Adequate pay key to providing more community pharmacy services across the globe

New survey results from the International Pharmaceutical Federation (FIP) reveal more pharmacies providing services beyond dispensing medicines, but how pharmacies are paid for these services remains an area for improvement. More than half the 79 countries who responded to FIP’s survey reported that their pharmacies are remunerated primarily based on the price of the medicine, which means pharmacies are vulnerable to fluctuations of drug prices. It also does not leave room for pharmacies providing additional services. “Across the globe, and even in Canada, we have a lot of work to do on remunerating pharmacy for their services,” said Shelita Dattani, vice president of pharmacy affairs at the Neighbourhood Pharmacy Association of Canada. Dattani was asked to comment on the FIP report by Pharmacy Practice + Business. In more than half the countries who responded, pharmacies were paid through multiple contractual agreements. Of the 65 countries where there was a third-party payer, 37 said there was a single third-party payer, and 28 said pharmacies deal with multiple payers. “This may lead to greater complexity but may offer greater flexibility for achieving remuneration for services. However, the low number of service-based remuneration models may limit service delivery and FIP will continue to advocate remuneration of services by third-party payers,” said Lars-Åke Söderlund, president of FIP’s community pharmacy section. The most common services that pharmacies get paid for is compounding of prescription medicines, medication review and administering vaccines. Dattani said that disease screening in pharmacies should be expanded. Of the 79 countries surveyed, by December 2020 only 18% had pharmacies performing COVID-19 testing. Nineteen percent of countries surveyed had pharmacy-based HIV testing. “It could have probably been better leveraged in many countries to have pharmacies involved in things like that,” she said. “I think it is a lesson for moving forward outside of COVID,” she said. The scope of pharmacy practice across the globe included dispensing emergency contraception (in 76% of countries), substituting generic for brand name therapies (37% of countries), adjusting prescriptions (32% of countries) and prescribing medications (16% of countries). Half the countries allowed pharmacies to provide first aid or immediate care services. “It is nice to see that pharmacists are starting to provide more professional care across the globe but it is important to be remunerated for that so they can be sustained,” Dattani said. The report shows that the global average density of pharmacists and pharmacies is increasing compared to FIP’s 2016 report. The global average density of community pharmacies per 10,000 is 2.75, with the average density of pharmacists at 5.19. Canada has 3.04 community pharmacies per 10,000 people, according to the report. However, in some countries, the number of pharmacists and pharmacies per 10,000 people is astonishingly low, with some low-income countries having less than one pharmacy per 10,000 people. “When you hear about some of the challenges around the globe it helps us understand that we have a real opportunity here in Canada because we’re so well integrated in communities,” Dattani said. The ratio of pharmacists to pharmacies is below one in some African and South-East Asian countries, suggesting that some pharmacies must operate without a pharmacist or that one pharmacist must work in more than one pharmacy. Dattani noted that Canadians can help countries with poor pharmacy access by teaching how to advocate for policy change, share experiences with regulations of certain medications, and demonstrate and share best practices. “There’s some opportunities that can happen at the global level in terms of medication management and stewardship and the role of the pharmacist and pharmacy,” she said. The global pharmacy workforce is uneven, with European countries and other high- to middle- income countries showing an increase in the ratio of pharmacists to pharmacies in the past six years. Having more pharmacists in pharmacies is a driver for adding services and improving patient care, Söderlund said. The majority of pharmacies around the world seem to be delivering patient-centred care, with 68% of countries having pharmacies providing home deliveries and 51% providing home care and review of medications. More than half of countries have pharmacies serving long-term care homes. All these services likely increased due to the COVID-19 pandemic, the FIP report said. The survey was conducted between November 2020 and January 2021, with organizations from 118 countries and territories invited to take part.

Adequate pay key to providing more community pharmacy services across the globe

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