Supporting Innovation in Pharmacy for a Healthier Canada

Digital world: differentiation or disruption?


Participants in CFP's Pharmacy Forum in June included, clockwise from top left: moderator Zubin Austin, University of Toronto; Fabio De Rango, Shoppers Drug Mart; Sean Simpson, Simpson's Pharmasave; and Andy Donald, The Health Depot Pharmacy

JULY 2021 - Digital pharmacy, online pharmacy, virtual pharmacy—the names and incarnations may vary but the implications for community pharmacy are the same, agreed panelists at the Canadian Foundation for Pharmacy’s “Accelerating the Pace of Change” Forum on June 24.

“I fully expect moving forward that [my practice will be] an integrated, hybrid online and in-person approach that supports people being able to interact with us when they want and how they want,” said Sean Simpson, owner of Simpson’s Pharmasave and several other community pharmacies in the Niagara region, Ontario.

At the start of the pandemic Simpson shifted to the delivery of both prescription drugs and frontshop items (the latter could be ordered online). Online booking for services soon followed, and the services themselves could be provided virtually by phone or video consult. A secure chat function enables asynchronous communications.

“What we’ve discovered is that our patients and the broader community now interact with our pharmacy on a 24-hour basis. They really appreciate the communication pathways of the online platform,” said Simpson.

Technology catching up

However, Simpson noted that the technology behind online orders for prescription products must catch up with what’s available for frontshop items. “Our software providers haven’t yet provided for that,” he said, although he hopes it’s just a matter of time given growing expectations from community pharmacy owners.

Andy Donald, former owner of a community pharmacy, developed his own API (application programming interface) before opening The Health Depot Pharmacy, an online-only pharmacy and health store, in 2019. Since then, he’s noted the growing availability of “plug and play” software options from platforms such as Shopify.

“Technology is slowing catching up to demand to make it a lot easier for pharmacies and individuals to…add this on [to their practice],” said Donald.

The Health Depot fulfills orders for prescription, nonprescription and personal care products. It delivers anywhere in Ontario and shipping is free. It also offers virtual consults for medication management and other services specific to older adults. Donald’s wife, Agata Donald, is co-owner and both are certified geriatric pharmacists.

They haven’t look back since opening just months before the pandemic. “I figured it would take five to six years [for the business] to come along, but everything was definitely more rushed with the pandemic,” said Donald.

While Fabio De Rango, associate-owner of two Shoppers Drug Marts in Oakville, Ontario, agreed that technology can enhance interactions with patients, he emphasized that the pandemic has also improved people’s perceptions of pharmacy and accelerated pharmacists’ role as direct service providers. Immunizations are an obvious example, including routine vaccinations beyond COVID-19 and influenza. At his pharmacies, De Rango also offers screening or testing programs for diabetes, atrial fibrillation, pharmacogenomics, cholesterol and strep throat.

“We will be seen more and more as frontline healthcare workers, as gatekeepers. People will come to us first,” said De Rango.

Opportunity or threat?

The three panelists agreed that online or virtual interactions with patients are the way of the future. “The technology is coming so it’s better to be on the bus to help steer it,” said Donald. “Automation will help pharmacists do more on the clinical side.”

“We’ve set up virtual consults as a result of even OTC purchases,” noted Simpson. More importantly, an online presence “enhances and allows for better care. [For example] we are catching patients at home in evening when they have more time. By being more available we are creating opportunities to provide better care.”

A new avenue for virtual care may also be coming from private payers.

“In the next 12 months…a large benefits trust with about $300 million a year in prescription drug claims [on behalf of multiple employer plans] will be moving to a vertically integrated, plan sponsor-controlled pharmacy,” announced Mike Sullivan, pharmacist and CEO of Cubic Health, a consulting firm for the employee benefits industry.

This virtual pharmacy is “not a mail-order play,” a way to scorecard pharmacies or a bid to reduce dispensing fees or markups. “They are doing this because they understand the profound value of integrating the pharmacy channel from a care standpoint. [This is about] changing the model to allow that clinical team to have a bigger impact,” said Sullivan.

The new model is required because the multitude of stakeholders on both sides and a lack of standardization has led to the realization that payers “can’t have an impact until they have a dedicated team that’s focused on their own plan members.” The team would provide medication management services to plan members with high-cost claims and/or chronic diseases.

Rather than see this as a threat, community pharmacies can become part of the virtual team. “Technology will enable you to synch in with payers,” said Sullivan, who added that he is “incredibly optimistic” about what this represents for traditional community pharmacy practice.

The foundation is also laid to study the results. “We’re working with enormous plans and we’re not just seeing their drug claims, we’re also seeing their data for extended health claims, short term disability and long-term disability. So we can actually measure the impact. That’s a really exciting opportunity,” said Sullivan.

Mike Jaczko, Partner and Portfolio Manager with KJ Harrison, summarized the feelings of all panelists during the webinar’s closing remarks, when moderator Zubin Austin, Professor at the University of Toronto, asked for parting words of advice to community pharmacists.

“You have no choice but to embrace and understand that technology is an enabler. It’s not an enemy, it’s not a competitor. And the rate of change has definitely accelerated,” said Jaczko.

Stats for guidance

Canadians would still rather pick up their new prescriptions than have them delivered, even after ordering them online. That’s one of the findings of a survey conducted in September 2020 by Abacus Data on behalf of the Canadian Pharmacists Association (CPhA) and presented by Joelle Walker, CPhA’s Vice-President of Public Affairs.

When asked to imagine ordering a new prescription online, 70% of respondents said they would prefer to pick up the prescription in person rather than have it delivered the next day. Eighty-two percent agreed it was important to have access to a pharmacist to discuss new medications when they are filled.

Other findings include:

  • 36% of respondents under age 45 would order prescriptions from Amazon, compared to just 13% among those older than 45.
  • After the pandemic, respondents estimated that about a quarter of their purchases for over-the-counter (28%) and prescription (23%) would be online rather than in-store (compared to 63% of clothing purchases that would be online).
  • 83% are completely comfortable (36%) or comfortable enough (47%) speaking with a pharmacist via video conference.