Pharmacists slam Ontario drug reforms

[ploughboy]

Wait a minute, I thought allowing pharmacists to both prescribe and dispense was going to usher in a brave new world of health care?

 

http://www.healthzone.ca/health/newsfeatures/article/791621--pharmacists-slam-ontario-drug-reforms?bn=1

 

Maybe the lesson is "be careful what you wish for"...

[RyanMaverick]

Wow, that's quite the condescending tone from somebody who probably doesn't understand the issue at all.

 

Perhaps pharmacists should stop giving free OTC counselling advice, or bill MSP $40 for each "consult"? Being uspet at not being reimbursed for providing a new service, while many cognitive services are already being provided for free, is not unreasonable.

[Mourning Cloak]

"Professional allowances"?

 

Money paid to pharmacists by drug companies to secure that drug space on their shelf?

 

Sounds suspiciously like the old days when doctors got perks from drug companies, in the hopes that those perks would (and, in fact, they do) influence their prescribing habits.

 

If pharmacists want the right to prescribe, then they, too, need to avoid undue influence by big pharma.

[funnykid]

The reason why professional allowances are crucial is because of the gap between funding and costs of pharmacy services. An independent study found that it costs the pharmacy $13.88 for every prescription it fills. Compare this with the $7 dispensing fee the government reimburses the pharmacy for and you've got the pharmacy losing around $5 for every prescription that goes through. Rinse and repeat and you will find the pharmacy running itself into the ground very quickly. Each pharmacy usually receives approximately $200K to $300K in professional allowances per year to help it stay afloat. Take this away and you have a deficit.

 

This is especially problematic for independent, smaller pharmacies that don't have the elaborate front store (think: cosmetics, toilet paper, etc.) to help them make back the lost income. In addition, a lot of services are provided totally free of charge to the patients (e.g. OTC advice, counselling, even paperwork such as photocopying, faxing, etc.) without appointments. When was the last time you saw a doctor without an often long, excruciating wait time? Even doctors' offices are now charging patients for paperwork (filling out forms, photocopying records, etc.) to help foot the bill.

 

So it's not really the shady, backroom deals that it seems to be. It's the way the system evolved that has sort of worked pharmacy into a tight corner.

 

FYI, I'm not out to attack anyone or act all defensive. It just seems a lot of people on here are misinformed on this issue.

[Alex2]

In Quebec, it is like 8.?? $ for a prescription and usually evreything is cheaper (labour, land, electricity, etc...) and there is more money for special things. I don't know how a pharmacy in Toronto will make money?

[iwh333]

Wow, that's quite the condescending tone from somebody who probably doesn't understand the issue at all.

 

Perhaps pharmacists should stop giving free OTC counselling advice, or bill MSP $40 for each "consult"? Being uspet at not being reimbursed for providing a new service, while many cognitive services are already being provided for free, is not unreasonable.

 

+1

 

10 char

[mrnursing]

This is a total BS, and it's very unfair to the pharmacists.

[runningdoc]

The backlash is already starting as Shoppers Drug Mart is cutting hours significantly. Shoppers is targeting London (where Deb Matthews riding is) by cutting 170 service hours a week in 7 of their 20 stores and they are going to start charging for deliveries.

[MansionMD]

what's going on? can someone explain in small words?

[thinkofaname]

are pharmacies allowed to charge whatever they want for drugs?

[AMmd]

are pharmacies allowed to charge whatever they want for drugs?

 

short answer for private insure yes, for public insurance no, it's already predetermined.

 

I doubt this will make much change tho. i think the gov should be fighting the bull face on. The problem here is that nothing guarantees that the money saved by cutting the personal allowances will result in a decrease in fees. the prices of medication (generic and brand) should be regulated, however the gov finds it easier to piss off pharmacists than the pharmaceutical companies.

[MansionMD]

what's going on? can someone *please* explain in small words?

[richuurd]

The pharmaceutical companies are rallying just as hard against the reform as pharmacists are. Part of the reform is that the cost of drugs from generic drug companies will be at most 25% of their brand name counterpart. I believe that it's currently set at 50%.

 

IMO, this drug reform is very short-sighted on the part of policy makers.

[richuurd]

what's going on? can someone *please* explain in small words?

 

I haven't read the bill itself, but I've heard a bit from my pharmacist buddies.

 

Here are some key points I remember:

- Generic drug companies are no longer allowed to give professional allowances

- The province will cover $1 more for each drug dispensed

- Generic drug companies will be forced to charge at most 25% for the drug prices of brand name counterparts

[MansionMD]

I haven't read the bill itself, but I've heard a bit from my pharmacist buddies.

 

Here are some key points I remember:

- Generic drug companies are no longer allowed to give professional allowances

- The province will cover $1 more for each drug dispensed

- Generic drug companies will be forced to charge at most 25% for the drug prices of brand name counterparts

 

So is this bad news? Will pharmacist salaries decrease or something?

[richuurd]

A pharmacist's salary will decrease drastically. Professional allowances are currently a major source of income.

 

The policy makers project that this will save the province $2 billion-something over the next 4 years. However, a lot of smaller pharmacies will hardly get by and will close down. We already see layoffs and stock plummeting at Shoppers Drug Mart.

 

Good or bad? I'm biased because I have family members who are pharmacists. This reform is terrible for them. I don't really see much good coming out of this myself though.

[RyanMaverick]

I'm currently in 4th year pharmacy at UBC so we are keeping close tabs on this because most provinces will try to follow suit to save money.

 

Pharmacists salaries won't decrease drastically (due to economic principles I don't understand somebody tried to explain). What WILL happen is that hours will be cut (as SDM is already doing) and many, many pharmacist jobs will be lost.

 

I'm clearly biased, but I am 100% against this reform.

 

Somebody already brought up the study where it costs $13.60 on average to fill a prescription, yet the government reimburses a maximum of $8.60. Professional allowances from drug manufacturers is what allowed many pharmacies to stay profitable.

 

Drug costs are regulated by the government. You can't charge a patient any more then what the drug cost you to purchase (plus, in some circumstances, a reasonable mark-up of a few dollars).

 

There is no "backroom deals" going on in pharmacy. Pharmaceutical reps aren't even allowed to give pens to a pharmacy anymore so they've eliminated that type of thing long ago. The professional allowances in question here are a common business practice.

 

They claim they are going to "give some of the savings back" in the form of reimbursement for cognitive services (i.e. paying pharmacists for conducting a full medication review and optimizing drug therapy - not that physicians actually listen to the advice anyways); however there is no system is place for this in the short-term which will be very, very bad for pharmacists.

 

Additionally, the public has zero perception of what pharmacists can actually provide, and expect everything they do (OTC consults, med reviews, etc.) to be free anyways (mainly b/c they have to "pay" at the pharmacy while they don't at the MD so the perception is different).

 

Overall, it's a terribly short-sighted bill and is attacking pharmacists w/o looking at the big picture. Pharmacare is under a different "umbrella" for funding then MSP. Pharmacare is 1% of MSP spending (don't quote me on that), yet they see this is the place to make aggressive cuts to cut-down on healthcare costs. A lot of pharmacists feel that they continue to make these cuts b/c we, as a profession, lack the lobbying power that nurses or physicians have (our advocacy organizations aren't that good).

[RyanMaverick]

I forgot to mention:

 

All of this is coupled with the institution of regulated technicians who will be able to check prescriptions in the community (similar to how they do in hospital now) via tech-check-tech. Pharmacists will still be required to check the Rx for appropriateness of therapy etc.

 

This is good for pharmacists b/c it removes us from a technical function when we have far more training then that; however w/o a system in place to utilize the cognitive services we can provide it will simply allow companies such as SDM to cut pharmacist hours and replace them with cheaper regulated technicians.

 

It's a bit of a perfect storm for pharmacy right now.

[mrnursing]

So is this bad news? Will pharmacist salaries decrease or something?

 

Yes.

 

Salary or money earned may decrease by even half perhaps.

 

A lot of the pharmacists will lose their jobs, and furthermore, we may see many small pharmacies closing down.

 

Like Richuurd, I have family members who are pharmacists, and this is an extremely bad new for them.

 

Also, if Ontario goes through with this, other provinces will follow its lead.

 

There are other ways to save money, and this is the wrong way to go about it.

 

Burden should not be placed on the pharmacists for mismanaged health care funding.

 

I'm definitely protesting against it.

[RyanMaverick]

To support my point about it being an "easier fight to pick then with MSP spending" and the lack of advocacy from pharmacists:

 

"Mr. McGuinty's government is on the verge of having done all it can to contain costs, short of igniting that debate. Its fight with pharmacies to reduce the cost of generic drugs, though heated, is the most winnable of the battles it could be fighting, and the least likely to cause a public backlash. But it's also a relatively small piece of the puzzle."

 

That is from the Globe and Mail article regarding the issue located at:

 

http://www.theglobeandmail.com/news/politics/health-care-reform-the-uncomfortable-conversation-we-really-need-to-have/article1487712/

[Spleen Spirit]

So the only benefit to the public is indirectly through the government saving money at the pharmacy industry's expense? Am I understanding this properly?

[The Law]

what's going on? can someone explain in small words?

 

Basically, the government sets the price of generic drugs. Pharmacists make a profit on these and the Ontario government is going to reduce their price by 50% in order to reduce the amount it pays for people who are covered under the drug plans the Ontario government provides to certain members of the population. They are estimating to save $500 million doing this. All this money, though, is coming out of the profit of pharmacies.

 

Honestly, I am really weary of when governments keep interfering with private businesses. You can't just go into an industry like that and take away such a huge chunk of their profits. What kind of capitalism does the ON government think we're living in? This is a really cheap move in my opinion by the Ontario government. Yes, it helps the average consumer... but then again, these are peoples' earnings we are talking about. Pharmacists are going to be hammered by this new legislation. It's unfair to place such a large burden of the provincial deficit on the shoulders of pharmacists.

[The Law]

So the only benefit to the public is indirectly through the government saving money at the pharmacy industry's expense? Am I understanding this properly?

 

No, if members of the public purchases generic brand drugs, their cost will also be lowered.

[seeking1]

Sticking to CBC on this one: http://www.cbc.ca/health/story/2010/04/09/f-generic-drugs-professional-allowances-implications.html

 

As I'm coming to understand it, the "professional allowances" (p.a.) program that indeed was set up and monitored by the Ontario government is not working. Quoting from the article, the p.a. program is supposed to help with:

* A pharmacist's time in explaining to patients how and when to take their drugs.

* The cost of delivering drugs to seniors.

* Flu clinic days.

* High-blood-pressure clinics.

 

Instead, "Pharmacy owners have reported that 70 per cent of professional allowances have gone toward fringe benefits, bonuses, overhead costs and boosting profits instead of patient services." (CBC)

[seeking1]

Also, to give some explanation, there are two separate industries here: pharmaceuticals, including generics (i.e. Apotex) and brand-names (i.e. Phizer), and pharmacies (independents, SDM, Rexall, etc.). As someone already pointed out by way of a Globe and Mail article, this move was going to happen.

 

Truth is, health care is expensive and eats up most of Ontario's budget. Its not fun to hear, but private plans will start playing a bigger role in Ontario.

 

Despite people throwing around the tired old example of brand-names influencing the way people buy and what is prescribed, I can only say generics are capable of doing much the same rather easily. Remember, a lot of people work very hard on new brand-name drugs, and generics tend to just legally plagiarize these drugs.

 

It is unfair for independent pharmacies to get hit by this, but frankly, I have little sympathy for SDM, Rexall, or any of the others challenging Tim Horton's to see how many stores they can fit within a few blocks. Especially since SDM basically became a convenience store, cosmetic counter and post office as well.