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Gazette
WI N T E R 2 0 21
IN S IGH T S . A DVOC AC Y. HE A LT HIE R C A N A DI A N S .
A publication of the Neighbourhood Pharmacy Association of Canada
Take
Care
WHAT YOU NEED TO
KNOW ABOUT TODAY’S
WELLNESS CONSUMER
ALSO IN THIS ISSUE:
Mental health
road to recovery
CONTENTS
MESSAGE FROM THE CEO
Winter 2021
Gazette I N S I G H T S . A D V O C A C Y. H E A LT H I E R C A N A D I A N S .
3 The deeper meaning
of wellness in 2021
Neighbourhood Pharmacy Gazette is
published four times a year by the
Neighbourhood Pharmacy Association
of Canada. 365 Bloor St. E. Suite 2003,
Toronto, ON M4W 3L4. 416-226-9100.
COV ER S TORY
5
info@neighbourhoodpharmacies.ca
Take care When sharing or reproducing content,
Five traits you need to know about please ensure it is sourced to
today’s wellness consumer Neighbourhood Pharmacy Gazette.
EXECUTIVE EDITOR
10
I N S I G H T S : M E N TA L W E L L N E S S
Jennifer Deschenes
Mental healthcare part
of long road to recovery CONSULTING EDITOR
Courtney Secord
A DVOC AC Y: 2020 Y E A R IN RE V IE W
12 How we made strides MANAGING EDITOR
Karen Welds
in the year that was
ART DIRECTOR
Shawn Samson
I N S I G H T S : C O V I D -19 VA C C I N AT I O N S
13 Canada’s maze for
vaccine distribution
CONTRIBUTORS
Anne Bokma, Matt Boudreau,
Jennifer Deschenes, Jeff Mehltretter,
Rosalind Stefanac, Karen Welds
A D V O C A C Y : P O S I T I O N S TAT E M E N T S
16 Where we stand on
current healthcare issues
ADVERTISING COORDINATOR
Lucy Montana
MEMBER Q& A : C A LG A RY CO - OP
18
Find us online
All for one, neighbourhoodpharmacies.ca
one for all
We want to
I N S I G H T S : N AT I O N A L P H A R M A C A R E THE L A ST WORD
19 COVID-19 marks new
path for pharmacare 22 A united
voice is hear from you!
key to Send us your ideas, opinions and
questions to help guide the content
pharmacy’s of the Gazette. We also welcome
submissions for contributed articles.
future Contact us
info@neighbourhoodpharmacies.ca
2 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
MESSAGE FROM THE CEO
The deeper meaning
of wellness in 2021
Before the pandemic, I regularly hit (page 13). Yet even so we are dogged by
the gym for my physical and mental the whisperings of doubt. Will enough
fitness. Not being able to continue to people get vaccinated in order to turn
do so was a huge adjustment, but I’ve this tide?
come to have a renewed appreciation Distrust is often a key factor
for slower paced activities that force me underlying vaccine hesitancy: distrust in
to be more introspective and reflective, the vaccine’s effectiveness and safety,
such as yoga and long walks. and for some a distrust in the healthcare
Chances are we have all had to system. Public opinion polling by the
try something new, or try harder, to Canadian Pharmacists Association
Sandra Hanna
maintain an even keel during this (CPhA) in December found that one in
CEO
terribly unsettling time. As explored three Canadians plans to get the vaccine Neighbourhood Pharmacy
in this issue’s cover story (page 5), as soon as possible and 48 per cent will Association of Canada
personal wellness has taken on a much “wait a bit.” 416-226-9100
deeper meaning, particularly in the Healthcare providers are a vital bridge info@neighbourhoodpharmacies.ca
@pharmacy_CAN
area of mental health (page 10), yet for building trust and overcoming
it can be more challenging due to the vaccine hesitancy. The CPhA poll also
restrictions imposed by public health reinforced Canadians’ high level of
safety measures. We’ve had to refocus
our efforts. On the other hand, perhaps
this was long overdue in a world that
was so fast-paced that we may have put
trust in pharmacists as immunizers.
Speaking on behalf of the members of
Neighbourhood Pharmacies, I can add
that huge efforts are underway to help
‘‘
The coming
months
our needs last, especially for mental community pharmacists leverage that will see a
wellbeing. trust in order to instill confidence in vaccination
The definition of preventative care has Canadians. campaign
additionally evolved now that “infectious March is Pharmacy Appreciation
the likes of
disease” is part of our daily lexicon. Month, formerly known as Pharmacy
Hand hygiene and physical distancing Awareness Month. The new name
which we’ve
will likely continue long after the reflects all that pharmacists have never seen
pandemic is finally over. done—and continue to do—to adapt before, and
Vaccination against COVID-19 is a vital to the changing healthcare needs of pharmacy
part of that broader understanding of Canadians during a pandemic. Our
will be
preventative care. The coming months wellness journey during this time is far
integral to
’’
will see a vaccination campaign the likes from over, and I hope you agree that we
of which we’ve never seen before, and appreciate that pharmacists are with us its success.
pharmacy will be integral to its success every step of the way.
3 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
Welcome to the
Neighbourhood
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Check out our new online home, renovated
and refreshed to serve you better.
It’s easier to locate our informative publications, including:
• Neighbourhood Pharmacy Gazette • “The Big Business of WELL” research report
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pharmacare and scope of practice, to name just a few) • And more!
Take
COVER STORY By Anne Bokma
Care
5 traits you need to know about today’s wellness consumer
The stress, uncertainty and fear caused by COVID-19 and anxiety. The pandemic has reignited—and for
over the past year have dramatically affected some, newly ignited—consumers’ quest for health and
consumer behaviour. Witness the bunker-style wellbeing, for themselves and their loved ones.
mentality of stockpiling essential goods such as toilet “Given the nature of COVID-19, one of the elements of
paper, the massive shift to online shopping and restoring a sense of control and safety is managing your
the plethora of ways explored to combat isolation health, especially when you are dealing with a disease
and loneliness, from virtual gaming with friends to that preys on co-morbidities,” says Doug Stephens,
skyrocketing sales of outdoor gear. founder of the Hamilton-based retail consulting firm,
A single driving force is behind all of these Retail Prophet, and author of the forthcoming book,
behaviours: a renewed appreciation of the importance Resurrecting Retail: The future of business in a post-
and fragility of health. A June 2020 survey by New York- pandemic world.
based WSL Strategic Retail revealed that 73 per cent “Combine this with the fact that we are already
of consumers worry they will get sick. Multiple other dealing with a rapidly aging population and a large
surveys show skyrocketing rates of sadness, depression group of baby boomers who don’t want to age the way
5 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
COVER STORY
their parents aged—when you underpin this with the “This is one of the biggest shifts we’ve seen
threat of COVID-19 and what it represents, that’s why during COVID-19,” says Gretkowski. Even essential
we are seeing such a big focus on the idea of actively retailers have seen dramatic changes. WSL’s
pursuing wellness.” research found that 54 per cent of shoppers ordered
That focus bodes well for the pharmacy sector if it groceries and health products online for pick-up and
can understand how best to respond to the factors delivery during the pandemic and half of them did so
contributing to consumer for the first time. Home
behaviour in the age of deliveries for prescriptions
‘‘
COVID-19. jumped from 21 per cent
This is an opportune time
While pharmacy may to 37 per cent.
never be able to “out-app” to build equity with the “Online shopping is
purely digital spaces like consumer and strengthen definitely here to stay,”
Amazon, it can provide what
can’t be ordered online:
human connection. “This is
the emotional relationship.
an opportune time to build equity with the consumer
’’ says Gretkowski. “Once
consumers try it and see
how easy it is, they stick
to it.” Her firm predicts 75 per cent of shoppers will
and strengthen the emotional relationship,” says Tony continue to shop online post-COVID-19.
Chapman, a Toronto-based retail consultant and host of COVID-19 has also stoked readiness and demand
radio show Chatter that Matters. for virtual healthcare services. Seventy per cent of
Neighbourhood Pharmacy Gazette gathered insights Canadians agree that virtual healthcare represents the
from Stephens, Chapman and Liz Gretkowski, a senior future of healthcare and an overwhelming majority of
consultant with WSL, to describe five key consumer working Canadians (82 per cent) agree their employer
behaviours that are shaping wellness trends. should provide access to virtual healthcare, according
to the 2020 report by Environics Research, Canadian
1 Home sweet home (or trying to be)
Statistics Canada reports that five million
Attitudes on Healthcare and Telemedicine.
Virtual care represents “a call to action for pharmacies,”
Canadians started working from home during the says Gretkowski. “Pharmacies don’t want to lose their
pandemic and, according to the Vancouver-based customers because they aren’t offering telehealth. It’s
polling firm Research Co., 73 per cent believe the work- important to meet your customers where they are at in
from-home trend will continue after the pandemic their life. And right now, they are at home.”
because of persistent safety concerns.
The home is now a workspace, classroom,
entertainment centre, remote gathering place and 2 Driven by convenience
Time management competes with price, as 53
(sometimes cramped) fitness area. The-do-it-at-home per cent of consumers say they plan to shop in ways
mindset has boosted renovations: a TD Bank survey that save time even if it means they have to pay higher
conducted in September 2020 found that 37 per cent prices, according to WSL.
of Canadians have done or plan to do significant home Consumers are also more comfortable with time-
renovations to accommodate their new lifestyle. The saving digital tools such as self-checkout and digital
early days of lockdown also saw massive spikes in the coupons. Twenty-two per cent of shoppers use digital
online sales of products such as bread machines (up coupons, of whom 55 per cent started using them
652 per cent in the U.S. in March 2020) and weight during COVID-19. “It saves time and makes the check-
training equipment (up 307 per cent), according to retail out experience much faster,” says Gretkowski.
technology company Stackline. She adds that pharmacies also need to be thinking of
Most significantly for retailers, the home has become expanding their delivery methods to ensure consumers
a place of e-commerce with online purchasing and get their products quickly. “Curbside pick-up is a given.
direct-to-home delivery—not just because physical Everyone should be doing that.”
shops are closed or less convenient, but also because She notes that even quick trips are moving online.
consumers want to limit contacts with strangers. “It’s not worth it for shoppers to run into the store
6 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
COVER STORY
and pick up something when they can shop 24/7 from they realize they need downtime, that they
their mobile phone and get delivery in an hour or a have to take care of themselves and find ways
day. There’s a big call to the pharmacy to think about not to be so stressed,” says Gretkowski. “The
convenience in a new way because getting out of the car, opportunity for pharmacy is to address it, to bring it to
putting on a mask, getting the kids out of the car, finding light, whether that’s providing sleep aids or vitamins
a product and waiting in line—this is not the future.” for mental health. What are the products that can help
Having said that, as an essential service provider that people relax?”
will always be open regardless of lockdowns, the bricks- Mental health conversations were already entering
and-mortar pharmacy has come to represent an oasis for the mainstream before 2020; now, it’s almost part of
consumers who need to talk about, see or get immediate daily communications from political leaders and public
access to products or services related to health. health experts as we cautiously navigate the uncharted
The trick, then, is to make the in-store experience as territory of a pandemic.
convenient and time-efficient as possible. For example, Pharmacies have an opportunity to be part of that
use shelf tags to identify specific types of products, such conversation beyond the pharmacy counter. They
as organic, vegan or sugar-free, and merchandise by can engage stressed-out consumers by offering
solution, rather than by category. Pull together displays compelling content adjacent to products and services,
that offer multiple products for a single need, be it to such as a video recordings, articles, podcasts or virtual
reduce stress, boost immunity or manage diabetes. “If sessions with experts, including their own pharmacists.
it’s a customer with sleep issues, rather than having Pharmacists can also recommend or “prescribe” vetted
melatonin, vitamins, lavender essential oil and chamomile mental health apps, such as those curated by Therappx,
tea in separate aisles, you can group them and say, ‘Here a Canadian firm founded by pharmacists.
are your solutions for better sleep’,” says Gretkowski. “There is a hunger for information and a sense of
Equally important, increase the visibility and promote connection and community. If the local pharmacy is
the availability of pharmacists. “Pharmacies have not just the place I go to when I am not feeling well
respected, highly trained healthcare professionals to but is also a beacon for great information, that gives
bring their brand ‘personality’ to life. This too is a highly me added value,” says Stephens. “The differentiator
valued form of convenience, for consumers who need between pharmacies that truly succeed and those that
to speak with a real person, sooner than later,” says struggle will be the fact that they are not solely reliant
Chapman. He adds that pharmacists can be proactive on product and prices but find valuable and creative
by making themselves available for regularly scheduled ways to engage customers.”
virtual chats, with content that addresses frequently For example, pharmacies can partner with local
asked questions. practitioners to offer or promote free mindfulness
clinics or yoga sessions. They can help reduce stress
3 Troubled in mind
The isolation and loneliness caused by COVID-19
due to misinformation or the lack of information by
posting weekly briefings or bulletins on COVID-19,
and the unprecedented decline in social activity have
taken a toll on mental health. In 2019, two-thirds of
The Big Business of WELL
Canadians said their mental health was good or very
good; in 2020, only 53 per cent could say the same,
according to an October 2020 report by Angus Reid. The
In early March 2020, WSL Strategic Retail surveyed
percentage of Canadians categorized as “The Desolate,”
Canadians on behalf of Neighbourhood Pharmacies
who suffer from both loneliness and social isolation,
to gain a better understanding of their perceptions
increased from 23 per cent to 33 per cent. One in five
of pharmacy and shopping behaviours, particularly
now say their mental health is poor or very poor.
Forty-one per cent of Canadians say stress is their in the areas of health and wellness. The resulting
number one obstacle to good health, followed by lack report, The Big Business of Well, is available on
of sleep (35 per cent). “Forty-nine per cent of consumers Neighbourhood Pharmacies’ website.
say it’s important to attend to their mental health—
7 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
COVER STORY
including vaccination details, suggests Chapman. bulletproof to infection and disease spread,”
(For more on mental health, focussing on depression adds Stephens. While all retailers need to take
and anxiety, see page 10.) ownership of making sure their stores are
clean, well-organized and disinfected, pharmacies
4 Infection rejection
Heightened cleaning protocols and contactless
are especially well positioned to take the extra step
of helping consumers with best practices for both
experiences are the new norms, as 64 per cent of personal preventative care and the home.
consumers say they are trying to avoid germs, says “Home is no longer just where the heart is, it is
Gretkowski. literally where the health is. What is pharmacy doing to
Boosting immunity is a primary objective. The global help customers protect themselves and their families?
vitamins, minerals and supplements market was on Pharmacies can become real thought leaders on how
track to grow by more than 25 per cent in 2020, and that consumers can build their immune systems,” says
trajectory is expected to continue into 2021, according to Chapman.
Bolst Global’s Health and Wellness Trends report.
“People are much more focussed on their immunity,
taking vitamins and also keeping their house clean,”
5 Conscious consumerism
Consumers are reasserting a sense of community
says Gretkowski. “When we talk about solution to counteract the isolation forced upon them by
merchandising, these are the solutions people are COVID-19. The ability to do good, to help others, is a
looking for—how do I keep my hands clean, my house powerful way to do that—including efforts to support
clean, the air in my house clean, and how do I build local businesses hit hard by the pandemic.
immunity, so my health is stronger?” A November 2020 survey by the Retail Council of
“The emphasis is on trying to make yourself more Canada found that 90 per cent of Canadians intended
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8 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
COVER STORY
to shop locally during the holiday season. “Those of 10 would pay a premium of 35 per cent, on
us who remain employed are more focussed on putting average, for brands that are sustainable and
our paychecks to good use, including by bolstering environmentally responsible.
local businesses and helping neighbours in need,” Conscious consumerism extends to the type of food
writes Marian Salzman in ZoomsDay Predictions: people eat. In 2018, 17 per cent of Canadians reported
Trends for 2021. they are vegan, vegetarian, pescatarian or flexitarian,
“The pandemic crisis has very real implications for according to a study by Dalhousie University. The
sustainability and social responsibility,” says Stephens. majority are under 35 and are likely to raise their
“It has shown us the degree to which we are truly families with the same eating habits.
interconnected on a global level. It has brought home The pandemic is accelerating changes in consumer
just how small this world really is.” behaviour that were already underway. What the surreal
“To give is the new reward,” summarizes Chapman, reality of the virus has added for many, however, is a
adding: “In pharmacy, loyalty points could be used to greater sense of purpose, one that circles around health
help the community, to provide goods for people who and wellbeing at all levels—physical, mental and social.
can’t afford them.” As healthcare providers in the retail space, pharmacies
Before the pandemic, consumers were already are uniquely situated to help achieve this higher purpose.
embracing social causes and environmental concerns.
A June 2020 study of almost 20,000 in 28 countries by
Research Insights found that 57 per cent are willing Anne Bokma is an award-winning journalist
to change their purchasing habits to help reduce the in Hamilton, Ontario, and former editor of
negative impact to the environment. Of those who Pharmacy Practice.
say this is very or extremely important, seven out of
PARTNER SPOTLIGHT
Building resiliency in SUPPLIED CONTENT,
BROUGHT TO YOU BY
Canada’s healthcare system
By Brian Heath, Vice-President and General Manager at Amgen Canada Inc.
A year has passed since the have come together to discuss how best to achieve health system
COVID-19 pandemic began in resilience. Four overarching policy pillars are needed:
Canada. The first wave dramatically 1) View health spending as an investment, not a cost;
impacted healthcare systems across 2) Break down the siloes impeding the delivery of seamless,
the country, exposing gaps and integrated and coordinated care;
fragilities previously overlooked. 3) Leverage data, tools and technologies to measure health
Efforts to protect the most outcomes and maximize value; and
vulnerable, leverage digital health tools and technologies, and 4) Increase collaboration across public, private and non-profit
establish new public health protocols have had modest success sectors.
in slowing the spread of COVID-19. However, the second Fueled by such early discussions, Amgen is increasing
wave of infections has exacerbated weaknesses in our health its engagement with prospective partners committed to
systems—from delays in treatments and surgeries, to hidden addressing health system issues. The goals are to better
crises in long-term care and immunization frameworks. integrate and analyze data, accelerate and expand access to
That’s why it’s so important for Canada to focus immediate innovative diagnostics and treatments, and leverage the skills of
efforts on building stronger and more resilient health systems pharmacists and other healthcare professionals.
in order to predict, prevent, manage and mitigate future crises. We look forward to working closely with Neighbourhood
With this mission in mind, Amgen, together with more than 50 Pharmacies and its members to identify the critical steps toward
other health system leaders, including Neighbourhood Pharmacies, greater resilience in Canadian healthcare systems.
9 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
INSIGHTS: MENTAL WELLNESS By Jeff Mehltretter
Mental healthcare part of
long road to recovery
These results have prompted some to predict a
mental health crisis that will be just as damaging to our
health as COVID-19.
What does drug utilization data tell us?
Psychotherapeutics already represent the largest drug
category by prescription volume in Canada, according
to IQVIA.4 We would expect that increased feelings of
anxiety and depression would be marked by a surge
in prescriptions to treat these conditions. To date,
however, that has not happened.
While prescriptions dispensed for depression and
anxiety peaked in June, this was followed by a trough in
August and reflects the after-effects of provincial 30-day
Few will deny that it has been a long 12 months. supply policies during the first wave of the pandemic.
We are all feeling the strain of isolation, new routines, British Columbia, which did not implement a similar
screen fatigue and anxiety about the future. Not to drug supply policy, shows a very flat trend from March
mention the disturbing social effects accelerated by 2020 onwards.5
COVID-19: political polarization and renewed awareness Why do we not see an increase in drugs used to
of socioeconomic divides. Even if we as individuals are treat mental health conditions when Canadians clearly
not particularly worried about infection, a new level of report increased mental health concerns? Three main
anxiety pervades all of our lives. possibilities exist:
Mental health clinicians and researchers quickly 1. People remain undiagnosed and untreated because:
realized that this pandemic has the potential to tip a. t hey have not sought help and are attempting to
those vulnerable to mental health issues from a manage on their own; or
healthy, coping state into an anxious, debilitated state. b. they have found it too difficult to access healthcare.
Since March 2020, a steady stream of survey data
indicates that they are right:
• Forty per cent of Canadians said that their mental health Drugs for Anxiety and Depression
has deteriorated since the onset of the pandemic.1 n Anxiety n Depression
• Twenty-seven percent of those with pre-existing 1.10
Prescriptions indexed
mental health issues reported an increase in suicidal
against Mar 2020
1.05
thoughts and feelings, up from 18 per cent during the
1.00
first wave of the pandemic.1
0.95
• Overall, 24 per cent of Canadians reported their
mental health was worse during the second wave 0.90
than the first wave.2 0.85
• Eight per cent of persons felt depressed five to seven
Mar 20
Apr 20
May 20
Jun 20
Jul 20
Aug 20
Sep 20
Oct 20
days out of every week, a 33 per cent increase from
June 2020.3 Source: IQVIA Canadian Rx Lite, retail pharmacy. Mar 2020 to Oct 2020.
10 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caINSIGHTS: MENTAL WELLNESS
2. People are getting non-pharmacological treatment, such direct, ongoing role to support care—witness the
as internet-based cognitive behavioural therapy (iCBT). success of the Bloom program in Nova Scotia,
3. People are self-medicating in ways that could cause funded by the province and in its seventh year.
harm. Two surveys found that approximately one in In recent years, at least two research projects are
five Canadians have increased their use of alcohol underway to evaluate an expanded role for pharmacists
and controlled substances.1,3 The Public Health in mental healthcare. A study in Australia concluded
Agency of Canada reported the highest quarterly that pharmacists are capable of conducting screening
count of apparent opioid toxicity deaths between and risk assessment services for depression, which can
April and June 2020 since surveillance began in improve rates of early detection.7
2016.6 These harmful behaviours compound mental The increased involvement of community-based
health concerns and make effective treatment much pharmacists in mental healthcare is more than an
more challenging. opportunity. It is a call to action. As these statistics
attest, for many Canadians the COVID-19 vaccine will
For all three of these possibilities, pharmacists can be just the first step on a long road to recovery.
play an important role given their frequent interactions
with the public. With appropriate training and
remuneration, they can screen for people who may be Jeff Mehltretter is a Consultant at
experiencing new or increased mental health concerns Mehltretter Pharma Consulting.
and help them navigate treatment options, including jeffmehltretter@gmail.com
iCBT and healthcare apps. Pharmacists can play a
References: 1. Mental health impacts of COVID-19: Wave 2. Canadian Mental Health Association and The University of B.C. in partnership with maru/matchbox; 2. In the News: Mental Health, Stress and
Anxiety. Leger Weekly Survey: Oct 19, 2020; 3. Examining the Impact of COVID-19 on Mental Health and Substance Use among Canadians. Centre for Addiction and Mental Health. 2020 Nov; 4. Licensed
from IQVIA. Rx Premium, retail pharmacy. Annual period ending Dec 2020; 5. Licensed from IQVIA. Canadian Rx Lite, retail pharmacy. Selected drugs from anxiety and depression. Mar 2020 to Oct 2020;
6. Opioid- and Stimulant-related Harms in Canada. Public Health Agency of Canada. 2020 Dec; 7. O’Reilly CL, Wong E, Chen TF. A feasibility study of community pharmacists performing depression screening
services. RSAP. 2015 June;11(3):364-81.
REGISTER NOW: MAY 11 & 12, 2021
THE ROAD TO RECOVERY
Progress at the Height of Uncertainty
Our virtual Executive Summit brings together pharmacy leaders from a variety of
disciplines to share insights, tips and opportunities in the business of pharmacy
and delivery of care. Attendees focus on strategy and relationship-building.
• Examine fresh ideas and critical trends impacting our economy and pharmacy
• Gather insights from thought leaders about the road to recovery
• Pharmacy leaders: benefit from strategic discussions with the thought leaders
• Premium associate partners: strengthen relationships with retail members
during private business meetings
11 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caADVOCACY: 2020 YEAR IN REVIEW
How we survived and made
strides in the year that was
The pandemic’s impact is nothing short
of devastating, yet it has also triggered
unprecedented levels of collaboration,
innovation and transformation. Community
pharmacy, in many ways, is in the thick of it.
As we chart new territory in a world with COVID-19,
Neighbourhood Pharmacies invites you to check
out our 2020 Year in Review: Stepping Up Together,
for a detailed retrospective on our Association’s
role in the year that was.
The Year in Review summarizes how Neighbourhood The Association developed seven position statements
Pharmacies’ advocacy, education and research work to inform its strategic direction and establish a
helped to move the needle on critical healthcare strong foundation for future initiatives, including our
priorities, including: grassroots advocacy program (more details on page 16).
• Pharmacies’ capabilities to deliver immunizations The Year in Review includes useful statistics about
(seasonal influenza, COVID-19 vaccines and all other community pharmacy, including its contribution to
recommended vaccinations); the Canadian economy. And you’ll find highlights and
• Modernization of the Controlled Drugs and Substances quick links to our research reports in the areas of long-
Act to better enable pharmacists to fight the worsening term care, specialty pharmacy, Canadians’ wellness
opioid crisis; attitudes, the early impact of COVID-19
• COVID-19 testing; on pharmacy and national pharmacare.
• National pharmacare (with renewed emphasis given
the economic repercussions of COVID-19; see page 19 Check out Neighbourhood Pharmacies’
for details); and 2020 Year in Review: Stepping Up Together
• Pharmaceutical supply and drug shortages.
11,000 5 km $8.2 billion 163,400
Community Maximum average Gross domestic product Canadians directly
pharmacies distance to a pharmacy directly generated by employed by
in Canada for most Canadians pharmacy sector pharmacy sector
12 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caINSIGHTS: COVID-19 VACCINATIONS By Matt Boudreau Canada’s maze for vaccine distribution The dawn of a new year brings a light at the end of the tunnel. While COVID-19 continues to tear through communities across Canada, the rollout of new, effective vaccines promises an eventual end to the ongoing pandemic. As with all publicly funded vaccines, Public Services and Procurement Canada (PSPC) orders and procures the products on behalf of the federal government and all provincial and territorial governments. PSPC and the Public Health Agency of Canada then face a raft of distribution challenges—and a patchwork of approaches pharmacy and pharmacist participation be maximized? to distribution across our provinces and territories. How will we avoid the shortages some provinces saw There are two distinct phases to the COVID-19 vaccine in this year’s flu season? Different provinces will have rollout: initially, a slow and halting trickle of doses that different solutions. are rationed to those in most need. Later, as production To complicate matters further, provinces and ramps up and more products are approved, mass territories have no say in which vaccines they receive, vaccination will kick in and the goal will be to get as their quantities or timing. The federal government many people protected as quickly as possible. makes these decisions. Provinces may prefer to have In Canada, our federalism makes this more more of the vaccine that can be stored in refrigerators, complicated. We cannot have a truly national effort which opens the door wider for pharmacy involvement, in distribution of the vaccines because healthcare is but this is not something they can control. Federal and the constitutional responsibility of the provinces. As provincial leaders will inevitably politicize gaps in supply a result, different parts of the country have different and distribution. priorities and distribution models. These are existential issues for government. Every We see evidence of this in the provinces’ respective elected official in Canada, from provincial backbenchers plans and stages. For example, Nova Scotia would to the Prime Minister, knows that vaccine rollout like to involve pharmacists as vaccine administrators will decide their fate at the next election. For all the closer to the beginning of its distribution plan, while novel complications a COVID-19 vaccine campaign Saskatchewan will involve pharmacists as the campaign poses, governments must learn from past success—in broadens and Ontario plans for the inclusion of this case, the central role pharmacy has assumed in pharmacy locations in its final stage. seasonal influenza vaccination campaigns. The success of mass vaccination is inconceivable This brings us to the final, and in some ways most without the wide-scale involvement of pharmacy. Many difficult, challenge: making sure enough Canadians decisions need to be made: Who will be prioritized? are confident in the vaccine to achieve herd immunity. How will compliance with a two-dose regime be There are promising signs. Recent public opinion polling ensured? How will the vaccine be safely administered indicates the willingness to get immunized has inched to large numbers? How will supply be tracked? How will upwards since vaccine rollout has begun. 13 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
INSIGHTS: COVID-19 VACCINATIONS
Vaccine
distribution
in Canada APPROVES
ADDITIONAL
COVID-19 COVID-19 COVID-19 COVID-19 COVID-19
Vaccine Vaccine Vaccine Vaccine Vaccines
PROCURED BY
ADVISES
Provincial and territorial governments DISTRIBUTES TO
PROVINCIAL AND TERRITORIAL GOVERNMENTS DISTRIBUTE TO
Public Health Hospitals and
and primary care Pharmacy
long-term care
But any of the difficulties described above could experts, healthcare workers on the frontline and
negatively impact consumer confidence. And in an age fixtures of the community (remaining open throughout
of fake news, when so many people are deeply skeptical the pandemic), few are better placed than Canada’s
of experts and politicians, even the best-designed pharmacists and pharmacies to make vaccine rollout a
public education campaign by government will have its success—and defeat this terrible disease.
limits. Pharmacists again can make a critical difference
in dispelling vaccine hesitancy.
Whatever approach a province takes for distribution, Matt Boudreau is a Senior Account Director
the best way to make sure millions of Canadians choose at Hill+Knowlton Strategies.
to get vaccinated is to leverage their bonds of trust with
their healthcare providers. As drug and medication
14 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caMonth
THANK YOU
PHARMACY MA
Across the country, Canadians have relied on you to support them
through the COVID-19 pandemic. This March and every day, thank you,
pharmacy, for your dedication to your patients and your profession.
Pharmacy
Appreciation
Month MARCH 2021 #PAM2021
THANK YOU
PHARMACY MARCH 2021 #PAM2021ADVOCACY: POSITION STATEMENTS By Jennifer Deschenes
Where we stand on
current healthcare issues
Advocacy drives everything we do at
Neighbourhood Pharmacies. With the immense Our Top 7 Priorities
and often competing pressures facing governments
1. C
reating Capacity 4. N
ational Pharmacare
during the pandemic, 2021 is unquestionably a year in Public Health 5. M
edical Cannabis
to showcase to decision-makers the incredible value
2. Creating Capacity 6. Pharmaceutical Price
pharmacy provides healthcare systems nationwide. in Primary Care Compression
Neighbourhood Pharmacies’ seven position 3. P
harmacists’ Scope 7. Pharmaceutical Supply
statements encapsulate our priorities, communicate of Practice & Drug Shortages
recommended actions and articulate the benefits to
governments, Canadians and other stakeholders.
The full statements are available on our website. Creating Capacity in Primary Care
• Pharmacies are often Canadians’ first
Creating Capacity in Public Health and/or most frequent point of contact with
• Pharmacies are a preferred destination the healthcare system.
for immunization services. • Pharmacists can alleviate backlogs in
• The pharmaceutical distribution system primary care.
facilitates vaccine distribution with a • Almost all provinces have authorized pharmacists to
high degree of efficiency. assess and prescribe for common ailments. Yet only
• Pharmacist-administered point of care testing three provinces fund this service (with limited funding
supports disease screening initiatives, including in a fourth).
rapid COVID-19 testing. • Electronic health records, lab results and point of care
• Pharmacists are prepared to deliver additional testing enable pharmacists to effectively monitor chronic
support in managing prescribed opioid therapy disease therapies and screen for infectious disease.
and supporting harm reduction strategies.
RECOMMENDATIONS
RECOMMENDATIONS • Implement fair, sustainable public funding for primary
• Enable pharmacists to administer all vaccines and care services by pharmacists to encourage their
fund pharmacists’ vaccination services. uptake by both pharmacists and patients.
• Use the pharmaceutical distribution system for all • Enable pharmacists to conduct point of care testing,
vaccines. order lab tests and access lab test results.
• Enable pharmacists to conduct point of care testing, • Enable pharmacies to access electronic health records.
order lab tests and access lab test results.
• Make permanent the temporary changes to Health Pharmacist Scope of Practice
Canada’s Controlled Drugs and Substances Act and • Pharmacists can do more to cost-effectively close gaps
build on that to further expand pharmacists’ role in in today’s healthcare system.
opioid therapy management. • Underutilized capabilities in the pharmacist’s scope of
• Fund pharmacists’ services to educate on the use practice include: the ability to renew, adapt and initiate
of naloxone and use pharmacies as a network for prescriptions, administer medications by injection,
distribution. conduct testing and administer immunizations.
16 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caADVOCACY: POSITION STATEMENTS
RECOMMENDATIONS
• Fund pharmacy services beyond medication fulfillment • Fund pharmacists’ services to educate and
to capitalize on pharmacists’ expanded scope of practice counsel patients on the use of medical cannabis.
and foster a more efficient use of healthcare resources. • Follow the drug scheduling model of the National
• Consider the value of pharmacy services using a Association of Pharmacy Regulatory Authorities
system-wide lens. Where pharmacy services are (NAPRA) for the scheduling of cannabis health products.
equivalent to services provided by other healthcare
providers, reimbursement levels should be the same. Pharmaceutical Price Compression
• Canadians deserve fair prices for prescription drugs.
National Pharmacare • Government-imposed price reductions reduce funding
• Canada’s pharmacies serve millions of to pharmacies since the current funding model
patients across the country, and the includes mark-ups based on the price of the drug.
sector has a deep understanding of Pharmacies serving patients who require complex
the gaps that currently exist in drug coverage. specialty medications are most negatively affected.
• An overwhelming majority of Canadians are
concerned about the potential impact of a national RECOMMENDATIONS
pharmacare program on their existing drug coverage. • Consult with pharmacy on drug pricing policy to avoid
unintended impacts on pharmacy and patient care.
RECOMMENDATIONS • Modernize the funding model for pharmacy to more
• Prioritize coverage for the uninsured and effectively recognize the value of services rendered.
underinsured, including those with rare diseases.
• Build upon current federal-provincial-territorial Pharmaceutical Supply & Drug Shortages
efforts to work together to provide drug coverage • Drug shortages place burdens on
to Canadians who need it most, while ensuring patients and healthcare providers.
continuity of coverage for those who already have it. • Drug shortages have become a regular
• Establish guiding principles to ensure an equitable occurrence. Pharmacists and pharmacy
approach, while maintaining the integrity of existing staff dedicate many hours to overcome shortages,
provincial and private plans. which takes time away from patient care.
•T
herapeutic substitution enables pharmacists to
Medical Cannabis address shortages in a timely fashion. However, most
• Pharmacists are well situated to educate, provinces have not granted this authority or have
support and counsel patients on the safe, limited its application.
effective use of medical cannabis.
• Many cannabis users today self-medicate RECOMMENDATIONS
without guidance from healthcare providers. • Establish ongoing collaboration between all
• Cannabis health products (CHPs) have emerged stakeholders to prevent drug shortages, mitigate harm
as a category to describe cannabis products that to patients and develop policies that lead to a more
contain cannabidiol (CBD), which does not cause the robust, sustainable pharmaceutical supply chain.
psychoactive (i.e., mind-altering) effects associated • Compensate pharmacies for time spent overcoming
with products that contain tetrahydrocannabinol drug shortages as part of continuity of care.
(THC). CHPs should not be classified as prescription • Harmonize therapeutic substitution authority for
products as this would make them less accessible pharmacists across all provinces.
than recreational cannabis.
RECOMMENDATIONS Jennifer Deschenes is Director,
• Amend the federal cannabis regulations so Communications & Stakeholder
pharmacists and pharmacies are authorized to Relations, at Neighbourhood Pharmacies.
dispense and distribute medical cannabis. info@neighbourhoodpharmacies.ca
17 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caMEMBER Q&A: CALGARY CO-OP
All for one, one for all
A conversation with Judy Roberts and Sonal Ejner at Calgary Co-op,
member of Neighbourhood Pharmacies
What has the pandemic meant for Certified Diabetes Educator (CDE) and the
pharmacy? pharmacy that’s most convenient to them.
It has propelled pharmacy forward as a Pharmacists at our five Centre of Excellence
destination for primary care services. Patients locations onboard, train and educate patients
have more broadly come to recognize that on specialty products.
they can go to their pharmacy for many On the technology side, online appointment
Judy Roberts services. This was a real boon for physicians booking has freed time for staff. Our central
Senior Director,
during the early weeks of the pandemic, and fill pharmacy does all compliance packaging
Pharmacy
we continue to see elevated pharmacists’ and robotics dispense frequently prescribed
prescribing activity even since physicians’ medications in high-volume pharmacies.
offices have reopened. For adult vaccinations,
70 per cent of the prescriptions at Calgary How do you collaborate with other
Co-op are now prescribed by our pharmacists. healthcare providers?
The pandemic accelerated the uptake of Advanced training is a core practice.
virtual care and this was another opportunity Our certified pharmacists include CDEs,
Sonal Ejner for pharmacy to shine. We were able to Tobacco Reduction Educators, Certified
Pharmacy
Professional Services launch our virtual platform quickly. Video Respiratory Educators and those with the
Manager consults are especially impactful for patients ISTM Certificate in Travel Health. We have
who prefer to stay home or need to self- experts in anticoagulation management, pain
isolate. Our patient uptake for video consults management, mental health and more. They
doubled last month, and referrals from family regularly collaborate with other healthcare
physicians and specialists to our certified providers as members of a patient’s healthcare
pharmacists has dramatically increased. team. For example, the CDE Greenlist is an elite
FULL COMPANY NAME
Calgary group of CDE pharmacists who work closely
Co-operative
Association
How is Calgary Co-op operationalizing with endocrinologists and complex patients to
Limited expanded services? support ongoing care in the community setting.
Twelve full-time clinical pharmacists rotate As well, our goal is for all of our pharmacists
ESTABLISHED
1956 through our pharmacies for appointments to have additional prescribing authorization
with patients. They consult with in-store (APA).* Currently 95 per cent do, which means
PHARMACY
LOCATIONS
pharmacists on other patients, provide they can universally offer prescribing for minor
23 in Alberta training and serve as mentors. They truly ailments and other conditions and prescribe
champion a patient-centred environment. and administer vaccinations and other
PHARMACY BANNER
Calgary Co-op At our Specialty HUB, three pharmacists injections. We’re proud of our pharmacists’
Pharmacy operate a centralized concierge service for ability to competently step in and work with
patients requiring specialty drugs and to physicians to seamlessly prevent gaps in
RETAIL FORMAT
Supermarket coordinate other services. For example, if a patient care.
chain physician is looking for diabetes support, he
*Pharmacists in Alberta can apply to obtain additional prescribing
or she sends the referral to the HUB and we authorization (APA), which enables them to prescribe any Schedule 1
match the patient with a clinical pharmacist drug as well as blood products.
18 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caINSIGHTS: NATIONAL PHARMACARE By Karen Welds How COVID-19 is marking a new path for pharmacare The pandemic has put many public policy initiatives on hold—and in the case of a national pharmacare program, it may indelibly change what comes next. Economic recovery, pandemic preparedness and An Act to enact the Canada Pharmacare Act, which was public opinion may have set pharmacare on the debated—and defeated—on February 24. path toward a fill-the-gaps, mixed-payor approach As well, the COVID-related issues of economic rather than the single-payor model put forward by the recovery and long-term pandemic preparedness Liberal government’s Advisory Council in June 2019. are key new talking points. The past year has been “There’s an opportunity, during this kind of holding a hard lesson in the importance of a resilient, self- period, to bring solutions to government ahead of them sustaining economy. “The new priority in Ottawa is to really reigniting their work on pharmacare,” said Jesse build up domestic industry, including pharmaceutical Shea, Public Affairs Consultant, Enterprise Canada, at manufacturing. It’s about creating a strong healthcare a webinar in January for members of Neighbourhood sector in Canada so we are better prepared for the Pharmacies. “It’s an opportunity to implement a mixed- future,” noted Katie Heelis, Health Practice Lead, payor solution that is a triple win for government, for Enterprise Canada, at the January webinar. industry and for Canadians.” The economic contributions of the pharmaceutical “Now is the time to provide a fresh influence on industry and retail pharmacy—sectors that are decisions,” agrees Jeff Mehltretter, Consultant, advocating for a mixed-payor model for pharmacare— Mehltretter Pharma Consulting. “The pandemic has carry more weight. “Communicating your economic created an openness to rethink how to proceed.” value and footprint in Canada is more important than (See page 17 for details on Neighbourhood Pharmacies’ ever,” said Heelis. position on national pharmacare.) While decisions around COVID-19 take priority, How Canadians feel the pharmacare discussion is also on the table, as To contribute further to the conversation, evidenced by the New Democratic Party’s Bill C-213, Neighbourhood Pharmacies enlisted Pollara Strategic 19 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.ca
INSIGHTS: NATIONAL PHARMACARE
Insights to conduct in-depth public opinion polling
about pharmacare in November.
FIGURE 1 Canadians’ top healthcare priorities
“It’s a story of good intentions versus brass tacks,”
summarized Craig Worden, President, Pollara Strategic What would you say are the two most important healthcare
Insights, at the webinar. “Canadians would ideally like priorities that deserve additional attention and funding?
everyone to have coverage for prescription drugs but,
n First choice n Second choice
when asked to make choices about healthcare policies,
pharmacare trails considerably behind other initiatives
COVID-19 23% 6% 28%
and issues as a public priority.”
When asked to name the two healthcare priorities
most important to them, Canadians scored pharmacare Mental health care 7% 10% 17%
eighth, close behind the similar priority of improved
access to medications (Figure 1). However, “both fall Care for seniors 5% 10% 14%
far behind higher priorities for Canadians like mental
health, senior care and better access to family doctors,”
said Worden. More family doctors 8% 5% 12%
The poll dived deeper by asking respondents to
Improved access
consider 13 specific healthcare initiatives, such as to healthcare/ 5% 7% 12%
improved long-term care and more support for reduced wait times
Canadians with opioid addiction. Were they more or
More medical staff 6% 5% 11%
less deserving of federal government funding than
a new national pharmacare program? All 13 were
Improved access to
deemed more deserving, most by a significant majority. medications/reduced 5% 7% 11%
medication costs
The poll also sought to paint a more accurate picture
of the number of Canadians without prescription drug National universal
pharmacare 5% 4% 9%
coverage. In November 2020, initial results indicated
that 16 per cent did not have coverage and another
Source: Pollara Strategic Insights, November 2020. N=4,120 adult Canadians.
six per cent did not know. This compared to 14 per Discrepancies in totals due to rounding.
cent and six per cent, respectively, in the time period
immediately before the start of the pandemic.
However, these numbers do not tell the full story. FIGURE 2 Prescription Drug Coverage in Canada
“The problem is that many Canadians do not know if
Canadians who: 10%
they have coverage, especially if it’s from a government Do not have coverage
program,” noted Worden. To get at this, the poll asked
additional questions of respondents in the “do not 4%
Do not know
have” or “do not know” categories to determine their
eligibility and awareness of government programs in
Note: Initially, 16% of
their jurisdiction (for example, OHIP+ in Ontario). respondents reported
After reassigning respondents who were eligible for not having coverage and
6% did not know. These
a government program or who indicated they were respondents were asked
part of a named government program, Pollara found additional questions to
that the incidence rates for those without coverage 86% factor in their eligibility or
Have coverage possible participation in a
significantly decreased, to 10 per cent who did not government program that
provides coverage, resulting
have coverage and four per cent who did not know
in final calculated levels of
(Figure 2). This is a difference of two points from the 10% and 4%, respectively.
pre-COVID time period, when the adjusted results were
eight per cent without coverage and four per cent who Source: Pollara Strategic Insights, November 2020. N=4,120 adult Canadians.
did not know.
20 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caINSIGHTS: NATIONAL PHARMACARE
Among those who reported having prescription drug that replaced all existing government and private
coverage, 80 per cent were satisfied with their current insurance plans, down from 30 per cent in 2018
primary plan, up from 71 per cent in a survey Pollara (Figure 3). The majority (57 per cent) prefer an
conducted for Neighbourhood Pharmacies in 2018. approach that focusses on maintaining existing drug
Overall, 82 per cent of Canadians supported the plans and providing coverage specifically to those who
idea of a national universal prescription drug coverage do not currently have it. Another 17 per cent felt that
program. However, when asked about specific models pharmacare should focus exclusively on Canadians
for pharmacare, only 25 per cent supported a program facing extreme circumstances, such as providing
coverage for expensive drugs treating rare diseases.
“Public opinion is clear: Canadians are satisfied
FIGURE 3 Canadians’ support for national pharmacare
with what they have and don’t want to see a lot of
their tax dollars go toward a new pharmacare,” says
82% Mehltretter. “Instead, we can improve upon our
Support the idea of
a national universal
prescription drug coverage
existing mixed-payor system, and Neighbourhood
program that would Pharmacies will continue to present suggestions to
provide all Canadians
access to the prescription
Support a government on how to do that.”
program that
medications they need. 25% would replace
all existing
government
and private Karen Welds is a journalist with
insurance
plans.
more than 25 years of experience
covering community pharmacy.
Source: Pollara Strategic Insights, November 2020. N=4,120 adult Canadians. info@neighbourhoodpharmacies.ca
Working Together
to Put Canadians First
Your partner in building a healthier Canada.
21 // Neighbourhood Pharmacy Gazette // Winter 2021 neighbourhoodpharmacies.caTHE LAST WORD
A united voice is key
to pharmacy’s future
We’ve heard about the importance Oftentimes, the average pharmacist-
of advocating for pharmacy, owner isn’t even aware of what is
especially in expanding the role of being done on their behalf to positively
pharmacists on the healthcare team. impact their future.
But as we approach another year of In my current role at McKesson, I’m
pandemic life in Canada, I’ve realized hoping to help change that. I’m on a
just how critical this advocacy will be team devoted to government relations
if we want our profession to thrive in and advocacy, where bringing a united
post COVID-19 times. voice for the profession of pharmacy is
As a pharmacist practising in Canada part of the mandate.
for the last 20 years, I’ve had the I’m also proud to be a board member
opportunity to work as a pharmacy of Neighbourhood Pharmacies, which Smita Patil,
manager and lead multi-store operations represents the profession and business RPh, BSc.Pharm
for both chains and banners. My role was of pharmacy across all pharmacy BOARD MEMBER
Neighbourhood Pharmacy
to support pharmacy teams in building formats, including independent Association of Canada
operational efficiencies and optimizing pharmacies. Policymakers and SENIOR DIRECTOR
workflow to enable them to spend governments prefer a single voice and INDUSTRY AFFAIRS
quality time caring for their patients. a strong message, and the Association McKesson Canada
Subsequently, I transitioned to a is equipped to provide that.
pharmacy services team with a national Neighbourhood Pharmacies’
responsibility that further expanded three regional caucuses inform and
my perspective. With high-performing disseminate what the Association
teams working at their maximum is doing on behalf of community
potential, I could redirect my focus pharmacies. As a member of all three
‘‘
to the bigger picture; namely, the caucuses and Co-Chair of the Central
hurdles preventing the profession as Regional Caucus, I feel privileged to
a whole from moving forward. The be able to provide a national lens, Policymakers
most common feedback I heard when which helps nurture collaboration and
working with independent pharmacy during conversations and the setting governments
owners, whether in operations or of objectives. prefer a single
pharmacy services, was that they felt a If anything, the last year has shown
voice and a
better job could be done in advocating us that pharmacists have the ability and
for their needs at the government level. willingness to come together and do
strong message,
It’s not that our provincial associations whatever it takes to care for patients and the
haven’t been doing their part, but until in need. It has also shown that when Association is
recently, the business of pharmacy and we communicate and collaborate, we equipped to
the needs of the pharmacist-owner
haven’t always been top of mind.
22 // Neighbourhood Pharmacy Gazette // Winter 2021
can influence change that benefits our
communities, and our profession.
provide that.
’’
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