A database containing prescription drugs and it connects Manitoba Health and all pharmacies in Manitoba to a central database maintained by Manitoba Health. • Uses: • Information about pharmaceutical dispensations, • Prescriptions identified as potential drug utilization problem, non-adjudicated claims, and ancillary programs and non-drug products is captured in real time for all Manitoba residents (including Registered First Nations), regardless of insurance coverage or final payer.

28. DPIN facilitates payment administration for eligible drug costs, incorporating functions such as real-time adjudication, and collects high-quality data on all prescriptions issued to Manitobans • The DPIN system also checks each prescription against drug history to help protect Manitobans from adverse drug interactions

29. Questions???