20 Years in Review: Reflecting on Pharmacy’s Path from 2000-2020

Updated on February 18, 2021 (Originally posted on February 13, 2021) The Tablet

Produced by Angela Poon

As we enter a new decade, with many opportunities and challenges on the horizon for pharmacists, four former presidents with the BC Pharmacy Association’s Board of Directors reflect on the past 20 years of advocating for pharmacy in B.C. 

While the practice of pharmacy has changed immensely since 2000, the purpose of the BCPhA remains the same—to support pharmacists and pharmacies in their day-to-day delivery of pharmacy services, to enhance the role of pharmacy within the greater health-care system, and to advocate for the economic viability of the business of pharmacy. 

Whether you have been practicing pharmacy for 40 years or 4 months, The Tablet invites you to look back at some of pharmacy’s biggest achievements and most challenging obstacles of the past 20 years.

2000-2005

Derek Desrosiers served on the BCPhA Board of Directors from 2000-2006 and held the role of president for two consecutive fiscal years, in 2004/05 and 2005/06. He is a former pharmacy owner, CEO of uniPHARM Wholesale Drugs, and BCPhA Director of Pharmacy Practice Support. Currently, he is President and Principal Consultant at Desson Consulting Ltd. and current Board member with the BCPhA. 

What were some of the most significant issues concerning pharmacy in B.C.?

We were dealing with a pharmacist shortage and struggling with how to overcome that shortage. It had been going on for a number of years already. A 20 per cent spike in prescriptions and only a one per cent increase in pharmacists between 1997 and 2001 caused a real labour crisis during this time. A lot of time was spent cultivating relationships with government and the Ministry of Health as the BCPhA built up its body of advocacy work. The cost of dispensing was an ongoing issue, and the dispensing fee has always been a significant issue of concern to B.C. pharmacists. The actual cost of dispensing issue led to a partnership that was formulated in late 2005 and implemented later, in March 2006.

Were there any issues at the time that inspired debate amongst pharmacists?

Back in that era, the First Nations Health Authority didn’t exist, and B.C. pharmacists were still dealing with Non-Insured Health Benefits (NIHB), as the federal health program for Indigenous peoples. There were always ongoing payment and coverage issues with NIHB, to the point that there was even talk of a lawsuit at one time to sue NIHB over some billing issues. The BCPhA appointed the Canadian Pharmacy Association on this issue, but it was ultimately determined that a lawsuit would not be precedent setting and would take many years to resolve. Also, the idea was abandoned as it was felt to be too risky in terms of the likelihood of it ending all communication and government relations with NIHB.

What were some of the biggest gains or achievements?

Pharmacists in B.C. were granted the right to prescribe emergency contraception in late 1999 and so in 2000, there was a significant amount of training going on for B.C. pharmacists throughout the province. Over 1,800 pharmacists were trained as ECP emergency contraceptive pills (ECP) prescribers in 2000. Pharmacist expertise was added to the BC Nurse line in the EPIC project in 2003. And the BCPhA partnered with the Ministry of Health to distribute the BC Health Guide to British Columbians throughout community pharmacies. 

How did you see pharmacy change during this time period?

I think this era—and especially with the advent of ECP—prescribing was the real beginning of the expansion of scope of practice and the move towards pharmacist prescribing not only in B.C. but across the country. Additionally, pharmacist salaries started to increase more to be in line with other health-care providers.

How did the BCPhA’s Board help impact positive change for pharmacists?

The BCPhA Board worked hard at developing inter- organizational relationships with a number of other health-care professional bodies, including regulators and advocacy organizations. Also, there was significant growth in the working relationship between the BCPhA and the Ministry of Health. Much of this was achieved through the advocacy work done individually by many Board members meeting with their MLAs in their local constituencies.

2006-2010

Linda Lytle served on the BCPhA Board of Directors from 2005-2011 and held the role of president in 2007/08. Lytle started her career as a pharmacist in Campbell River and Vancouver, before joining the College of Pharmacists of BC as the Communications Coordinator in 1980. She went on to serve as Deputy Registrar for seven years and Registrar for 10 years, before retiring in 2005. She currently divides her time between Vancouver and Mexico’s Pacific Coast.

What were some of the most significant issues concerning pharmacy in B.C.?

The significant issues during my time as a Board member continued to include the pharmacist workforce shortage, economic issues relating to prescription preparation costs and rising competitive pharmacist compensation vs. PharmaCare prescription fees and other cost containment efforts, the College’s Professional Development and Assessment Program (PDAP) requirements, expanding the role of the pharmacist, and the development of formal pharmacy technician education, practice standards and registration.

Were there any issues at the time that inspired debate amongst pharmacists?

Two of the above noted topics created a lot of controversy, which affected the work of the Association: The College’s PDAP and pharmacist prescribing beyond the emergency contraception products (which had created their own controversy when introduced in 1999).

What were some of the biggest gains or achievements?

As with many other types of controversies, both topics lead to pharmacy gains with the Association’s involvement. Some adaptations were made to the PDAP which provided additional methods of meeting the College’s continuing competency requirements, and expansion of the pharmacist’s role paved the way for enhanced roles in diabetes management, smoking cessation programs, asthma management and medication adherence programs, followed by injection authority for pharmacists trained to do so. The Association was an active participant with its 2003 position paper, “Expanded Roles for Pharmacists.”

Another gain during the timeframe was the Association’s participation in the Activity-Based Costing Study, which resulted in the collection of accurate information pertaining to the actual cost of producing a prescription and documenting the range of pharmacist’s hourly compensation and average annual salary. The study also highlighted the complexity of the role of the individual pharmacist, which proved useful in the creation of public messaging promoting the role of the pharmacist in public health.

All of these efforts lead to useful and high-profile government partnerships in the Medications Return Program and the province-wide distribution of over 750,000 copies of the B.C. Health Guide handbook by pharmacies in all areas of the province.

How did you see pharmacy change during this time period?

My sense is that pharmacy changed during this time period with an increased level of confidence by individual practitioners and pharmacy businesses, supported by the BCPhA’s innovative measures to place the profession in the public’s eye, on the government’s radar, and changing other health profession’s perceptions. 

How did the BCPhA’s Board help impact positive change for pharmacists?

The Board of Directors contributed to the “atmosphere of change” by encouraging Association staff to be creative in their programming and by taking steps to ensure that pharmacists themselves knew that their work was being recognized and appreciated.

2011-2015

Don Cocar served on the BCPhA Board of Directors from 2009-2015 and held the role of president in 2013/14. Following graduation in 1994 from the University of British Columbia, Cocar’s first job in pharmacy was in Whistler, before returning to his hometown of Kelowna the following year. He has since worked throughout the Okanagan Valley, mostly owning his own independent pharmacies. He is currently the owner of Knights Pharmacy in Penticton.

What were some of the most significant issues concerning pharmacy in B.C.?

Two of the largest issues at the time were: the remuneration cut back by PharmaCare and third-party payers and the rampant audits being done on pharmacy by PharmaCare.

Were there any issues at the time that inspired debate amongst pharmacists?

There was always good debate around the BCPhA Board table, but I guess the biggest issue we faced at that time—and continue to face—is the lack of solidarity we have amongst pharmacies. Independents, banners and corporate pharmacies all have different agendas, and it is hard to fight a united front without the solidarity between pharmacy groups.

What were some of the biggest gains or achievements?

For a period of time, we did all come together as a united front and we were able to meet with PharmaCare and third-party insurers to voice our concerns and believe it did make a difference going forward.

How did you see pharmacy change during this time period?

As I alluded to earlier, we had buy-in from all stakeholders in pharmacy to come together to voice our concerns to government and insurers, which I believe made a difference and continues to make a difference.

How did the BCPhA’s Board help impact positive change for pharmacists?

There were many great minds on the Board during my time, some very influential people from both corporate pharmacy and independent pharmacy. We put our personal agendas aside and made decisions together to better the pharmacy in general. It was very rewarding.

2016-2020

Chris Waller has served on the BCPhA Board since 2015 and held the role of president in the final quarter of 2018 and the entirety of 2019, following the restructuring of the BCPhA fiscal year. Waller grew up in the pharmacy world, working for his pharmacist father Ron Waller at Lakeside Medicine Centre Pharmacy in Kelowna in the 1980s before attending pharmacy school at the University of British Columbia. After graduation in 1998, he returned to Kelowna and Lakeside Pharmacy, where he is now owner pharmacist. He continues to serve on the BCPhA Board until the end of 2021.

What were some of the most significant issues concerning pharmacy in B.C.?

The viability of small independent community pharmacy continues to be challenging. Most of this sector of pharmacy relies on prescription sales and tends to be smaller format stores with little room for much retail product. Automation is another part of health care that will continue to have an impact on pharmacy. Mail order, Zoom meetings, e-prescribing, central filling, and preferred provider networks will all continue to take away from the one-on-one interactions that patients have with their community pharmacist.

Were there any issues at the time that inspired debate amongst pharmacists?

Pan-Canadian pricing, OAT training, changes to pharmacy ownership disclosure requirements, expanding the scope of practice of pharmacists to include things like treatment of minor ailments, and changes to some third-party insurers that grade pharmacies based on patient claims history and ability to offer structured coaching for patients that are not compliant and may not want to be. Most of these things are designed to improve patient outcomes and improve the quality of care that patients get at their community pharmacy, but with less funding these kinds of changes to patient care remain difficult for pharmacists.

What were some of the biggest gains or achievements?

Vaccinations. In recent years, pharmacies are the places to go to get your flu shot, travel vaccines, and schedule publicly funded vaccines and unfunded vaccines like Shingrix and Prevnar 13. Pharmacies are in most cities and towns and are generally easily accessible for these shots. Our next big challenge will be stepping up for the COVID-19 vaccine when we are called upon.

How did you see pharmacy change during this time period?

I find that I spend much more time documenting and charting on the patient’s chart or by writing on the prescription. All this to ensure that I am more protected against future audits, but also to ensure my fellow pharmacist colleagues understand the communication between me and the patient or allied health-care professional such as physicians, nurses and social workers.

How did the BCPhA’s Board help impact positive change for pharmacists?

So many things over the years: Both the regulatory bootcamp and OAT training showed our Ministry of Health and PharmaCare that the BCPhA can set all pharmacists on a structured path of how to ensure proper documentation on prescriptions that we receive and what insurers are looking for with audits. With OAT training, it offered a structured approach to a program that has changed over the years—from a time when pharmacists were compounding 1mg/ml methadone with Tang and prescribers were writing on regular duplicate pads to the present day where we have commercial 10mg/ml methadone as well as Suboxone sublingual tablets and injectable Sublicade (and other options), all requiring specialized duplicates in order to ensure proper dispensing and compliance.
 
Other areas include working with the College of Pharmacists of BC to produce the pharmacy manager training program and with the First Nations Health Authority to ensure a smooth roll out of the new Plan W program for B.C’s First Nations communities. 

This article is featured in The Tablet. The Tablet features pharmacy and industry news, profiles on B.C. pharmacists, information on research developments and new products.