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Ontario vs. the pharmacists

Just who will pay in the battle to cut drug costs remains to be seen


 

Andrew Tolson

On April 7, six months to the day after she took over as Ontario’s health minister, Deb Matthews kicked off what she must have known would be an epic battle over the price of generic drugs. She was taking on a powerful group—Ontario’s 3,306 drugstores and its pharmacists. The Ontario government is one of the world’s biggest buyers of prescription drugs­—it pays for drugs for seniors, low-income people and many others­—and it spends one-quarter of its money on generic drugs, which are supposed to be a lot cheaper than the brand-name ones. But instead, she says, Ontario is paying some of the highest prices for generic drugs in the world. “We are not getting the deal we deserve,” Matthews told a packed room of reporters.

With that, she announced Ontario was chopping the price it will pay for generic pills in half, to a maximum of 25 per cent of the brand-name price, one of several moves that will save the government $535 million per year. But that was only the start. The government will also regulate generic prices for the private sector—people who pay cash or are insured by their employers. Right now, they pay whatever the market will bear, but by 2014, they’ll pay the same price for generic drugs as Ontario will later this spring.

No other government in Canada has gone this far to cut generic drug costs and, if it is implemented as planned, the big financial losers will be Ontario’s pharmacies, and the drugstore chains. Shares of Shoppers Drug Mart Inc. fell with the news. An industry coalition warned that Matthews’ “reckless” health care reform will cost them the equivalent of three pharmacists from every store. It will hit independent pharmacists like Donnie Edwards, who co-owns a couple of pharmacies in the Niagara area. “We’re front-line health care providers doing the best for our patients,” he said. “Who’s hurt when there’s a gap? It’s the patient who gets hurt, the patient.”

The pharmacists say Ontario is depriving them of a key source of revenue, one that keeps many drugstores afloat. Pharmacies get paid a dispensing fee plus a markup to fill prescriptions and offer professional advice to patients. But they also get a second stream of money that nearly doubles their revenues. It comes from their own suppliers—manufacturers of generic pills—who pay pharmacists to stock their products behind the counter. These rebates, or “professional allowances,” as they were renamed a few years ago, were worth $815 million to Ontario pharmacies last year. (Drugstores get rebates for generic drugs—not for patented drugs like Viagra.)

Standing in front of that news conference, Matthews hammered these payments. “I will not go so far as to call them kickbacks,” she said, but whatever you call them, they’ve turned into a “scheme to enrich pharmacies.” According to a government handout, they’re one reason why Ontarians, and not just the provincial government, pay, for instance, 82 per cent more for a gastrointestinal drug like ranitidine than Americans do. So it wasn’t enough to just slash the price of the generic pills, Matthews indicated. She reiterated what was in the recent budget: Ontario plans to do something no other province has dared to do—outlaw professional allowances. “These days of artificially high drug prices,” Matthews said, “are gone, gone for good.”
Well, maybe. Pharmacists are pushing back as the proposals move through the legislative process. This week, a coalition of Ontario’s pharmacies called any suggestion they’ve abused the system “provocative and wholly offensive.” It’s shaping up to be a tough fight.

No one knows that better than the senior bureaucrat in the slim grey suit who briefed reporters at the press conference. She is Helen Stevenson, the driving force behind this aggressive legislation. At 46, she is the Health Ministry’s $280,000-a-year assistant deputy minister and executive officer of the $4.1-billion Ontario Public Drug Programs, the second-largest single payer for drugs in North America. Among other things, she decides which drugs are funded for seniors, the poor, and cancer patients requiring intravenous drugs; she negotiates with drug companies and monitors the pharmacists. It is a complex job, but hardly the kind that should merit danger pay. Yet of all the senior bureaucrats in the Ontario government, Stevenson may be the only one who has a security guard at some public outings and a panic button under her desk.

She started advising Ontario on its drug policy as a health care consultant in 2005. (She formally joined the bureaucracy in 2007.)At the time, the province was on a mission to eliminate rebates, but the pharmacists fought hard to keep them. They needed the rebate money, they said, to counsel patients. Their position held, in part: under the law enacted in 2006, the government cut the price it paid for generic drugs to 50 per cent of the brand price. Pharmacies would still get a dispensing fee and a markup, but their other source of revenues—the rebates—would be restricted. Henceforth they could only ask generic manufacturers for a maximum rebate of 20 per cent of the price the pharmacy paid for the pills. These new rules only applied to generic pills paid for by government. In the private sector—which spends just as much money on prescription drugs as government does—there were no limits set. Pharmacies could still charge what they thought appropriate to people who paid at the counter, or for drugs funded by employers or insurance companies. As well, pharmacists now had to report the amount of their rebates and prove they were used for patient services.

Stevenson’s troubles began soon after the law was passed. “I received a couple of death threats,” she told Maclean’s. “One of them came to me in a phone call. A pharmacist was unhappy and blamed me for the changes. He had just put his pharmacy up for sale, and he said, ‘If we had a gun, we’d come and kill you.’ ” She reported the threat to the OPP, but declined to press charges. “At the end of the day, he was truly disgruntled. I called him back and told him it’s not acceptable to speak to me in this way.” Then Stevenson was told another pharmacist had said in public that ‘he was going to come by and chop my head off.’ ” The police paid him a visit but didn’t press charges. Stevenson was assigned a security guard to protect her on public outings—the OPP says it was based on a “threat assessment.”

In the first two years after the law was enacted, the government says it saved taxpayers $683 million, and the rise in prices for drugs slowed from more than 10 per cent annually to five per cent, even though the government agreed to pay for some new and expensive cancer drugs. Stevenson was convinced the government could save more. She hired forensic auditors from Grant Thornton to perform audits on how pharmacies were conducting their business. She says pharmacies themselves reported that over 70 per cent of professional allowances funded salaries, bonuses and fringe benefits. Nadine Saby, president of the Canadian Association of Chain Drug Stores, says that’s to be expected. “That shouldn’t be a surprise. Direct patient care is [provided] by individual pharmacists.”

Stevenson also took issue with the fact that a number of pharmacies were telling some patients to come in daily or weekly to pick up prescriptions. Pharmacists argued they were doing this for the benefit of those who couldn’t handle their own drugs—especially elderly or mentally ill patients who were confused by all the pills. “It’s done for a reason, to help people manage their medications,” says Saby. “It’s the only thing keeping people out of institutions.” But since that practice was costing the ministry $170 million a year, Stevenson informed pharmacists that Ontario wouldn’t pay those daily or weekly dispensing fees any longer, although some exceptions were made.

Soon Stevenson found her mailbox stuffed every day with 300 to 400 postcards. On one side was a tombstone, bearing the inscription “R.I.P. Independent Pharmacies of Ontario,” while the address portion on the other side had her name and business address. The postcards came from independent pharmacists, who were trying to make the point that pharmacies “may well close their doors and go out of business,” says Ben Shenouda, president of the Independent Pharmacists of Ontario.

But Stevenson took the postcards personally. “It was horrible,” she says. “It’s unacceptable for a civil servant to be threatened.”

Shenouda insists the postcards were never meant that way, and says he’s very sad to hear how Stevenson interpreted them. “The tombstone was not for her but [to indicate] the end of independent drugstores if the government does not protect us.”

These days, before you can reach Stevenson’s office, in a nondescript government building in midtown Toronto, you have to make your way through two sets of locked doors, a security measure recommended by the police. If anyone tries to barge into her office, with some of her three children’s paintings pinned to a wall, she can press the panic button under her desk. She nearly did so last May, when a man made it past her secretary and entered her office, unannounced. Stevenson, who is five foot eight, with the lean athletic build of a tennis player, rose from her seat and told the man: “If you don’t leave this minute, I’ll call the police.” He turned out to be the server of a lawsuit—just one of the many she received after she accused some industry players of using a variety of ploys to enhance their revenues. “I’m always a little on my guard,” she says. “There’s so much anger directed against me.”

In the summer of 2008, she tried another way to cut generic drug prices. Although the government had set the price for virtually all generic drugs at 50 per cent of the brand price, she thought the price could drop further. Some generic manufacturers told Stevenson that they were under pressure from pharmacists to keep their prices high, since the rebates were a percentage of the price. “If we submitted a lower price, we’d lose our customer,” said a retired executive from the generic pharmaceutical industry, who asked not to be named.

The government held a competition that effectively asked the generic companies to indicate the lowest price at which they would sell a particular drug to the pharmacies. The one or two companies with the lowest price would win the government business for that drug. One of the drugs was ranitidine, a drug to treat ulcers and heartburn, which was listed on the government’s formulary at 40 cents a pill. Just before the government opened the competition, GlaxoSmithKline Inc., the maker of Zantac, the brand-name version of ranitidine, dropped its price to 18 cents per pill. Stevenson says the generics never bid. According to the retired executive, it would have angered their customers and led to a lowest-price-wins market that would have dug into profits. With no bids from the generics, the government halted the competition and accepted GSK’s price. Then, the government surveyed 150 pharmacists to see whether they were actually offering Zantac. Yet, according to Stevenson, many pharmacies did not stock it. It’s not hard to understand why: it’s far more profitable to sell a generic drug with a rebate than a brand-name drug that doesn’t have one.

To Stevenson, this was just another example why the system needs reform. A year before the first wave of baby boomers are about to hit the age when they’re eligible for government-paid drugs, Ontario says it can’t afford to pay any more than it has to for generic drugs. “Taxpayers,” she said, “will have to decide whether that’s right or wrong.”

Last winter, as word of the upcoming changes filtered down, some pharmacists were asking patients at the counter to sign petitions to complain. Without the rebate money, some fear they could go under. The government did little to relieve those concerns last week. It promised to pay pharmacists an extra $100 million for counselling, and it’s hiking dispensing fees by $1—or up to $4 in underserved regions—to make up for the loss of rebates. Pharmacists say it’s not nearly enough. “They’re taking $3 out and putting $1 in,” said Donnie Edwards, the pharmacist from Niagara who raced to Toronto through heavy rain to meet reporters after Matthews announced the changes last week. “We’re going to make sure patients are aware that it’s detrimental to their health.”

Pharmacists are already saying they will have to take steps to deal with the reduction in income, by offering fewer free services or shorter hours for example. But while patients will notice those reductions, many won’t be likely to see the potential upside­—lower generic drug prices—because only 15 per cent of Ontarians pay for their prescription drugs themselves. The rest are insured either by the government, by their employers or by their own insurance companies.

The Ontario government was careful to invite some key allies to Matthews’ press conference. Sid Ryan, president of the Ontario Federation of Labour, said the announcement is “a gutsy move and long overdue.” The cost of drugs is going up so fast, he said, that negotiators at the bargaining table have to make an awful choice between maintaining drug plans or laying off employees. Beside him was Rick Perciante, acting CEO of the Canadian Cancer Society. People who are fighting for their lives, he said, “shouldn’t have to worry about how they’re going to pay for cancer drugs. The changes will allow [for] greater access.” Matthews was counting on that support: “This is a fight I’m prepared to take on with the pharmacists.”

Less than a week later, Shoppers Drug Mart shortened hours at several stores in Matthews’ home city of London. It announced that customers there would have to pay for home delivery of prescriptions. In a statement, CEO Jürgen Schreiber said the decision was “a difficult one for our associate-owners” but “given the impending funding cuts,” Shoppers must “modify our business model to ensure the long-term sustainability of our stores.” (Shoppers did not return phone calls from Maclean’s seeking comment for this story.)

If nothing changes, more pharmacies will have to take steps to cut costs, said Nadine Saby of the Canadian Association of Chain Drug Stores: “I don’t think they’re going to have a choice.” She sees nothing wrong with ending the rebates, but only if dispensing fees double and other fees are hiked to pay pharmacists for helping patients manage their drugs. That demand, which could cost the government hundreds of millions of dollars, shows just how high the stakes are.


 
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Ontario vs. the pharmacists

  1. id like to know what these services are that are being defended here…as far as i know all i get out of mine besides counting my pills is to suggest which cough syrup i should use and we pay how much for this service??????

    • Some services are:
      Contact physician for repeats.
      Recommending to physicians alternate therapy due to dangerous drug-drug interaction that physician may have missed.
      Recommending to physicians a lower or higher dose, because the one prescribed is not sufficient or an overdose.
      Recommending additional or alterantive therapy because the patient's condition has worsened.
      Knowing when to have you see you see your physician for an ailment or to treat it with non-drug measures.

      these are just a few of free services you would get

    • When was the last time you were able to walk up to a lawyer or dr. with no appointment, ask for advice and were not charged a cent??????!!

      • I walk into stores all the time and discuss the products they have for sale with the staff all the time at no cost.

        • no problem, pharmacists will join the doctors and lawyer side, not the regular stores side. bye bye, see you in the nextpharmacy visit . hahahahahaha

        • that's a valid argument…if you regard your medication as any product you would buy on sale..meaning your health equals your clothes or a BBQ that you'd buy on sale!!!

          • Nice try. But I have yet to get any advice from a Pharmacist that my Dr hadn't informed me and the Drs info is usually been repeated on Shopper's "Health Watch" label.

            The clerk at BestBuy provides more "value added" service than my local pharmacist.

            Face it pharmacists are not worth 6 figure salaries.

          • good for you!

          • this is evidence that the public really has no idea what a pharmacist does….so sad and ignorant of you guys…pharmacists have much more drug knowledge than doctors. Let’s just say that a pharmacist can be a doctor, but a doctor can’t be a pharmacist. You guys have no idea…

      • That's his job and why I pay a filing fee……and they get fees from the Government to give you that information. There job is to dispense the medice only?????? Then why do they get big bucks to do that? I can count.

        • Dispensing medication is not the main role of a pharmacist…that’s why there are pharmacy techs. Get educated about the profession before you speak negatively about it. I guarantee when you’re 75 years old and you’re on 10 different meds you’ll be thinking very differently of pharmacists…

    • Hi Ken,

      Please visithttp://www.pharmacyreporting.ca to see the many services pharmacists perform throughout the day. The website is constantly updated throughout the day as pharmacists post drug therapy problems which they come across daily.

      More often than not, these services are completely free, and actually save the government hundreds of dollars by preventing complications.

      • Don't forget to also visit "The Public Relations Hall of Brilliant Ideas (at the time)" where you'll find great ideas on how to set one profession against another. Like say, a site where pharmacists list all the mistakes they fixed, mistakes made by doctors…

        Way to bring your allied professionals to rally behind ya, fellas…

        • Well no, change your business plan. You've known since 2005. My walk-in clinic is open at 2:00 a.m. so I don't need a prescription at 2:00 a.m. My Doctor should be counseling me on the drugs and interactions. If you are only paid to dispense, then why do you get a fee from the Government for counseling?

    • ken,
      these are the things i did for my patients
      1- on an average day, i call on 3-5 drug interactions that the doctor missed (including severe allergies that the doctor has on file). suggest alternatives..meanwhile i still have to check the lineup of rxs and provide otc and counselling
      2- check blood pressure readings for seniors and explain the results
      3- provide emergency fills for patients who dont have enough refills because
      a) too lazy to go to there doctor
      b) doctor actually refused to give refills untill seeing them regardless of how important these drugs are!
      c) patients forgot their meds at cottage, lost, eaten by their dogs or fell in toilets

      4) blister pack medications and check them some of them are 20 medications
      5) i personally used my own car to drive an old lady to a competitor to get her her meds which we didnt have. ( i work in a chain, no personal interest there!
      6) dicern all the myths about herbals, check intercations for herbals and meds bought at another competitor (no benifet but waste of time there).

      now here is my questions to you?
      1- how many times did you ask your doctor for a refund because HE PRESCRIBED THE WRONG MEDICATION ?
      2-How many times you thanked your pharmacy staff by writing a thank you letter ?

      • George.

        As someone with a chronic condition requiring more meds then I prefer to take (about $25K per year), I do appreciate the work of pharmacists, esp on point 1. I have never utilized points 2-6 and now that my Rx has stabilized (about one year of fluctuation and now three years of stability) point 1 is no longer even a big issue, beside the odd special event (e.g., travel Rx requirements on top of normal Rx). my answers to both your questions is never (I have personally thanked in my pharmacist numerous times, just never in writing).

        all that being said, I do find it much preferable to have all those services offered at a cost, set by pharmacists/their employers then it is to alter the prices of the drugs to cover the services on an across the board basis. it seems to me that 1 would be made part of a dispensing fee, the rest as either special surcharges or add-ons to the dispensing fee (e.g., 3, 4, 5). and the others dealt with separately.

      • In tegards to
        1 Why suggest alternatives? Maybe, just maybe the customer isn't telling you everything they are on, but the Doctor knows because he is prescribing it. What if they failed to tell you some herbal medication they are taking that will interact with your new suggestion?

        3 b) – you are not a Doctor maybe the Doctor realized after testing they didn't need the medication, but the client was not mentally stable so insisted on getting it from you and told you a lie about the Doctor? I saw it at the Hospital recently (little guy broke his elbow) and a woman that was unstable mentally was insisting on medication which was being denied.

        3 c) maybe they are scamming you?

        I know a friend who recently got the WRONG medication from a pharmacist and became very ill. I guess the names were similar so that was their excuse.

    • I am happy that you never have a pharmacy question that needs to be addressed. Unfortunately, many people do. By phone alone I answer 20 medical/drug/herbal related questions per day. There is no charge for this service. For the Telehealth system in Ontario, where anyone can call with a similar question, charges $39 PER CALL (paid for by the government). If I simply referred all my calls to that system, that would be $780/day, $285000/year. $996 million per year if every pharmacist of the 3500 Ontario stores do the same thing. Pharmacists are FOR lower prices, but services such as these need some kind of reimbursement.

      • You reminds me about when i was working as the hospital pharmacist just the first year after i graduated. Working during one night shift alone, I had to receive many calls form doctors, ER, nurses and also the patients from home. I did not complain for working without extra reimbursement….

    • Pharmacists keep you alive you dumb ass. Shake your head, open your eyes and think before you speak garbage.

      Who do you think are the experts in the 1000's of drugs and interactions that exist? Doctors?? LOL. Think again.
      Next time you get your meds, thank the Pharmacist for keeping you alive and for calling your Doctors to correct them.
      That my friend is reality!!!!!!!!!!!!!

      You disagree with me? Go talk to your Pharmacist. (And by the way I am not a Pharmacist.)

      • My friend almost died from getting the wrong medication from a pharmacist. They admitted their error, because the names were similar.
        No pharmacists don't keep me alive. There are places that are looking at getting machines to dispense medications for patients and it is working great.

  2. The Ontario government has over $1 billion for the e-health scandal, but only cuts for health care. The McGuinty liberals regrettably signalled that seniors may pay increased prices or have services reduced with their funding cuts by voting against the following motion from the opposition: I move that the Legislative Assembly of Ontario calls upon the Premier of Ontario to guarantee that Ontario seniors will not have to pay increased prices or have services reduced as a result of cuts the McGuinty Liberals made to front-line health care delivered by independent local pharmacists, announced on April 7, 2010.__This is addressed to the Premier __

  3. Pharmacists dont need this allownces. but they should atleast get paid for services that they provide free of cost and mimimum dispensing cost which costs to pharmacies- which is $14. Why dont govt pay $14. and they take off allownces, govt is just doing dirty politics to get some votes of ontarion. Ontarion will have to pay for this deficiet.
    -Increasing ER time
    -Less pharmacist availability
    -No time for OTC counseling..
    many more….People dont understand the value of a pharmacists…nor govt..

    • I'd be more likely to understand the value of a pharmacist if any of the stuff you described had ever actually happened to me. Otc counselling? Pharmacist availability? Really?

      • Like I said to others earlier, you're going to the wrong pharmacy.

      • Hi M_A_N,

        It's unfortunate if you are visiting a pharmacy where the pharmacist isn't interested in upholding the standards of practice of the profession.

        Please visithttp://www.pharmacyreporting.ca . This website is being used for pharmacists to submit all sorts of encounters they experience throughout the day. You may be surprised to see how many serious situations are intercepted and resolved by pharmacists.

        Thanks,

        — Joe

        • Yep. Keep reminding the doctors about all the mistakes they make. They'll be right behind you at the next protest march.

        • Interesting site. Yeppie, I got a similar case just a few days ago about PPI and Plavex, and I heard govt is trying to move PPI to OTC ~~. Another potential problem is PPI with Calcium supplements. Good cases for OTC counseling or Pharmacist Prescription right.

          "Patient recently transferred to our pharmacy. She asked for a refill on her stomach pill. Rabeprazole was on her profile, but she is also on Plavix. Since there is a drug interaction between Plavix and PPIs, and pantoprazole is generally considered the best choice in the class, I contacted the patient's physician to discuss the change from rabeprazole to pantoprazole. I also sent the Limited Use criteria so the physician would know that LU would be required if he did want to switch to pantoprazole. It took 1 week (and a re-fax of my note) for the physician to reply; he changed to pantoprazole and included the required LU code. "

      • There are many people who get some good advice from the pharmacist even when they buy OTC –

        This is called value of someone's profession .

  4. you pay none for advice on cough syrup. because professional allowances subsidize for it.

  5. Great move. It's about time Ontario stops getting gouged by pharmacies over the price of generic drugs.

    • I think that you might be the first one to complain when a pharmacist gives you advice next time on a cough syrup, pain medication or first aid advice from sun burn – just don't get upset when you have to wait 30 minutes for that pharmacist to come out talk with you because he is overwhelmed due to these cut backs. Less pharmacies will mean more wait time for you. And oh yes, since you are talking about gouging….don't complain about paying $10 at the check out for the advice you received….just like a lawyer or accountant would.

      Fee for service is what the real issue is – and if you think that removing these allowances is not going to cost YOU….then you really need to have see your doctor…….oh wait, or shoul i say, oh WAIT, they have already cut back on hours and dont really care about you as much anymore – because we did the cuts to them already. now they wont even come to the phone anymore to get you a refill….now you have to visit them for $32 visit.

      • Whatever will I do without the wisdom of a pharmacist when choosing a cough syrup. Seriously, if you think I'm going to pay you $10 for advice on cough syrup you're in for a surprise. I say cut away and stop your whining.

        • sbt, you may not need them now, but when you're on certain medications and that cough syrup can cause convulsions and coma if mixed with the wrong drugs, boy will you wish there was a pharmacist around. Lose the cocky attitude, you don't have a clue what you're talking about.

          • You're right that my previous comment was harsh. I misunderstood the point the poster was making. Still, I really don't see pharamcists not mentioning this to people when they pick up their medications (isn't that malpractice?).

            Maybe the line's a bit longer but pharmacies all over the world survive without this gold-plated rebate structure. I really don't see why Ontario taxpayers should fund it. If you want to pass the costs onto the consumer, I'm all for it. If you want to change your business model to charge people for advice on products you sell. Go right ahead.

          • Ontarians aren't funding it.

            But they will be.

            The government pays $7 to fill a $14 prescription. The PA's meet the other $7. The government is legislating that other $7 can't come from generic drug companies. OK. Guess whose pocket it will come out of then?

            Cut away, government. Download yet another cost onto the taxpayer.

            Our drug costs may be highest compared to other countries, but what our government pays is lowest compared to those same countries.

            This is going to cost thousands of people jobs, and cost every Ontarian more out of pocket.

            We gave GM (who mismanaged their way into a bailout) a big helping hand – when independent pharmacies start going under right and left, will the government bail them out? The same government that legislated them out of business in the first place?

            Somehow I doubt it.

          • in all actuality, pharmacies all over the world in some way shape or form are getting this rebate. i am a pharmacy student currently studying in australia and it is a very common practice to get volume rebates here. not to mention rebates for stocking their product. it is a method of keeping the drug companies competitive, and pharmacies out of the red. from my understanding it is commonplace in new zealand, and several european countries as well.

            as (hopefully) a second generation pharmacy owner i am personally not opposed to getting rid of the rebate structure… all im asking is that we are reimbursed appropriately for the services that we do provide. it would not be a bad thing to be able to bill for direct patient care. if the government were to come back to the table and say "we can pay you to do blood pressure checks" or "we can reimburse you for contacting the doctor to clarify/fix/get repeats/etc." (because we know the doctors are getting reimbursed every time we contact them) then we wouldnt need to have the rebates to keep us afloat.

            also, if we were getting a true "fee for service" as opposed to a blanket layer of professional allowances, savings could be had on the part of the customer, and those pharmacies that do provide the extra level of service would be able to continue to be profitable.

            the issue at stake is that the government is taking away the professional allowances and has not effectively told us how our future reimbursement for services is even going to be. also, they have said 100million, but that is pretty much a drop in the bucket compared to what is being taken away. not to mention the fact that this 100 mil is not a promise, it is just a big number that woos taxpayers. they have not guaranteed us that money at any point. we still may not even get that.

    • agreed

  6. I agree with Ken,

    The doctors decide on the pills to be dispensed. All they do is ensure you get all 60 or 120 pills.

    when I ask for advise on which pain medication to treat an ailment the answer is always wishy-washy: 'oh well that ones good… this ones good too… its really up to you'

    One questions I've yet to have answered, what is the percentage of revenue this law will affect? when walking into shoppers drug mart, 85%+ of the floow space is for ragu pasta sauce, glade air wicks, Guess cologne…

    If the pharmacies cared about the drugs they sold more than the high margin non-medical related things, then yes, they may have something to complain about. yet they haven't had that business model in years

    • Pharmacies carry high margin non-medical products to supplement the fact that little money is made in the dispensary. If they could survive without other products they probably would. If you feel that pharmacists give you a "wishy-washy" answer why do you bother wasting their time. They probably were just interrupted by you while checking a prescription for a patient who was waiting at the end of the pharmacy, hadn't gone to the bathroom or eaten all day and perhaps you were giving a vague description of your symptoms. Consider all these elements for commenting on something you obviously know nothing about.

      • You make your own choice of not eating all day, not going to the bathroom! There are a lot of people out there who work without breaks! Gimme a break! Don't feel sorry for yourself!

      • Actually, Shopper's Drug Mart don't need the front end to break even. In fact, it's the opposite. Cosmetics are high margin but extremely low volume while the rest of the front-end has minimal markup and for the most part only sell in high volume when they're sold under cost.

        Why else do you think the shares tanked at the announcement of this legislature? Because the shareholder know just how much of Shopper's margins rely on the kick backs.

        I know, because I manage one.

        I get all the propaganda, the misinformation, the utter bullshit, and against my better judgement I participate in it because my job is more important to my family than my integrity. But this war turned this liberal into a conservative.

        The pharmacists are trying to make it seem to their customers as though it's the government that's charging them for all those service charges when in fact it's the pharmacists who've been charging the government, who's been paying with our tax money. The pharmacists also play with the notion that these fees are too much for the customer to bear, so why have they been charging those fees in the first place?

        The pharmacists HAVE been abusing of the system.

    • Hi Mike,

      I agree that Doctors decide what pills to be dispensed. However, pharmacists do much more than ensure you simply get the amount of pills written for.

      There is a new website,http://www.pharmacyreporting.ca, where Ontario pharmacists have begun to post drug therapy problems they encounter throughout the day.

      Consider these two examples :
      http://www.pharmacyreporting.ca/home/?details=30 http://www.pharmacyreporting.ca/home/?details=29

      In both cases, the pharmacist prevented medical complications from occurring. It can be difficult to empathize with people you don't know, but try and imagine if these situations happened to you. I am certain you would find yourself quite thankful that we do more than ensure you get the proper # of pills.

      I leave it up to you to go through the rest of the website. It is full of examples similar to the above.

      Thank you,

      Joseph Zingaro

      • Guy, you have posted those links at least twice now – speaking maybe just for me but it makes you look like some kind of industry shill.

        I'm sure pharmacists in little local stores have a tough go but when I hear the moaning and worse coming from Shopper's Drug Mart it kills the case for me. I don't see why Ontarians should have to foot the bill for you to attend "information sessions" put on by the pharma industry. Sorry.

  7. It's funny how people make comments while having little clue about the subject.
    It's even funnier when those same people will be directly impacted.
    Go get all the facts before you speak.

    • No, clearly you are a pharmacist. You've know about this since 2005, yet you haven't changed your business model. If they were smart, they would have said that we will not cut services. My walk-in clinic (tons) aren't open past 11:00 p.m. and few are even open past 6:00 p.m. I DON'T AND NEVER HAVE HAD A PRESCRIPTION FILLED AFTER HOURS. In at least 100 prescriptions in about 8 years (kids) I've been to the hospital twice and they've given medication at 2:00 a.m. which tides you over until the pharmacy opens.
      It is a kick back.
      We don't need pharmacists giving advice, when there is a Doctor. A patient can scam a pharmacist to getting meds that maybe the Doctor has realized the patient should not be getting after test.

  8. I notice that Ontario pharmacies had enough money to quickly pay for full page ads in the newspapers so I guess they aren't that broke.
    The system needs reform and I'm glad that's being tackled. It's definitely time. As for advice from pharmacists – re medications – you mgiht get a printout with info that is provided by the drug company if you use a chain pharmacy. That's about it really.

    • If you had to fight for your livelyhood, wouldn't you?

    • that's not true at all; I work for a chain, and can spend 5 to 20 minutes reviewing someone's meds. Not sure where you shop, or did you just make this up to justify your comments?

  9. It's funny how people make comments while having little clue about the subject.
    It's even funnier when those same people will be directly impacted.
    Go get all the facts before you speak.

    • That's always the best way to win supporters in a public uprising. Make sure you insult them first. Hope you're not paying too much for your PR advice…

      • Hey M_A_N,
        I am a customer of a Pharmacy. A customer who realizes that Pharmacists are the drug experts. They keep us alive and correct the many, many mistakes Doctors make daily.
        So sick of dumb ass comments people make on here. If you don't have all the facts, don't post a comment. Good rule to life by!!!!!!!!!!!!!!

        • One pharmacist almost killed my friend, they supplied the wrong drug and admitted their error. They have low-paying assistants (students) that actually help them do the counting, etc.
          If they were selling Ford and GM, but got a kick back for selling me a GM I would want to know. I NEVER realized that they got a kick back. In the past, I've had problems with NO NAME brands and after reading an article in PREVENTION magazine I realize that other people have too. it makes me wonder what a generic version really means, beside cheaper drugs.

    • If they were selling Ford and GM, but got a kick back for selling me a GM I would want to know. I NEVER realized that they got a kick back. In the past, I've had problems with NO NAME brands and after reading an article in PREVENTION magazine I realize that other people have too. it makes me wonder what a generic version really means, beside cheaper drugs. I think we are more aware than OTT wants us to be know that everyone realizes that actual preventative stuff has been cut from the system (rehabilitation, chiropractic – if you believe in it) while they were warned in 2005 that the system was changing.

  10. this $$$$$$$$$ that the governement saved in 2007 where did it go to the e-health? or to this useless telehealth ontario that after 1 hour on the phone they say the standard sentence "if you feel any chest pain or shortness of breath go to the neaerest eergency room" or to the doctors who are charging the governement for visit to get rx for test strips

  11. To those of you who are getting little to no counselling from your pharmacists, you are going to the wrong pharmacy. Spend some time in a pharmacy that provides only pharmaceutical services (ie no cosmetics, ragu, gift wrap, etc) and you will see that these pharmacists consult with doctors and other health care professionals, council patients thoroughly, povide medication management, educate both the public and other other health care professionals, support families, and make referrals, among other things. All of this without charging you or the government one red penny. You may not require these services today, but one day you may, and today, a lot of people do!

  12. This plan by our govt. will end up with:

    (1) Doors closing on small pharmacies
    (2) Drug costs rising (more brand names)
    (3) Less or no access to pharmacy services

    Last time I looked at my cheque I see where most of my money goes. So now in the future more of my disposable income will have to pay for higher drug costs because the competition will be lower and generic drugs companies will be run out of town for certain drugs.

    • The generic companies aren't going anywhere. They print money, the only difference here will be a little less printed.

      What will happen is one or two of the 9 pharmacies i pass on my way to get proceries will close. Supply and demand isn't always happy news, but that's what it is.

    • Poor Shoppers Drug Mart! They are recording record profits, they are diversifying (you can buy frozen pizza!!). They hire pharmacists who DO NOT SPEAK ENGLISH!! Pathetic.
      Yes, I want to go to pharmacy school to learn how to count in 5s. These pharmacists have it too good, they double dip, they get their dispensing fee (which in the US is either $4 or nothing), AND they get to have a markup on the drugs they sell. This should be illegal!!
      If a pharmacist dispenses say 50 scripts an hour, $12 * 50 = $600 FOR DOING NOTHING!!! Nice.
      McLiar is finally showing a backbone!! Finally!!!

      • 1. Lucky Shoppers – they diversify! that is why they can survive because they are not primarily a "pharmacy".
        2. so you think pharmacy school only teaches how to count in 5's – ever wonder why it's so hard to get into Pharmacy School – try if you or any of your children can get in!
        3. you don't know anything about pharmacy – a pharmacy is good enough to have 100 scipts per DAY – so do your math.

  13. Mike, you think your doctor is ordering your pills, but what you don't see is the common occurence of that doctor going in the back room and phoning the pharmacist to ask what to prescribe. The doctor got paid for that phone call, the pharmacist did NOT.

    • oh please ! Thats absolute nonsense. Common occurrence ? Absolutely not ! Besides, after the patient, the doctor is the one who has to live with the consequences. NOT the pharmacist.

    • I'm happy to see that most of the people realize that it is totally insane for the pharmacist to get a "kick back." They were notified back in 2005 that it would be changing, and they've had 5 years to change their business plan. I have NEVER had a doctor (my regular), walk-in clinic or hospital leave the room to get advice from a pharmacist. They write the prescriptions while I am in their office, and unless by way of some magical trick (my Doctor isn't a magician that I know of….), has never left the office to call the pharmacist. Oh wait….maybe he is a fortune teller and can predict what I have so he can call the pharmacist before he comes into the room where I'm waiting. I am not affiliated in any way with the Government, like Ott wrote. Just a pretty much stay at home Mom, who is concerned about the cost of medications, quality of generic drugs, and real lack of information that the pharmacist has ever given to me.

  14. Do all the manufacturers of other "store products" provide kickbacks too? Maybe they should call Schick or Gillette, Lever Bros. etc. Let them know they will only sell their products if they provide
    "financial allowances".

    • Actually, many of these companies "buy" shelfspace at your local grocery store. Ever wonder why some stores carry more varieties than others?

  15. Costco only charges $4.11 for dispensing fees and I don't see them changing this pricing structure even with the new legislation coming into place.

    These high cost are a barrier to those who need the meds and to society as a whole.

    Most independent pharmacist make more money than family physicians. My relative who owns three pharmacist makes over 1 million dollars per year. I think he should make $300k and let society absorb the rest of these scamful profits.

    • Get your facts straight, pharmacists even more seasoned one who own a pharmacy make somewhere around 100k figure before taxes. Their median income is not even a fraction of what the median is for a family doctor's income, not to mention a family doctor does in fact have the potential to make over 1 million dollars per year while such figure is absurd for a pharmacist. Even owning multiple pharmacies and a clinic will not make it close to that figure for an independant pharmacist (not some business owner related to shopper's dug mart…)

      Don't just spew out bs you know nothing about.

    • costco doesn't pay rent for its pharmacy. independent pharmacies have leases to pay. hence the higher fee. don't be jealous of how much money a pharmacist makes. if you had a higher education or good business sense, maybe you too could be making that salary.

    • an independent study conducted triggered by the governement by auditors reported that the cost of filling a presciption (i.e dispensing fee) is roughly around 13.60. Yet, the government is only willing to pay 8 to 9 dollars per presciption. that means every presciption is actually a loss to the pharmacy. these rebates are to cover the costs the government refuses to cover, even though their own research shows that presciption filling costs more. and now that is being taken away. no one in governernment ever says they will take a pay cut to help reduce costs and fund healthcare. why should the burden be dumped on pharmacists all of a sudden. how does this make sense. if a nurse was forced to take a huge pay cut because the government refused to pay her wages, you think they would not strike. it is unfortunate that pharmacists don't have a strong lobbying body that can help them fight what is owed to them. if all of ontario's pharmacists for 1 day closed their doors and sent all the patients to the hospital for their medications, maybe the public and govenment would value their services. too bad nothing like this was organized. i hope that someday, this will happen. we need to show these fools how important our role really is.

  16. http://www.stopcuts.ca

    2. Indirect Funding

    The second component of funding is what's called ‘professional allowances' and is paid on generic drugs (medications whose patents have run out and can be manufactured by a company other than the one who developed it) by the drug manufacturer. Professional allowances were established by the McGuinty government in 2007 through the Transparent Drug System for Patients Act. This indirect funding is regulated by the government and capped at 20% of the price of the drug. It's also important to note that this funding must be spent by pharmacies to support patient care.

    Ontario pharmacies have been forced to rely on professional allowances over time because of the growing Funding Gap between the cost of filling a prescription and the government's direct funding.

    Direct funding through dispensing fees has increased by only 56 cents in the last 20 years while community pharmacies have faced inflation, rising health care costs, an aging population, increased demand for pharmacy care and expanded health services for their patients.

  17. what is wrong with you? are you mentally challenged you pig?

  18. Yeah. That happens all the time.

    Sheesh.

    • Daily, in fact. I'm not sayin' it happens every time an rx is written, but it does happen, and pharmacists to need to have the knowledge to immediately answer such questions. The main point is that 'all they do is ensure you get all 60 or 120 pills" is a vastly incorrect and naive statement.

  19. Pricing of pharmaceuticals are not really market based. The brand name companies (ie Big Pharma) have their prices regulated by the federal Patented Prices Review Board. These in turn are based on international prices and on comparative drugs used in its market (ie other similar brand name drugs deemed to be therapeutically equivalent).

    The prices of generic drugs are regulated by each province. These prices are arbitrary since the government decides what they should be. Usually they are a proportion of the brand name price (ie 90%, 70%, 67%). They are NOT determined by any pharmacy, or in fact ,by the generic companies. The provincial government themselves set the maximum price that a generic drug will be paid. Under this scenario there is no incentive for the generic company to compete with respect to the provincial government, but there is of course, with the pharmacies. So the government could have decreased these prices 2 years ago or even 10 years ago, but did not, since this practice has been ongoing for 20 years with government knowledge from all 3 parties. Why eliminate these "allowances" at this particular time? I'm trying to figure that out.

    This new proposal does not change this underlying fact. It just vaccuumed $750million from the pharmacies (NOT the generic companies) to be put into the government coffers. Even with this new proposal at 25% of brand, the provincial government will still not be getting the best price from a generic in some cases and in other, a generic manufacturer may not make a specific generic drug since it will no longer be profitable to manufacture it. And no ODB patient will actually see a decreased price, hard to say if that will occur with private drug plans; only those who pay totally out of pocket will see a difference (about 16% of the population).

    • Valencia50, The answer to why now? is simple. Big Pharma wants it this way. They are having difficulty getting their biologic drugs covered due to the huge increase in pricing. If the government can save money on the generics then they will cover these costly drugs. The brand companies are all now producing their own generics and will push to get a stronger presence there. Traditionally , the brand has done little for pharmacies and will try to erode the relationship between the generic manufacturers and the pharmacy.

      • Yes, I think you are right Atlantic. Very interesting. And brands producing their own generics as is common in the US. Hmmm……this also fits in with what is happening at the federal level. Ontario listing brand name products which were recommended not to be listed by the Canada-wide Common Drug Review as well as their own provincial committee. Things that make you go hmmmmm

        The Ontario plan has listed some drugs that the expert Committee to Evaluate Drugs had recommended against covering over concerns about safety or efficacy for certain patients, said Dr. Gerald Evans, a Queen's University medical professor and chair of the advisory group. Ms. Stevenson, though, said such concerns were dealt with in the agreements struck with companies. Seehttp://www.globaltoronto.com/money/Drug+rebates+r

    • first paragraph would mean that if Ontario is one of the biggest customers then their prices should be the least…supply and demand.
      2nd paragraph, they do get a bidding amount, hence one drug that a Name BRAND pharma company gave a bid on when it went off patent the U.S. Government used because the non-generic companies didn't want to manufacture for less
      3rd paragraph, this has been know since 2005. I remember my small pharmacy complaining about it many years back, but has NOT changed anything about his business plan since. In the meantime, I have at least 7 drug stores within walking distance in my Town of about 45K. We have 3 Shoppers Drug Mart. If I drove in a 15 minute radius, I would probably hit 25 pharmacies. You have Costco, Walmart, Loblaws, Zellers…with pharmacies. Perhaps that is the issue…too many carriers?

  20. As I remember, the pharmacies all complained that they would go under when cigarettes were not allowed to be sold anymore… funny that… now i actually see MORE of them….

    Same stuff here I would think. They'll just raise the prices again. And again…. etc…

  21. Now I know how Shoppers Drug Mart can finance opening 3 mega stores in a 25 km radius in the last 2 years, with that much cash being generated through kickbacks .

  22. Although these cuts will be harmful for every pharmacy across the province, they will be particularly devastating for independent, owner-operated pharmacies which make up the majority of pharmacies in the province.

    Over two-thirds of pharmacies in Ontario are either independent or independently-owned franchises. These small businesses will be forced to cut staff, operating hours and critical patient services.

  23. Some observations that others seem to be missing:

    (1) Deb Matthews claims that loss of income to the pharmacies will be offset by paying for counselling. This they get now. For example a senior can have a complete drug history review and the pharmacy may receive compensation for this expected 1/2 hour of activity.

    (2) Pharmacists are not idle now and the changes will not affect prescription volume. Where would they find time for the new counselling activities?

    (3) The government does not provide enough compensation to employ the number of pharmacists there are. The "professional allowances" are paying the salaries of many pharmacists.

    • That's what Doctor's are supposed to do. They are the Doctor and should be counselling on the medication, not the pharmacist.

      • doctors only spend about 1 year of their degree learning about drugs. pharmacists spend 4 years. trying to say that doctors should be counselling on meds is about the equivalent of saying that any kid that can work a pipe wrench should be doing your plumbing. that makes me think… if thats your mentality than you would be fine with the following:

        – anyone whos played with an erectors set should be able to be a carpenter
        – the average newspaper is written at a grade 7-8 reading level, so theoretically, any high school student could be a reporter
        – anyone that can walk and talk could work in a factory.
        – etc.

        oh so thats not what you mean. ok, leave the people that were trained properly to do their respective tasks then.

  24. (4) Why are the generic companies so quiet? I have not heard one peep out of Apotex or Novopharm.

    (5) Without the kickbacks, there should be more competition for drug store shelf space. Why is everything Apotex now? Because Apotex pays the biggest kickbacks. Even though their product may be inferior (see recent news articles)

    (6) Are the differences in prices cherry-picked? Or are they representative. If a U.S. company can produce a generic for 1/10 the cost of a Canadian compant, why doesn't the government buy its supply from the U.S. company?

  25. (4) Why are the generic companies so quiet? I have not heard one peep out of Apotex or Novopharm.

    (5) Without the kickbacks, there should be more competition for drug store shelf space. Why is everything Apotex now? Because Apotex pays the biggest kickbacks. Even though their product may be inferior (see recent news articles)

    (6) Are the differences in prices cherry-picked? Or are they representative. If a U.S. company can produce a generic for 1/10 the cost of a Canadian compant, why doesn't the government buy its supply from the U.S. company?

  26. Generics won't be losing here, for the most part. I suspect most are secretly happy and so are the brand name companies.

    Pharmacies are the only losers here. Drug utilization is not being addressed in this proposal either, so the docs aren't getting trained to write for cheaper prescriptions or more appropriate ones.

    Who benefits from these changes????? Not most patients, see my note above

    • No, generic drugs will be cheaper without kick backs.
      I don't need a pharmacy to be open 24 / 7 in my small Town. We have 3 Shopper's Drug Marts, and many more smaller drugstores. The walk-in clinics ARE NOT open at that time to prescribe medication.
      Shame on you.

      • me I think

        I am not a community pharmacist. I am a researcher, academic, clinician and critically review drug literature for pricing purposes. I have not commented on pharmacy hours or need for the number of pharmacies etc. I am commenting solely on the pricing issue. Generic drugs will be cheaper but the patient WILL NOT SEE THE DIFFERENCE, unless you do not have a drug plan. This is only 16% of the population. And ONLY for generic drugs. The Ontario government and insurance companies will see generic prices drop. That is the point I am trying to make and the fact that you cannot see this is very disturbing.

  27. And we would probably still get many of those services. I don't really see a pharmacist not raising flags on potential drug-drug interactions that a doctor may have missed unless they want to be included in the lawsuit that would almost surely follow.

    • While you would likely still get drug interactions verified, you might not be able to get your prescriptions as quickly because there would be less pharmacists available and perhaps your local pharmacy would close making it much more difficult to receive your prescriptions.

      Also, in a pharmacy where there is usually more than one pharmacist, if pharmacists are laid off there might not be anyone available to answer your questions on cough syrup, since the one pharmacist left would be busy dealing with issues related directly to prescriptions (like interactions). There also might be no one available to answer questions via telephone.

      You might just respond by saying you'd just go to another pharmacy in this case, but this legislation reduces funding for EVERY pharmacy in Ontario so it's likely that services would be reduced at any pharmacy you would try.

  28. The Health Ministry's assistant deputy minister makes how much? $280,000 a year!! I need to quit my pharmacy job and start working for the Ontario government.

    • do

  29. Here's another wonderful plan from our Ontario government.

    McGuinty claims there are too many pharmacies… well… prescriptions in Ontario are finite. If there are 3,300 pharmacies or 1,500 pharmacies, Ontario patients will still fill the EXACT same number of prescriptions. So instead of walking into your neighborhood pharmacy and waiting 10 or 15 minutes for a prescription (which I think is fair since getting the wrong drug, either via the pharmacist or what the doctor prescribed, could KILL YOU), now you'll wait more… an hour, a day? And I have rarely met a pharmacist that doesn't have time to answer questions for you after you fill a prescription. Sure, they'll tell you the usuals, with food/without food, morning/night etc etc. But it's the other information that they give you that is the most valuable – does this work with all my other medications, how can get my blood sugar lower, why is my blood pressure still high? They provide these answers day in, and day out… FOR FREE. Call my doctor about that question and maybe I will see them in 2 weeks.

    From what I understand pharmacists proposed something to lower the price of generics, save the government and public money and keep them profitable. What's wrong with that? What's wrong with a business EARNING MONEY? Shoppers earned half a billion last year serving your health needs, banks earned twice as much as that, gas companies even more. I think I'm okay with a company striving to better my health making a little money to stay sustainable.

    • You should speak to the IDIOT public more and knock some sense into their moronic heads. I would never trust anything the government says , EVER.

  30. It's outrageous – FREE delivery of drugs? Why should I subsidize free services of pharmacies?

    The drugs stores are inefficiently run – get your business model in order then stop complaining.

    I don't give a rip if Shoppers shortens their hours – let them.

    • But how will you feel about scheduling three trips to the doctor because he didn't get it right the first two times?

    • Bang on……I keep saying that – get a better business model. Funny, they've known about it since 2005 and they haven't made any changes.
      If they were smart, straight out of the gate they would have said…..we WILL not reduce services because in the end we need our customer.
      Also, what walk-in clinic or Doctor is open in the wee hours to get a prescription to fill at 2:00 a.m.? I've been to the hospital at that time, and they give you medication to tide you over until the drug store opens up. I don't need 3 Shopper's Drug marts in my small town open 24 / 7.

  31. Costco dosn't provide free delivery and they charge you a yearly membership! Not to mention that half the time you can"t get through to their pharmacy. Their answering machine is on most of the time and the fee will go up once the laws are passed don't kid yourself. They also sell alot of crap to cover their loss… ever hear of a loss leader? Get the facts before commenting on the future of small pharmacies who don't sell patio sets.

  32. http://www.stopcuts.ca

    Q: What about the other health care services my pharmacist provides?

    A: Community pharmacists in Ontario deliver hundreds of services that are not funded by the government. These services include:

    •Clinics for chronic conditions such as asthma, heart disease and diabetes
    •Delivery of medications for seniors
    •H1N1 and seasonal flu vaccination and education programs
    •Medication-related home visits for patients unable to get to the pharmacy
    •Blood pressure and glucose monitoring
    •Triaging patients into or out of emergency rooms, clinics and hospitals
    •Educational seminars for seniors, other patient groups and schools
    •Drug abuse and fraud prevention
    •And MANY more.
    Most of these services provide tremendous cost savings and relief to over-burdened emergency rooms, clinics, doctors and hospitals. The government agrees with the pharmacy community that these are critical services supporting the Ontario health care system. However, the proposed funding cuts would make these services simply impossible for many pharmacist to deliver.

    • Well since I have NEVER received any different information on my 100 prescriptions in over 8 years (kids) and they get a compensation fee for that…in addition to a hefty filing fee then maybe they shoudl do free deliveries. The community health unit did the H1N1 seasonal fule vaccine, and most people go to their Doctor to get information on the items listed above. Also that's what the community health centre does too…..why an overlap of services, again and again?
      Stop complaining, find a better business model…this change was in the works since 2005.
      I want lower costs, because my insurance has a yearly and life cap on the amount of $.
      Stop whining.

      • i wish you were a newly diagnosed diabetic and your dr sent you with a presciption for insulin after talking to you for 5 mins about diabetes and you showed up in the pharmacy. i would slap a label on the insulin bottle and tell you to figure out how to use the insulin pen yourself. this happened to me today and i spent 20 mins explaining the proper use of the pen and another 10 mins educating the patient on what diabetes is and how it can effect them. this is one example. learn to broaden your views. you may be fortunate, but millions of people go this every day. imagine how much harm you could do if you didnt know what was going on.

  33. The Ontario government could have decrease the generic price to 30% of brand more or less, left the allowances in, slightly increased the dispensing fee and let the pharmacists duke it out among themselves. This would have decreased the number of pharmacies that McGuinty wants, given him the same savings, and he would not have been blamed. So I still don't get it.

  34. *do need to…

  35. I started following this story after the Mathews news conference. I do not subscribe to a newspaper, since there is really no local content anyway, but follow the news on the google news site.
    The thing that I found to be strange was that in the Ontario newspapers, I found that most stories seemed to support Ontario Health's position, but I noticed that most days the Montreal Gazette had an editorial speaking against the Ontario Health position. I'd hate to be a cynic here but does this have to do with Shopper's head office being there? Why are they taing such an interest? At my home I receive at least one phone call per week, to inform us that certain cosmetics are on sale, and to be sure to come in. These guys are not so much a pharmacy as a general retailer. I do not see why the Ontario gov't should be subsidizing this type of operation

    • Shoppers' HQ is not in Montreal, it's in a suburb of Toronto.
      Shoppers doesn't subsidize their cosmetics business with their drug business, they're complementary to each other. In other words, they are both profitable right now.
      With the revenue on the drug business falling, medicine-only pharmacies may go kaput, or be forced into selling more things like high-end cosmetics…
      The local independent pharmacy just doesn't have a PR department, because they're (unfortunately?) too focused on pharmacy services, so you don't hear as much from them.

      • sorry I was confused with the Jean Coutu chain in Montreal my apologies

  36. As Janis shared in her song, Me and Bobby Magee "Freedom's; just another word for nothing left to lose…". Soon there'll be nothing left to cut ! So much for free health care.

  37. Better yet, call Telehealth….did you know that each call costs $39 to gov't……that means you, sbt = taxpayer….and you should think of an ailment and call Telehealth – go ahead, fake it and call them. Just dont fall of your chair when they tell you the standard answer: go to the emerg or contact your pharmacist (oh, the pharmacist who use to give you free advice over the phone???????)
    LOL – you believe the gov't spin…….

  38. While the Ontario plan may not be the ideal solution here, it's painfully obvious that drug costs need to be brought under control. I can respect that Pharmacists, who are highly educated professionals performing a vital job, feel their income is under assault, but this visceral anger and no-holds-barred approach to reform are completely unacceptable.

    If a brand-name company can provide a drug for less than half what generic brands do, there's a problem, one that flaunts both free market principles and proper public bidding on expenditures. If they don't like the Ontario plan, they'd better come up with one of their own fast – if it maintains current expenditure levels, fine, but there needs to be some real cost controls for future growth, because even 5% annual growth is far too much for our system to handle.

    • Pharmacy groups sat down with government 9 months ago to offer suggestions and to work together to reduce drug costs. The government implemented zero suggestions. The issue is the discrepancy – while we pay more for drugs than other parts of the world, other parts of the world receive better compensation for it. Ontario is the #1 buyer of drugs, yes, but they're also the #1 scrooge when it comes to paying a dispensing fee. The PA's were put into place to cover the shortfall between what it costs to fill a prescription and what the government is paying. Had the government simply paid what they owe, pharmacists wouldn't be complaining. Pharmacy wants lower drug costs too; but pay them what it costs to dispense them.

      • So, the government isn't paying enough, so that's why the pharmacists are charging more than anywhere else? How on earth does that make any sense?

        If payment schemes are coupled to drug price, which it seems that they are, then obviously the best thing to do is break that coupling – exactly what the Ontario government is proposing. The pharmacists seem to feel that what they get back in other compensation is insufficient. That's a valid argument, but the media I see out of the pharmacies is not "let's do drug reform right", it's "pharmacists are under assault from the Ontario government!"

        That attitude needs to change.

        • Craig,

          The Pharmacists of Ontario would love to approach the issue as "get drug refrom right". In fact, we tried that for 9 months. The government listed 5 possible outcomes in 2009. Pharmacists made a counter-purposal that would save the system $1.6billion over 5 years, while maintaining the sustainability of pharmacies, and increasing the level of services that pharmacists could provide. When the announcement was made by the Liberal government, it included only the 5 outcomes they had listed in their original purposal – in essence, they made the decision to ignore any input by the pharmacy community.

          If the government is not willing to listen, what purpose does it serve to ask for appropriate reform? It's apparent the government is concerned in cutting health care costs to lower a deficit, nothing more. With that agenda, the only outcome is a lower level of care for patients. The government has forced our profession into a defensive position, to which we have responded with our media campaign. We have to get our message out before legislation is passed, or it will be too late.

  39. I'm wondering why this article made no mention of the fact that it costs a pharmacy 14 dollars to dispense a medication, yet the government only pays 7 dollars. This was the reason for the subsidies from the generic companies, which the government legislated. They didn't want to pay us,so they needed someone else to offset the loss. What business would purchase something for 10 dollars and sell it for 5? It's basic math, plain and simple.

    As an fyi, the government receives these "kickbacks" from the brand name companies, which makes up over 70% of prescription drugs. However, they refuse to disclose how much they receive or where these monies are going. Interesting, isn't it?

  40. Macleans said: "The pharmacists say Ontario is depriving them of a key source of revenue, one that keeps many drugstores afloat. Pharmacies get paid a dispensing fee plus a markup to fill prescriptions and offer professional advice to patients. But they also get a second stream of money that nearly doubles their revenues."

    Do you know WHY that second stream doubles the revenue on a prescription? Because the government froze the dispensing fee and what the government is willing to cover is only half of the cost of dispensing a prescription. So when you take the 50% that the government isn't paying, and add the 50% from professional allowances, then the pharmacy gets paid 100% of what it costs to fill a prescription.

    Once the government intervenes and removes that other 50% without replacing it completely, pharmacy does business at a loss. How long do you think a pharmacy will stay open losing up to 50% on every prescription filled?

  41. People get all your facts straight before making comments. The Government has not given a raise to pharmacy owner in over 20 years!!! They were well aware of the professional allowances that we given by generics companies in fact they were happy about it because they did not have to raise our salaries for 20 years!! (see more)..

  42. It cost approximately 14$ for us to fill a prescription (rent, salaries, hydro, etc) and they give us 7$ and on top they introcused years ago a copay of 2$ or 6.11$ . So we are gettting either 5$ or 0.89$ from the government, the reminder has to be paid by patients. With the elimination of PA, they are asking us to go back to our salaries of 20 years ago!!! Do you think anyone in the public or private sector would be ok to go back to the salary they were making 20 years ago??? I dont' think so! (see more)

  43. We the owners, are Ok with the reduction of generic prices and the elimination of PA BUT pay us in 2010 money, not in 1989!!! And do not be fools in thinking it won't affect us at all, that we will change our model of business and adujst… more than 300 small family owned pharmacies will disappear for good. Our small independent pharmacies are our pension plan. Now my pension lost 1/2 of its value… maybe more.. How would you like if your employer told you tomorrow your salary will go back 20 years and you will loose 1/2 of your pension plan???
    Make sure you get all the facts. The government is not being honest in this battle. They are looking only at generics which is 12% of their budget for the Ontario Drug Program, why aren't they looking at the brand name (33%) and their Administrative overhead (55%).? Something smell very fishy…

  44. Pharmacies that are in proximity to medical clinics are a license to print money- why do you think Shopper's Drug mart and Loblaws/Stupidstore are paying for doctors to set up in clinics either inside or next door to their premises. These huge chains are paying all costs to set up fully equipped clinics so that they can generate huge profits from their pharmacies. Huge profits- nice to know we're all funding those mass chain stores.

  45. Why is no one talking about how much pharmacists make? If they face a pay cut, which they obviously do under this legislation, how much will they be making now compared to before? I

    • Check the median a pharmacist makes on job sites. Personally, my family owns an independent pharmacy in a populated area of Maple/Ontario and it produces 90k income before taxes. That's after 15 years of being in business. People have this crazy idea that pharmacists make about the same amount that a family doctor does but it's far from the truth. With these new cuts, the pharmacy suffers big losses and we may need to sell it off.

  46. I'm all for $500 million/year in savings just to start with. The bottom line is pharmacists are grossly overpaid. Shoppers is a gold-plated retail behemoth. It's disgusting that the same people who make 70-100K+ are threatening to cut "services". This is their JOB = their duty. I say cut away. If independent pharmacies go under, that's market forces. And the first time someone gets sick, and the pharmacist tries to blame cut backs – trust me, we will be quick to sue the pharmacist, not the government.

    • Hmm, pharmacists are grossly overpaid, yet you'd be the first to sue them if someone gets sick. Because, hey yes, they are responsible for the health and wellbeing of their patients, and their lives, but they shouldn't get paid. They spend at least 5 years in University to become the experts on these medications that save lives everyday, but perhaps they should just volunteer their time? Is that your suggestion? By the way, do you get paid for your job? Just wondering.

      The facts are they never got paid the cost of filling the prescription in the first place; they worked at a loss. So the government legislated the professional allowances to offset the loss. Put it like this, would you buy a car for 20,000 and turn around the next day and sell it for 10,000?

  47. Ott, the PR agency called. They're reminding you they don't pay overtime for weekend work.

  48. Really? Just a customer?
    Because you keep posting these lovely talking points and websites, as if you had some personal interest.

  49. Isn't Ranitidine became Over-the-Counter for more than a year, well at least in our province? I think Mr.s Steveson is a bit out of touch. If our drug cost is really more than the States, than we should have Internet Pharmacy serving Canadian, not the other way around. You need to get the facts straight. The fact is our drug cost per capita is cheaper than the States.

    It's fine to reform the generic rebate, but do it the right way please. What OPD do will likely harm the healthcare system and the real purpose is to take the money from healthcare to plug other financial holes of the Province. People will pay more dispensing fee unless they are covered. Some generic will no longer be viable due to the 25% cost rule, and we will have to fall back to more expensive off-patent Brand Names. So essentially you save 50% on some and pay 100% more on others.

    Get the facts straight please. And reform the RIGHT way, not the eHealth way.

    — Steveson said "for instance, 82 per cent more for a gastrointestinal drug like ranitidine than Americans do" —

  50. Shoppers Drug Mart told me that they would not fill a full prescription because the cost of the drug was so high and the government only allowed 10 pills at a time. I then went to the hospital pharmacy and they filled the whole prescription in full. Guess Shoppers Drug Mart wanted the dispensing fee times 5, it's the only reason I could think of. I trust the pharmacists at Shoppers Drug Mart but Shoppers should not forget where they started and what gave them their success.

    • It is illegal for the pharmacy to not give you the full amount of the drug to get the dispensing fee, reread the first part of your statement. The government would NOT ALLOW more than 10 tabs at a time. Why is the pharmacy getting blamed? Because they delivered the message. The hospital pharmacy is not a private business, and not subjected to the same rules of retail pharmacy.

  51. It is interesting to note that David Peterson the former Liberal premier of Ontario is related to the present Minister of Health in Ontario and the same tactic was used in the dubbel fee charging by Ontario Docters during his reign. Guess who won, and lets not forget that reportedly Peterson is a Director of Shoppers Drug Mart. The end result of this Liberal Govt move will be the ELIMINATION of small independent drugstores. So it is no wonder that Peterson is quiet about this issue. Things are going their way, and the big chains will not be blamed. Nice going.

    • No, change your business model. Shoppers Drug Mart did, after being denied the right to sell cigarettes. If you sell Ford and GM, but you get a "kick back" from GM and push that on your customer or change it to a GM product without the customer being aware is that fair?

  52. The pharmacy chains are worried because they've over-expanded. There are more than 10 Shoppers within 10 minutes of where I live and near a friend's place there are two Rexall's right across the road from each other.

    • The amount of drug stores has no bearing on the amount of prescriptions filled. There has been a 15% increase in prescriptions in Ontario, yet only a 4% increase in the number of pharmacies built . The baby boom population contributes significantly to this increase, through no fault of their own. It just makes sense that the more people filling prescriptions, the more pharmacists required to serve them.

      • sld50
        If that were true, then I would expect to see the pharmacy taking up the lion's share of space in the new big box model Shopper's Drug Marts, but we all know that is not the case.

    • True, and there are ones in Loblaws, Zellers, WalMart, Costco. The thing is we really don't need all these pharmacists on every corner. Right now, I can think of 7 pharmacies I could go to and that's within walking distance and I'm in the suburbs. If I spent the time driving, then I would say at least 20 that are within 15 minute drive. Maybe, that's why there are so many….they realized it was a cash cow?

  53. If pharmacies are unable to remain in business because of the end of 'professional fees', then these pharmacies are not meant to be in business. Our tax dollars are meant to pay for the drugs, not for all the other services. If the pharmacists want to do more, charge it. If the tax system is meant to pay for these services, then let it be transparent so that all taxpayers will know that they are funding delivery services, 24-hour pharmacies etc.
    If the government backs down from these changes, then we can kiss the single-tier health care system good bye. And at the end of the day, we will have to pay more for our health care as government will have to cut back on health care spending. Perhaps even ending the free drug programs for seniors.

    • Agreed. The pharmacist is paid to dispense and advise on the drugs. They shouldn't in addition be given a "kick back" on the drug they are giving you….is that not conflict of interest?
      Gee…if I sell Ford, and GM but I'm given some money to sell you GM then am I being fair to my cutomer by not telling them the truth?

    • Exactly….what needs to be said.

  54. The pharmacist is paid to dispense and advise on the drugs. They shouldn't in addition be given a "kick back" on the drug they are giving you….is that not conflict of interest?
    Gee…if I sell Ford, and GM but I'm given extra "kick back" money to sell you GM then am I being fair to my cutomer by not telling them the truth? Am I really going to give you the best mediation? Do I know if I change you to generic that it could affect the balance of other medications (research in Prevention magazine) you are taking?
    Shame on you.

  55. We're over run with pharmacies, ther are ones in Loblaws, Zellers, WalMart, Costco. The thing is we really don't need all these pharmacists on every corner. Right now, I can think of 7 pharmacies I could go to and that's within walking distance and I'm in the suburbs. If I spent the time driving, then I would say at least 20 (probably more) that are within a 15 minute drive. Maybe, that's why there are so many….they realized it was a cash cow?

    • me thinks me I think works for the government

      • Not at all….just an almost stay at home Mom that has had to go to Doctors or walk-in clinics at least 80 times in the past 9 years….Never worked for the Government, or a Union and NEVER will! If they were selling Ford and GM, but got a kick back for selling me a GM I would want to know. I NEVER realized that they got a kick back. In the past, I've had problems with NO NAME brands and after reading an article in PREVENTION magazine I realize that other people have too. it makes me wonder what a generic version really means, beside cheaper drugs.

  56. Everyone is missing the point. In Ontario we pay more for generic drugs, and we are one of the biggest customers. The generic companies aren't saying anything because if they don't have to give "kick backs" then their drugs are cheaper.
    I can honestly say that in over 8 years I've had at least 100 prescriptions filled (kids…) and I have NEVER received more information from a pharmicist then I get from the Doctor and the printed piece of paper.
    Pharmacists have seen this coming since 2005 – guess what change your business model.
    It is incorrect to say that most people have insurance so they don't care. Yes, we care, because we are taxed on the benefit and there is often a limit on the amount of $ that can be spent per year, then per life of the policy. So, for someone that needs many medications they will cap that amount quicker because of higher drug costs.
    We also pay as taxpayers for those not covered. I don't need 3 Shopper's Drug Mart stores open in my small Town for 24 hours. First off, walk-in clinics aren't open to give prescriptions in the wee hours, and I've gone to the hospital with a sick baby and they give you enough medication until the pharmacy opens.
    Shame on anyone for defending "kick backs." Also, the name brand pharmaceutical companies do actual research and development. The only development and research the generic companies do is for lawyers to sue to get drugs off patent.

  57. …continued
    Instead, all (!) papers should have been printed at factory, as well as all drugs be hermetically packed there into reasonably small packs. This would eliminate a tremendous part of pharmacy cost, client would know when his particular package of pills actually expires and no chance of contamination. Besides, factory packed pills will be in different packs, so distinguishing them will be easier.

    • Yes…I agree, they should be prepackaged….more sterile….never thought of that. They hire people at minimum wage to be their assistant, and don't know anything when I ask question.

    • Do you know we pay for the disposition of the unused/returned drugs and interest on inventory? Preprint labels won't work because every prescription is difference. Some drugs are already pre-packaged if it is cost effectively – the keyword is "cost effective".

      You also missed a few crucial steps in your previous reply; I will come back to that when I have time… Basically the steps you mentioned are task of the Techs. Pharmacists are responsible for other more important tasks behind the desk.

  58. The major flaw with Ontario pharmacy system is not about allowances or government funding, it's the way they organize the business altogether. Just take a fresh look at the operation as it develops, let's say in Shopper's Drug Mart:
    1. a clerk takes a prescription from a possibly sick person
    2. same clerk walks to a desk just a few feet away, opens a gigantic jar with pills and counts them off into a small jar
    3. same clerk prints general recommendations (which, BTW, do not include actual expiry date, storage recommendations and dispose procedure)
    4. same clerk walks to cash, takes the payment and gives medicine to the client

    All this happens in a general hall of the store, clerk wearing outdoor shoes and not even a pretense of anything being sterile. This procedure is extremely costly, purposeless and plain ridiculous. Just think how many germs may be landing on your pills before you swallow them!

  59. Our government thinks there are too many pharmacies. Our cities are growing, neighbourhoods are expanding, guess what? Pharmacies and grocery stores and other stores open. Surprise! Yet when the legislature wants to expand with 18 more MPPs the same argument does not apply? Like we need 18 more at the trough!!!

    • Lui Longo – you thought I worked for the government (me I think)
      Not at all….just an almost stay at home Mom that has had to go to Doctors or walk-in clinics at least 80 times in the past 9 years….Never worked for the Government, or a Union and NEVER will! If they were selling Ford and GM, but got a kick back for selling me a GM I would want to know. I NEVER realized that they got a kick back. In the past, I've had problems with NO NAME brands and after reading an article in PREVENTION magazine I realize that other people have too. it makes me wonder what a generic version really means, beside cheaper drugs.

    • the MPPs are different, know your political stuff. The issue is to give the same amount of representation to the Provinces based on population, etc. and that is to ensure the same political representation that is fair for the provinces. Presently it isn't. This has nothing to do with a "kick back." If you sold a Ford and GM, but got a kick back for selling me a GM and didn't tell me I don't think that would be fair…now do you? I do not work for the government, pharmacies, drug companies, unions, etc….I'm a mostly stay-at home Mom….and worked in an industry not even associated with any of the ones I mentioned above….not hospital, doctors either.

  60. I think all pharmacy customers need to fuck off

  61. People who do not work in health care do not even know what pharmacists actually do. The same goes for any profession…if you haven’t done it, then you don’t know a thing about it. Dont’ hate, appreciate.

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