Community pharmacy in Japan and the lessons we can learn

This year’s Pharmintercom was held in May in Singapore and among a host of opportunities, delegates were invited to hear from two representatives of the Japan Pharmaceutical Association – President Susumu Iwatsuki and Executive Director Atsushi Toyomi.

Mr Toyomi delivered a presentation which revealed how Japan’s community pharmacies are tackling its ‘super-aged society’, offering lessons for Australia and New Zealand these countries both approach similar demographic shifts.

Stark statistics

Japan’s demographic situation is stark, with 29 per cent of its population aged 65 or older.

Australia won’t reach such proportions until the mid-2060s, and New Zealand until the late-2050s. The worker-to-senior ratio in Japan has plummeted from 12 to one in 1950 — to just two to one today, which is the lowest ratio of working-age people relative to elderly people globally. And those numbers continue to decline.

With annual healthcare expenditure consuming 11 percent of gross domestic product, Japan’s universal health system faces an unsustainable budget strain which has forced a radically rethink of healthcare delivery.

The urgency of these demographic trends is driving a rapid evolution of community pharmacy practice. Japan has the highest density of practising pharmacists in the world – one for every 500 people.

Unusually, their model does not have dispensary assistants or technicians, as the law requires that only pharmacists are involved in the dispensing process. The high density of pharmacists represents an opportunity, but authorised scope of practice has lagged many other countries, as has the funding of services beyond dispensing.

Changing roles

Pharmacists in Japan cannot yet administer vaccinations, for example. However, this is changing. The role of pharmacies is expanding beyond dispensing medication to include disease prevention and health promotion.

This strategic shift is essential in addressing Japan’s demographic challenges while maintaining fiscal discipline and health system productivity. While funding remains a major challenge, Japan is empowering its reducing workforce to manage population health more efficiently.

Interestingly, despite the ageing of the population, Japan’s community pharmacy sector has not forgotten young people. In fact, pharmacists are perhaps more ingrained in the lives of school-aged children than in any other developed country.

The school pharmacist

One of Japan’s most distinctive pharmacy initiatives is its school pharmacist system. Since 2003, all schools — elementary through to secondary – have been required to appoint a school pharmacist.

School pharmacists conduct environmental and hygiene assessments, provide advice and support to school principals to help maintain a safe and comfortable learning environment and, perhaps most importantly, they deliver health education, including drug abuse prevention programs for middle school students and lessons on proper medication use across all grades.

Each year, some 9,000 pharmacists deliver 30,000 such classes nationwide. This system leverages the expertise of local pharmacists to create early relationship-building opportunities which prove invaluable later in life.

Children grow up recognising their community pharmacist as a trusted health authority long before they require prescription medications. This early relationship with pharmacists sets the foundation for the systems which supports patients throughout adulthood.

Centralising family care

In 2015, the Japanese Ministry of Health, Labour and Welfare announced a 10 year Pharmacy Vision for Patients. It aimed to shift from a drug‑oriented to a patient-oriented model to cope with an ageing society and a fragmented health care landscape.

A major component has been the introduction of the Health Support Pharmacy, or HSP. Under this system, families formally designate one, HSP-accredited pharmacy as their primary provider, and the family pharmacist assumes responsibility for medication management, health counselling, home‑care visits, and coordination with the family doctor. Around 70 percent of pharmacies meet the HSP criteria.

A 2019 revision of the Pharmacies Act established a legal requirement for pharmacists to follow up on patients’ medication use after dispensing. This involves checking on the patient’s condition, such as the drugs, effects, side effects and changes in health status, using phone call or message between visits.

Pharmacists prioritise follow up, particularly when a new medication is prescribed or when side effects are suspected and share information with the physician as needed. The objective is to maximise the effectiveness of drug therapy and ensure patient safety.

Failure to complete follow-up is treated with the same seriousness as dispensing errors and is subject to audit by prefectural health authorities.

Supporting Japan’s ageing population at home

With Japan’s aging demographic, home medical care has become increasingly vital. The number of patients receiving care at home is increasing and pharmacies are actively engaged in home medical care by visiting these patients’ homes to manage and guide medication use.

Pharmacies now collaborate closely with physicians, nurses, and care managers to prepare tailored medications, provide usage guidance, and monitor any side effects. As medication experts, pharmacists support patients so they can live their lives with peace of mind at home.

This home care model represents a strategic response to Japan’s demographic challenges, allowing elderly patients to remain in their homes longer while receiving appropriate pharmaceutical care.

The growing use of home-based care also heightens the vulnerability of elderly patients during Japan’s natural disasters, when access to medications and healthcare support can be abruptly severed.

Disaster preparedness

Japan’s vulnerability to natural disasters has led to formal roles for community pharmacy in disaster management. The JPA has built a nationwide system which can quickly reestablish pharmacy services in affected areas. There are 20 mobile pharmacy vehicles available nationwide that can be deployed to an area struck by a disaster.

Recent guidelines promote the inclusion of disaster pharmaceutical coordinators. These coordinators manage medicine supply and hygiene control in evacuation shelters — ensuring displaced residents, including seniors, do not lose access to their vital medications. This has proven essential following earthquakes and typhoons.

Lessons from Japan

The Japanese experience offers valuable insights for countries which must prepare for the demographic shifts. Japan’s school pharmacist program demonstrates how early engagement creates lifelong trust.

The Health Support Pharmacy system represents Japan’s recognition that coordinated care, built around local relationships, leads to better outcomes. The new dispensing follow-up protocols highlight the level of importance Japan places on regular patient-pharmacist contact.

And the extensive and proven framework for community pharmacy involvement in disaster response represents a proactive model of preparedness worth following for any country.

For nations like Australia and New Zealand, Japan’s experience is part warning, part roadmap. As our own demographics shift toward a ‘super-aged’ reality, community pharmacies must become pillars of prevention, continuity, and resilience.

The JPA’s vision for Japan is to build a system which guarantees access to necessary medicines and pharmacist services, ‘anytime, anywhere, for anyone’. This vision can be applied around the world, and Japan’s approach makes it clear: pharmacists are the most accessible, trusted health partners across every life stage — from schoolyards to home aged care, to disaster zones – and are the key to a sustainable, person-centred health system.