Shoppers Drug Mart Pharmacist Barry St. Pierre works in the dispensary at the Prescription Centre at a Shoppers Drug Mart location in Toronto, Ontario, Canada.Deborah Baic/The Globe and Mail
Ontario pharmacists doubled their billings under a patient counselling program to recoup millions lost in revenue from the province's generic-drug reforms.
At drug-store counters across the province, pharmacists have almost doubled the number of patients they counsel - and, in turn, doubled the amount they charge the government for it. Taxpayers paid pharmacists $22-million last year for one-on-one medication-counselling compared with almost $12-million the previous year, according to figures obtained from the province.
The biggest uptake in claims under MedsCheck - a program in which pharmacists are paid $60 to hold annual counselling sessions with some customers who have multiple prescriptions - came in July and August, just after pharmacies were unsuccessful in an attempt to stop generic-drug reforms in Ontario that would hit their bottom lines. The number of claims doubled in those months as pharmacists scrambled to make up for lost revenue.
For policy-makers, the expansion of MedsCheck couldn't come sooner. In changing the generic-drug program, the government argued that pharmacies could earn their money back by delivering front-line services to consumers. But some wonder if the program needs to be evaluated to make sure patients are getting value from it.
Pharmacists say they had to turn to MedsCheck when the province cut the price they would receive for generic drugs to 25 per cent of the equivalent brand-name medication from 50 per cent. British Columbia and Alberta have also taken steps to reduce costs in their prescription drug plans, but have not gone as far as Ontario.
"There was more incentive to pick up MedsCheck," said Dennis Darby, chief executive officer of the Ontario Pharmacists' Association. "Has it made a huge economic difference? Certainly not."
Mr. Darby said it's too early to quantify how much pharmacies are losing as a result of the generic-drug reforms. During the dispute with the province, pharmacies warned that they would be forced to close stores and cut jobs because, as part of the reforms, the province abolished so-called professional allowances totalling $750-million annually that generic-drug manufacturers paid drug stores to stock their goods.
The province committed to put $100-million more into the system for professional services to help make up some of the shortfall. It also expanded the list of patients recommended for regular MedsCheck sessions to include diabetics, and added patients in long-term-care homes to the program.
Linda MacKeigan, an associate professor in the faculty of pharmacy at the University of Toronto, who has been looking into MedsCheck claims since the program began in 2007, said she was a bit surprised by the jump in claims last year. Pharmacists, she said, are responding to the incentive, but the program still needs to be evaluated in terms of its impact on patient care.
One Toronto-area independent pharmacist said he usually reviewed medication with his patients on a one-on-one basis, but never claimed the money from the government. The new generic-drug policy has forced him to claim each consultation, adding more paperwork to his day at a time when he's seeing a huge drop in revenue, he said.
"It is doing nothing to solve the finance problem by any means. They make it look neat. They tell you how much money they're putting in, but they don't tell you how much they're taking out," said the pharmacist, who didn't want his name used. "It's just another thing to jam into your day. Honestly, it's a lot of paperwork and nonsense."
Health Minister Deb Matthews said she doesn't believe pharmacists are taking advantage of the system in the face of revenue shortfalls.
"At this point, I am not at all concerned about that. What I am very pleased with is that pharmacists are putting their education to work," she said in an interview. "They're not just paid for dispensing anymore. They're paid for actually doing the work that only pharmacists can do."