REMARKS BY

MARC KEALEY

A CHALLENGE FOR INNOVATION

SOLUTIONS IN DRUG PLAN MANAGEMENT

JUNE 15, 2006
TORONTO, ONTARIO
Good morning everyone, and my thanks to Rogers
for hosting another series of solutions based
discussions and inviting me to be part of this one
on Solutions in drug plan management.

If you’ll permit me a stream of consciousness for

the next while, I want to talk to you about the
opportunities in the market place – in particular for
pharmacists.

We, as a profession, are in an extraordinary

position at present. At a time when integration
and collaboration are the buzzwords in the health
care system, pharmacists appear to be part of the
solution.

For the most part, in Ontario most especially,

pharmacists are staring straight at change. We
might not all agree on whether its good – but we
all agree much is based on Bill 102.

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As you may know, Bill 102 brings the most
significant change in history to Ontario’s public
drug system.

The government’s motivations with Bill 102 can be

stated as “the right drug for the right patient at the
right price.”

The objective, said the Minister of Health George

Smitherman, is better value for taxpayer dollars.

The way to get there, he suggested, is a more

efficient drug system, more accountable and
transparent, and better drug pricing that reflects
the volumes the province purchases.

The target, said the Minister, is a drug system

where patients get better access to drugs they
need, taxpayers get better value for money, and

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retailers, pharmacists, doctors and manufacturers
get treated fairly.

My purpose here today is to try to shed a little light

on the pharmacists’ perspective on this Bill.

But let me begin by stating clearly one inescapable

truth: We have to move forward. If there is one
principle we have to come together on the same
page about, it is that the status quo on the drug
system is not acceptable and not sustainable.

Keeping the public system sustainable and the

private system affordable for business is not just
good policy, it’s critical to this province’s economic
competitiveness.

Do you think for one minute that the best

economic news in the province this year – the
announcement by Linamar, the number-two auto

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parts maker in the country, that it’s investing 1.1
billion dollars in Guelph and creating 3,000 new
jobs – would be happening in this province if we
did not have a public health-care system, including
a drug system, that supports internationally
competitive labour costs?

Take the health care and drug piece out of that

puzzle and I’ll tell you what you end up with – a
parts plant in Tennessee or Mexico, and a weaker
and less productive economy here in Ontario.

We should never take our drug system for granted

– and never be short-sighted enough to just attack
outright a government that undertakes to ensure
its long-term sustainability. And don’t think for one
second that the need to take on that challenge
would be ignored by any government in any
province, Liberal, Conservative, NDP or any other.

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What is incumbent upon pharmacists to do today –
as a major health care stakeholder– is to make
certain that changes to the drug system aimed at
ensuring its sustainability do not in turn undermine
the sustainability and viability of community
pharmacy. We have worked hard over the past
weeks to ensure that this will not happen, and that
Bill 102 does not put at risk the ability of
pharmacists to deliver value-added services to
their patients.

The world has been moving very quickly for

pharmacists over the past eight weeks since the
introduction of Bill 102, and I do understand those
who share our concerns. The facts are
complicated, not simplistic. Change can be
intimidating and frightening for some.

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But most pharmacists look forward to change. In
fact, we recently completed our annual conference
where the theme – Ready for Change – was
embraced quite openly and enthusiastically.

But I also want to point out that fear of change can

quite often be tied to a lack of knowledge and
understanding. And with Bill 102, part of the
problem is exactly that.

The Bill was introduced on April 13th. Five days

later, on April 18th, we went into the field with a
massive public opinion survey to measure
awareness and support for Bill 102.

What we found was very revealing. Leger

Marketing interviewed 1,000 Ontarians in the two
weeks following the introduction of Bill 102.

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What Leger found is that only one in five
Ontarians, 22 percent, had heard about the
government’s plan. And only 2.8% had a high level
of familiarity with it.

When they were provided with a summary of the

plan stating the government’s objectives, just
under half – 47 percent – approved of it. And
nearly as many – 41 percent – could not even
understand what the government has proposed.

These findings describe a public that needs to hear

more and understand more.

The remarkable thing about Bill 102 is that when

the people understand its intent, they like what
they hear.

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We asked Leger to describe the key aspects of the
Bill to Ontarians and determine their approval.
Here’s what we found.

92 percent of Ontarians approve of ensuring that

the voice of patients is taken into account in
determining whether new drugs are covered under
the province’s drug plan.

They approve of that – and it’s in the bill.

The survey goes on.

82 percent of Ontarians approve of increasing the

level of involvement of pharmacists in making
decisions about the province’s drug system.
Another massive majority approval – and it too is
already in the bill.

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Let me be clear – this new role for pharmacists, as
partners with government in making decisions
about the future of the drug system – is a huge
victory for our profession. A new model for
pharmacists and it has rock-solid support by the
people of this province.

Government cannot legislate line-by-line how we

do our business. It can, however, enable us to do
our job and provide the funding and resources to
better serve patients.

That expanded range of professional services

includes chronic disease management, medication
management, patient education and other patient
services of enormous benefit. As accessible, highly
trained health care providers, pharmacists are
perfectly positioned and fully prepared to deliver
these services directly to patients with tremendous
effectiveness.

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And what we know today, thanks to the Leger
survey, is that patients are right there with us.

86 per cent of Ontarians told Leger they agree with

the following statement:

“I would not hesitate to consult with my

pharmacist for information on health-related issues
other than filling a prescription.”

75 percent of Ontarians say:

“I would not hesitate to seek education services

and patient care from my pharmacist for smoking
cessation, diabetes, asthma or another health
condition.”

These are extraordinary statements on what the

patients of Ontario already know about their

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pharmacists – which they have the skills, the
knowledge, and the expertise, to step up and play
a powerful new role in health care delivery.

What Bill 102 has laid out is the potential for a new
model. It’s bold.

Like it or not, we have an opportunity to define the

future for the public drug plan, and I believe the
private sector too.

At present, community pharmacy is recognized as

a commodity service. There are innovators – and
many of them out there. But we still see
discounted fees, waiving co-pays and various other
schemes to create foot traffic in many community
pharmacies.

What government and the private sector want is

cost containment for the ‘drug file’ and the service

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we provide and that, my friends, led to the
introduction of Bill 102.

What we have always wanted to see is a blended

model. A new model that blends traditional
pharmacy practice with some kind of professional
service. Something like what is proposed in Bill
102.

As I stated earlier, the reason you’re hearing so

much noise about Bill 102 is that many don’t know
or haven’t put their minds to what that potential
new business model could look like. They haven’t
followed through on the thinking.

If you consider for a moment what the Ontario

Ministry of Health has recently announced - it’s
new vision. It has moved to break down its
traditional silos. It has introduced horizontal
integration.

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In effect, it is laying the groundwork for a future
where cause and effect are the order of the day. If
you spend so much on the one hand for a service,
the Ministry will experience a decrease in cost for
another service on the other.

We agree with this approach and it has infected

our strategic planning.

Let me explain.

The classic service mentality respecting

pharmacists pervaded government and third party
payers – you all believed that pharmacists cared
only about fees and not about patient outcomes
nor did many of you think we could impact same.

In three short years, we have assembled a team of

clinical, financial, policy and organizational

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expertise that has made us one of the premier
advocacy organizations in North America. Our
opinion matters and the work we do and have
done matters.

What we have moved to do is position pharmacists

in the marketplace where their role and the work
they do in counseling patients, collaborating with
physicians and other providers and the programs
we have developed for disease management and
medication management can impact on drug plans
and the system writ large.

We are working with the Group Health Centre in

Sault Ste Marie, the OMA and Canada Health
Infoway on a project that will link all the
community pharmacies in and around the Soo on
an integrated net-based drug platform. The
project is in the development stage at present, but

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is being heralded as a true collaborative model to
ensure better compliance, better outcomes and
better service for patients - with the best outcome
being the right provider at the right time. That’s
true horizontal integration.

Governments and the private sector share similar

issues related to drugs. The payers have to get
value for the money being spent.

Whether it’s a tax-payer, an employer, an

employee or a third party payer. We have to work
together to uncover common solutions.

I trust that my remarks here today have

enlightened you a bit about where we can play a
role to help realize a common thinking and
solutions to those issues.

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I used a word there that I want to close on this
morning: Trust.

This is a time when government, industry,

employers and employee groups and indeed
pharmacists need to trust one another. Trust that
the right programs and the right intent will benefit
everyone.

We have a lot of work to do. This is a time to build

on those giant steps forward.

For our part, and those pharmacists in the

audience, we’ve been put on notice by the
government that our opinion matters and that item
Bill 102 represents the greatest opportunity we
have seen in generations to rewrite the role of the
pharmacist in health care – to create the kind of
efficiency you’re all starving for.

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We have to take up that challenge together. It’s
not just good for us. It’s something our patients
are telling us they want.

And that too, is all about trust.

Because there’s something else we found in the

Leger survey that blew us all away.

Back in November 2004, we were pleasantly surprised

by a Decima survey we conducted that showed 97
percent of Ontarians trust their pharmacists.

In our most recent survey, which concluded this

month, Ontarians were asked once again: Do you
trust your pharmacist?

And this time, 98 percent said yes.

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