Duane Hicks
Plans by the McGuinty government to further reform the prescription drug system are not receiving a warm welcome from pharmacists.
The province says the changes are being made “to provide better access to lower-cost generic drugs for patients while continuing to increase annual funding to the drug system as a whole” but pharmacists argue they will hurt their businesses and adversely affect patient health care services.
Among the changes, the provincial government plans to eliminate most of the $750 million in professional allowances generic drug companies pay pharmacies to secure shelf space.
Pharmacist Kim Metke, who owns Pharmasave and the Fort Frances Clinic Dispensary here, as well as Pharmasave stores in Dryden and Kenora, said the proposed changes will be devastating.
“What we see is it’s going to be decreased services for everybody because it’s going to be less money to retail pharmacy,” Metke remarked, estimating the loss of $750 million in professional allowances roughly breaks down to $300,000 per pharmacy in Ontario.
Back in 2006, Ontario cut generic drug prices and capped professional allowance fees at 20 percent.
“They’ve twice now come to us and said, ‘This is really to go after the generic drug companies,’ and the last time around, we sort of went, ‘You know, this is going to hit retail pharmacy’ and they said, ‘No, no,’” recalled Metke, adding the pharmacies estimated they would lose 30 percent off their earnings while the drug companies would break even.
“A year later, we went back and analyzed it. We got the 30 percent haircut, and we figured generic drug companies made an extra 10,” he noted.
“This obviously will impact the generic drug companies more, but again, we’ve already got our kick in the teeth.
“Why are you [the province] coming after us again?” he wondered.
In simplest terms, the elimination of professional allowances will mean a reduction in the level of service pharmacies will be able to afford to offer the public, said Metke.
This could mean reduced pharmacy hours, increased wait times for patients, and fewer pharmacists, with less time—or no time—to talk to patients.
This, in turn, could affect medication and over-the-counter medication counselling, monitoring for drug interactions, helping patients with conditions such as diabetes, MS, asthma, cancer, and high blood pressure, and educating patients on medical devices such as blood
glucose or blood pressure monitors.
Also potentially impacted would be public health advice on H1N1, infusion therapies like injection/IV services, compliance packaging for the elderly (like blister packing), health education clinics, free prescription delivery, medication and syringe disposal, patient triage, and general health concerns.
“It’s hard to provide these services when we’re basically going to have to cut our staff to a minimum, as far as I am concerned, to stay in business,” Metke reasoned.
The province says it plans to compensate for the lost income by paying fees to pharmacists who take time to do one-on-one counselling or provide enhanced services such as ’flu shots.
But the $100 million they’ve earmarked for this is a far cry from the $750 million from the generic drug companies, and how pharmacies can do these extra services on a reduced budget remains is puzzling, said Metke.
“It’s always the same deal,” he remarked. “‘Well, we’re going to give you this money over here. Of course, you’re going to have to do extra work for it.’
“Well, they’re creating an economic situation where I am going to have to cut staff, and now you’re talking about me doing more work?” added Metke, noting that at this point, pharmacists haven’t been told how they’ll be able to access the $100 million.
The province also says it will lower the cost of generic drugs by at least 50 percent (to 25 percent of the cost of the original brand name drug) for Ontario’s public drug system, private employer drug plans, and people who pay for drugs out-of-pocket, which the government notes will save taxpayers—and the government’s Ontario Drug Benefit Program—millions of dollars.
“Let me get excited about that—you’re requiring me to lay off staff so you can make things nicer for the auto workers?” Metke mused.
“It’s like every time the government gets involved and makes these top-down decisions, I can sort of see where they’re coming from, but is this really fair?” he asked.
“Most of these people are not making anywhere near what an auto worker is making.
“Our pharmacists are, and there will be some cuts in that regard, but for most of the staff that’s going to bear the brunt on this, they’re going to be out of a job,” Metke stressed.
“These people are performing a worthwhile function and they’re not overly well-paid, and the government’s saying, ‘We don’t care. We don’t care about patient services. We’re saving money.’
“I am saying, what’s your justification?”
Metke said the province expects to save at least $1 billion each year for the next three years minimum by lowering the cost of generic drugs, but at what cost to pharmacy owners?
“Profit gets a dirty name, but at some point I have to make a profit,” he argued. “If I don’t, I can’t replace equipment, my computer systems, I can’t pay my staff.
“I can’t even maintain my staff.
“I don’t mind doing my fair share, but the government keeps coming after retail pharmacy,” said Metke, noting the province tells pharmacists they perform a valuable service, but then asks them to expand their scope of service but not get paid for it.
“We would like to provide better patient care, but we’re not seeing how they’re allowing us to do this,” he remarked.
The province also has said it will increase dispensing fees from $7 to $8 to help make it up to pharmacies. But given this is only the second increase is 20 years, Metke noted that is a very small increase compared to inflation over the years.
By contrast, pharmacists’ wages have doubled in the past 20 years.
“What really bothers us, as pharmacists, is we keep going to the government and saying, ‘We want to help. We want to do what we can. Can we co-operatively look at this?’” Metke said.
“And the government says, ‘No . . . if we have a pharmacist involved, it might corrupt the process.’
“Well, who else knows about operating pharmacies? It’s this arbitrary in-your-face attitude of negotiating—they’re not really negotiating at all,” he added.
“It doesn’t have to be this way. Why can’t we work together to improve people’s health?
Shouldn’t that be your objective?”
Sarah Berg, owner of Rainy River Pharmacy in Rainy River, agreed the drug reform plan is a raw deal.
“What they’re taking away from us is not close to what they’re proposing we get back in return,” she noted.
“They propose we get paid for alternate services, like clinics and whatnot, but that’s not really feasible in a pharmacy that has one pharmacist on staff,” she argued.
“How do you even manage that?”
On top of that, Berg said there is no listing of how pharmacies will access this funding or what services will be worth what.
“Myself, I couldn’t hold a ’flu shot clinic while I work. We’re busy enough as it is,” she stressed.
“You can’t have a clinic in the middle of the workday.”
Berg said the province has been putting its own spin on the drug reform, and it’s not fair to pharmacies or the public.
“The way that it was sent out to the public by the government is almost slanderous, the way they went about making the cuts and saying this is happening and it has to stop,” she argued.
Unfortunately, to sit down and explain to people how the whole system actually works is very time-consuming, she added.
If the drug reforms go through, Berg said that at the very least, there will have to be a reduction in the level of service customers have come to expect.
“Right now, if insurance doesn’t cover a few bucks here and there, we usually waive that,” she noted. “We wouldn’t be waiving differences on prescriptions.
“There might be a charge for deliveries, or have one set delivery day a week and if you can’t it on that day, there would be a charge,” warned Berg.
“I guess just get rid of some of the services that we’ve provided at no cost up until this time. There will have to be some sort of tightening of the strings to make up for it,” she reasoned.
“It won’t be good for the industry,” echoed Mike McKinnon, a pharmacist at Emo Drugs in Emo.
He said there’s some misconceptions being put out there that are painting the drug reforms as being better than they really are.
For example, the reforms are to lower the cost of generic drugs. But McKinnon said it’s estimated 75 percent of the money spent by the Ontario government on prescription drugs is spent on brand-name drugs, and only 25 percent on generic drugs.
“If you’re trying to save money, why wouldn’t you try to attack the brand name molecules? But they haven’t,” McKinnon remarked.
Local Shoppers Drug Mart owner and pharmacist Kevin Nielson didn’t comment directly on the issue, but referred the Times to a press release the company made immediately after the province’s announcement earlier this month.
“The company is strongly opposed to the changes announced [April 7], and believes that they will have a direct negative impact on pharmacy services and patient care in the province of Ontario,” the press release stated.
“The plan indicates an unreasonably low rate of reimbursement compared to what was proposed by community pharmacy, suggests that the Ontario Liberal government will further interfere in the commercial relationships between generic manufacturers and pharmacies, and that this government will play an increased role in the regulation of private-sector drug benefit programs—programs which it does not fund or pay for,” it continued.
Shoppers Drug Mart also indicated the Ontario Drug Benefit Program already benefits from some of the lowest generic drug pricing in the country and the province pays the lowest dispensing fee in Canada.
“The $300 million in annual savings from the community pharmacy proposal would be in addition to those savings already being realized through drug system reform introduced in 2006 via Bill 102, which reduced the price of generic prescription medications in Ontario by more than 20 percent,” the company said.
“Additionally, with a large number of branded molecules scheduled to go off patent in the coming years, it is estimated that the Ontario Drug Benefit Program is in line to save a further $2.3 billion between 2010-14,” it added.
The Ontario Community Pharmacies coalition, which represents independent owner-operated stores as well as large and small pharmacy chains, has said these cuts “will slash more than $1 billion per year from community pharmacy funding.”
“For neighbourhood pharmacies, the government’s cuts will mean reduced hours of operation, less staff, and fewer patient services,” said Ben Shenouda, a community pharmacist in Brampton and president of the Independent Pharmacists Association of Ontario.
“Health care cuts hurt patients–and this multi-million-dollar cut will hurt a lot of vulnerable patients across the province,” he argued.
“Pharmacists will fight hard to stop this cut, on behalf of the thousands of patients we treat every day,” Shenouda pledged.
Since the ministry is asking for comment on the proposed reforms right now, Ontario pharmacists are asking the public to speak up and let the province know how they feel.
The Ontario Community Pharmacies coalition wants Ontario residents to contact Premier Dalton McGuinty, Health and Long-Term Care minister Deb Matthews, and their own MPP through their website: ontario.communitypharmacies.ca
Last week, the marquee at the local Shoppers Drug Mart read: “Help stop the cuts. Save Pharmacy Services,” and requests the public contact local MPP Howard Hampton’s constituency office (274-7619).
Metke said politicians are motivated by votes, votes mean people, and pharmacists “know a lot of people.”
“Everybody in this community deals with a pharmacist at one time,” he stressed, adding pharmacists take interest in their patients, want to improve their health, and people appreciate that.
“Does a politician take an interest in your health? Well, we sort of hope so, but he doesn’t really do much to demonstrate it on a regular basis,” Metke remarked.
“We think, as pharmacists, we do. We try to get a good deal for you,” he added, noting if a patient is prescribed a drug that isn’t covered by their drug plan, a pharmacist can talk to that patient’s doctor and see if there’s a more affordable alternative.
In the future, they probably won’t have the time to spare.
