Paying pharmacists for what they are trained to do

The role of pharmacists is changing in Ontario. Pharmacists are now an integral part of the health care team in hospitals as well as key players in the more recent Family Health Teams.

The province also operates a program called MedsWatch, which pays community pharmacists to spend half an hour reviewing medications with patients who are on three or more prescriptions. Recently Ontario increased the budget for the program by $100 million.

MedsWatch makes sense – paying pharmacists for the work they are trained to do, as opposed to the expectation that professional allowances paid out by the drug companies, coupled with dispensing fees, is going to adequately pay for this professional time.

York University’s Joel Lexchin (MD) is blunter in his analysis: “Part of the solution is to stop paying pharmacists for being storekeepers and start paying them for the knowledge they gained from going to university for four years,” he writes in The Bullet. “As provinces reform primary care they should be looking to move many pharmacists out of stores altogether and putting them down the hall from doctors. When doctors write a prescription people can easily go to a pharmacist who has the time to spend with them and the knowledge to properly advise them.”

On Tuesday Janet Cooper, a Senior Director with the Canadian Pharmacist Association, addressed the Canadian Health Professional Secretariat (NUPGE) on the changing roles of pharmacy professionals.

Representing a majority of members in the private sector, Cooper said that the new Ontario drug regulation was going too far, too fast. However, she did appear open to the idea that we need to find new models of compensation, acknowledging she wasn’t defending the status quo.

Given increases in dispensing fees is an odd way of decreasing the price of drugs – especially for those who are not on a drug plan and have to pay out of pocket – it makes sense for government to look at additional ways of providing the services of pharmacists in a much more direct way. It would also guarantee that the money would be directed towards these services, unlike the current model.

We also can’t forget that the price of generics, as high as it is, has been directed by government policy. Government places a cap on the cost of generics based on the price of the brand name counterparts. In 2006 it was 70 per cent. Now it wants to move that figure down to 25 per cent and expand it beyond the public drug plans.

The pharmacy owners are reimbursed by government at the list price of the medication, not the discounted price passed on by the generics through so-called professional allowances or kickbacks. These discounts can be as much as 20 per cent of the price of the drug. The argument they make is that without the professional allowances, pharmacies can’t cover costs. Given the long hours and the explosion of drug stores in the province, this is not a surprise.

While the pharmacists are making it a question of access, one has to question the logic of a system that promotes the existence of more drug stores in Ontario than there are Tim Horton’s across Canada. There is no question that the private sector has provided more access to pharmacists than to any other health care service. When the drug wars started, Shoppers Drug Mart said it was putting on hold plans for 40 more stores in Ontario. Do we really need to pay higher prices for that level of access?

Further, Janet Cooper says that despite 31,384 licensed pharmacists in Canada, we are experiencing shortages.

The outcome of the so-called “drug war” is important. Cooper presented a study that suggested 24 per cent of hospital admissions are drug-related. Seventy per cent of those are preventable. They include such issues as individuals who take the wrong drug, the wrong dose, or who were not monitored. It also includes individuals who didn’t take their prescribed drugs because they couldn’t afford them.

Joel Lexchin suggests that if government really wants to go where the savings are, they should take action on brand name pricing. The average cost of a generic prescription in 2008 was $26 versus $66.50 for a brand name drug. Of $20 billion in revenue drug manufacturers receive, 70 per cent goes to brand name drugs. In 2007/08 Lexchin says two brand name drugs accounted for 10 per cent of the total cost of Ontario’s drug plan.

Is the Ontario government willing to take on big pharma? That remains an open question.

To real Joel Lexchin’s full essay, go to:

One response to “Paying pharmacists for what they are trained to do

  1. I was dispensing the other day. As I dispensed multiple prescriptions for Brand name Biaxin XL and Cipro XL (there is a generic version of these drugs that needs to be taken twice a day instead of once) it made me think of all the money that could be saved by reviewing the Brand name products that are on the governments formulary.

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