Pharmacy Takes Another Haircut

There’s a lot going on in the wacky world of pharmacy these days, and as usual a great deal of it doesn’t make any sense; some of it is contradictory.

First, in Ontario, the MOHLTC has decided it needs to save even more money as the government is running a deficit of over 7 billion, all due to the previous Liberal government of course. So, it needs pharmacy to make a generous contribution of 436 M over five years, thank you very much.  This is in addition to several other bites taken out of pharmacy over the last several years.  Death by a thousand cuts is the expression.

It could have been a whole lot worse according to the Ontario Pharmacists Association/Neighbourhood Pharmacy Association of Canada’s (OPA/NPAC) self congratulatory announcement.  The government apparently wanted 791 M, but as a result of ‘astute negotiations’ by the OPA/NPAC alliance, that amount was “reduced by 45%”. Talk about taking a negative and turning it into a positive.

Also, Medscheck has been saved, but who cares? …this one has been milked to death already.  The important achievement apparently is that the OPA/NPAC alliance and the government are now friends and the future is surely going to get better.  Not sure where this rosy prediction comes from, but it sounds optimistically hopeful at best.

The reality is this.  This unholy alliance between the OPA/NPAC is seen by government as another business lobby group representing Big Pharmacy Retail (BPR) mainly, and to some lesser degree small businesses called independent pharmacies who are often seen in the news ripping off the government somehow through unauthorized rebates, or other nefarious or sneaky deeds.  Maybe not totally fair, but those are the optics.  So, not much sympathy from government.

The unfortunate critical element is that the government does not see itself as negotiating with pharmacists.  The government has no compensation framework with pharmacists, and it likes it this way.  Much better to hack away at big business who has lots of money, and as big retailers have ample opportunity to make up any shrinkage in prescription drug profits by selling higher margin stuff like OTCs, Halloween candy, pizzas, lawn chairs, pop & chips.

The fact that unrepresented employee retail pharmacists will suffer the consequences through even more reduced compensation (already down at least 30%), even less technical support, and even more quotas, is not government’s concern.  These consequences are indirect and not in the government’s eye.

Too bad the Canadian Press and other media outlets continue to use the word ‘pharmacists’ when what is really meant is ‘pharmacies.’  Pharmacists are real people, while pharmacies are things.  Pharmacists have no negotiating power and government knows this.   Pharmacy students should be given a five by eight-inch card with this reality written in red ink & in large print on it on the first day they enter pharmacy school.  It would save a lot of tears and anguish six years and $150,000 down the line.

And in the face of all this, the holy grail for pharmacy now appears to be even more increased scope of practice ‘privileges’ i.e. do more stuff for a level of compensation which is yet to be determined.  And what is this extra stuff?  Mostly prescribing for a predetermined number of so-called minor ailments eventually, and extending prescriptions up to a year over the short term.  In other words, do more for less to help the government with its fiscal problems.

The OPA/NPAC alliance likes this.  Why not?  A chance to generate more revenues with no extra costs.  Think any of these yet to be determined fees will trickle down to employee pharmacists?  Join the line to sit on Santa’s lap.

Let alone that after six years of university education, today’s pharmacy graduates have little or no training in diagnoses nor ordering nor interpreting lab results.  The Ontario College of Pharmacists (OCP) knows this.  Imagine what the OCP will put its members through before they are allowed to enter this new arena.

Up to now, these activities were the purview of Medicine, not Pharmacy.  As one physician recently stated: “There is a big difference between medicine and medicines.”  So, a huge assumption of liability (more insurance costs), more courses to take (a few thousand dollars at least) and mostly to increase the bottom line of non-pharmacist owned pharmacies.  The Ontario Medical Association (OMA) doesn’t like the idea, and the Canadian & Ontario Nurses Associations have serious reservations as they see a direct conflict of interest between prescribing and selling medication.  This observation goes back a thousand years and was the basis/rationale for separating medicine & pharmacy in the first place.

There may not be a great deal that individual pharmacists may be able to do to avert this juggernaut, but at least they should not add delusion and a surreal sense of self-importance to the list of their travails.  A lot has already been written about all this, and more will surely come down the pipe, but pharmacists must maintain a critical perspective and separate the wheat from the chaff.  The truth is often the last thing people want to talk about.

4 thoughts on “Pharmacy Takes Another Haircut

  1. Bill, thank you for this blog.

    There is so much to say, but I’ll do so for now with bulleted observations, possibly expanding later:

    1) The recently-closed Scope of Practice consultation at the OCP received a letter from OPA THE DAY AFTER the OPA distributed a News Message to members about this impending legislative change by the government. So they knew about it (having been “at the table” for the discussions) when they penned their input letter to the OCP which then only appeared for viewers to read AFTER the closing of the consultation on October 26th. Not one advance notice of the OPA/NPAC “negotiating” with the MOHLTC was circulated to the “members who support this position” (incorrect again, but they like to believe that all OPA members agree with their Board position). The almost 200 or so comments made to the OCP consultation contain “quite a few” that would not be in agreement with Mr. Bates’ comments to the OCP.

    2) Addressing the OPA(NCAP) comments to OCP, I will chalk up the comments made by Mr. Bates to not being a pharmacist and not knowing better. He quotes the (alleged) OCP core mandate by extracting directly from the OCP homepage “About the College”: https://www.ocpinfo.com/about/. But he missed including the very next line: “The College also ensures that pharmacies within the province meet certain standards for operation and are accredited by the College” when he boldly states that “…it is the position of OPA that the identification of operational or workflow-related challenges fall outside the primary objective of the College in this consultation,that being to assess if the proposed change would pose any risk to patient safety.” The sentence he missed does, in fact, show that is within the College’s primary objective,” because it’s not an objective at all. If one considers the fact that the ICR committee at the OCP makes recommendations to members before it on how to change their practice to prevent recurrences, etc., then in fact the college DOES have a duty in the area of “workflow-related” items, as they impact upon the operation of the pharmacy which is regulated by the college under the DPRA and Standards of Practice, etc. for members. (As an aside, consider that in light of the issues about pharmacist:tech ratios to properly ensure the public interest…).

    The College (as are all regulated colleges under the RHPA) has legislated objects, all set out in the RHPA Code at section 3.(1), and in the Pharmacy Act at section 6. There are many, and none take precedence over another in any order. The Code section lists 12 “Objects of College” and the Pharmacy Act section lists 3 additional objects to those in the Code. All of them are important, in no particular order. But THEY are what establish a college’s “mandate”. Ironically, he later identifies (p3, c)) another area (vaccinations) where he states it is “outside the purview” of OCP but this time suggests they SHOULD be active in that area, notwithstanding it being outside its purview (in his opinion). And this occurs yet again at p6 regarding remuneration issues.

    3) The issue of extending prescriptions to “12 months or what was originally prescribed, whichever IS LESS” is getting watered down by this very agency referencing only the “12 months extension” aspect. It’s not; only if the original prescription with refills authorized that period of time could it be extended TO THAT MAXIMUM, but no pharmacist is required to “do the full extension” but rather, use discretion as to how much may be needed to effect coverage until the patient can see a doctor again…that’s patient best interests, and is repeatedly commented upon in the submissions to the OCP in the consultation. Why is the OPA/(NPAC) now abbreviating references to this aspect of practice to the “12 month extension” sans the “or as previously prescribed, whichever is less”? Is that the corporate influence? (If you need to see the comparison of “now versus proposed” in this regard, to the OCP consultation under “Closed” and at the bottom of the information that appears before the comments begin, choose the additional information topic that nicely charts that “now and proposed” areas of the legislative areas).

    4) I would suggest that when the OPA says it has the “support of its members,” it has missed the word “Board” in front of “members.” Given the corresponding “pharmacy” (not pharmacist) comments made by NPAC, it’s as if they sat together to draft the letters; even the organizational formats are eerily similar. As such, maybe the OPA should be renamed (again) to “OPA/NPAC” because the timing of the move from NPAC to OPA by Mr. Bates, along with the topics of discussion being “lobbied,” are very suspect to any informed observer. I don’t believe for a moment that any member of the OPA believed they were becoming members of an association that would work JOINTLY with NPAC; they’re supposed to represent the MEMBERS, not the businesses, because the OCP doesn’t represent those members.

    I wonder how many other provincial pharmacy associations are “negotiating” in their members’ interests in concert with NPAC. Why is Ontario? It can’t be because it’s “Ontario-centric” with being the OPA, because NPAC is national….and therefore, every province should be in cahoots with them. Not the case, though.

    5) The OMA’s comments to the consultation are largely “concerns” in areas that many pharmacists have commented upon over and over. Apart from the reference to “conflict of interest” in being able to prescribe what is being dispensed (whether perceived, or real) and the fact that there are dispensing physicians still practising (which can raise that same debate, although such dispensing is on a far lower scale and is regulated by meeting the immediate need of the patient when assessed, not “ongoing”), most of the OMA concerns are valid.

    6) Finally, it was interesting to see both the CNO and ONA provide comments. The CNO is the regulatory agency for nurses in Ontario. They are speaking out. Why, in other matters relevant to pharmacy, does the OCP not also do so but defer to the OPA which is seen as being self-serving by so many of its members and non-members? (That’s a rhetorical question).

    To close, I remember quite well how many DECADES it took to get an increased ODB dispensing fee from the MOHLTC, and how the OPA crowed in that “accomplishment” as well. Yet, no such similar period of time has elapsed without the MOHLTC “recovering” part of that (and markups) with their pending “reconciliation” legislation. They did the Remittance Advice recovery for missing their original targets to reduce the $$ burden; now, they “missed” their reductions yet again and continue to carve it off the turkey that is pharmacy. It won’t stop, for sure.

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    • Also add to the end of the first paragraph in 2) — if you look at Appendix 14.3 in the Council Minutes of OCP from September, 2019, you will find the following “background” general statement:

      “The College has a duty to understand the impact of pharmacy practice to ensure that the pharmacy profession is continuously contributing to improved patient outcomes.”

      No more of this “not our jurisdiction” mumbo-jumbo when it comes to issues about workflow management, please.

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      • Has anyone bothered to find out how much OHIP+ is costing the province. I have had pts who usually filled 1 EpiPen at a time, suddenly fill 3 pens. 1 for home , 1 for school and 1 for the baby sitter. OHIP+ is also nonsense. Most pts are employees who have drug plans. Therefore they are not eligible for the plan. Millionaires with big businesses have their kids getting free drugs as they usually dont have drug plans. Ohip continues to cover otc drugs like tylenol , fibre drinks and iron preps etc. I’m getting rid of these will save money? I won’t mention frivolous med checks to satisfy quotas. Oh sorry just mentioned it. And it’s been saved. Hooray for the chains. They can continue to milk the system and destroy our livelihood in the process. They dont care if pharmacy remuneration plummets. This will be good news for them. It will be an excuse to drop pharmacists wages further. We all know that pharmacist wages are a source of irritation to the BPR shareholders. Lower wages means more money in their greedy hands.
        I think the title of this blog should be changed to Pharmacists take another hair cut. Pharmacy aka grocers are wringing their hands in delight as its an excuse to cut our wages further.

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  2. As the snowflakes come down, so do the snowflakes on the Canadian healthcare network come out of hiding. Some of the comments by those who work in corporate pharmacy are so removed from reality that it hurts my head to try figure them out.

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