The Angry Pharmacy Technician

2010-07-03T06:59:00.001-04:00

Added by Stanley Tam
to "Ontario’s Community Pharmacies"

7/32010

"Here's the problem with SDM's strategy - throughout the last few months, they have defended their image as being professional and upholding the high standard of the profession. They have many great pharmacists, including many of my former classmates, who wholeheartedly believed in this cause and stood up for their profession. Now suddenly they too are seeing the true nature of the corporate colours. The pharmacists at SDM know that in the end this will affect their salaries, their work environment and the nature of the profession itself. Many realize that they are being used as tools by faceless corporate big shots. Their morale is not high. After talking about the value of pharmacists, big font capital FREE, FREE, FREE, does a lot to tarnish that value. The public may be stupid to an extent, but the pharmacists, and technicians, who work for SDM (and Loblaws,etc) are not.

A future monopoly will mean higher prices for customers, poor working environments and lower wages for pharmacy staff, and a spiral downwards for health care in Ontario. So everyone who supported the Liberal cuts was supporting BIG pharmacy, BIG pharma, BIG government, BIG CEOs, and BIG monopoly. Is this what you wanted?"

UPDATE: Transitional Issues

2010-06-21T17:49:00.000-04:00

On Wednesday, June 16 Coalition members met with Helen Stevenson and Pamela MacDonald of the MOHLTC to discuss transitional issues arising from the new regulations.

Following are the highlights of that discussion:

• The Ministry currently has no plan for a washout period for existing inventory, but are providing a 10-day notice period of price change. We asked the Ministry to consider the financial penalty to pharmacies of this decision, and reconsider a 30-day period for washout — including markup. The Ministry agreed to provide an update by end of next week.

• Transition fees will be paid automatically and manually as a separate line item in the normal OPDP payment record, based upon scripts filled. Methadone, LTC or equivalent, and pre-Trillium claims are not eligible.

• Variable Dispensing Fees — Pharmacies eligible to receive more than the $8/script dispensing fee will be notified by the MOHLTC as soon as this week. The Ministry has completed its analysis of eligibility. If we are in disagreement with their analysis we can appeal the decision on the fee. The Ministry indicated that stores will receive these letters ONLY if they are eligible to receive more than $8/script. All other stores will just automatically receive the $8 fee if submitted on July 1st.

• Professional Services Funding beyond the $75 Million to be covered by transition fees, $25 Million will focus on, but not necessarily be exclusively for, rural pharmacy services. An ad hoc committee will be formed in July/August to put together a plan for payment for services. Coalition Representatives will participate on this committee.

• MedsCheck Accessibility, there will be consideration made for MedsCheck ‘at home’ in rural locations to be eligible for some kind of mileage/time fee because of distance. Program will be expanded to include diabetic patients not otherwise covered and will be at the pharmacists professional discretion. There will be consideration for payment for additional counseling at the same time (diet, exercise, foot care). It appears that MedsCheck (Home, LTC and Diabetes) may be priced differently than the $60 fee. A complete Q&A document from the Ministry on these services is to be sent out next week. Follow up MedsChecks remain at $25.

•Generic Pricing (including exceptions) will be announced in the upcoming formulary notice of changes, expected 10 days before implementation. All Generic vendors have been asked to submit their exception lists (non 25% pricing) to the MOHLTC this week.

Other Issues:

• Appeal Process — When opening a new pharmacy, the dispensing fee is automatically set at $8. MOHLTC will assess the category of the new pharmacy and re-set the fee. This could take a few days. Retroactive payment would be made available. Likewise when a store category changes (a pharmacy closes in the town, etc.), the Ministry will only re-set the categories annually. Once again, retroactive payment will be allowed in this case.

• Methadone scripts under capitation are not included with any fee increase at this time. These will be dealt with this fall. Suboxone would be included in this as well.

• MOHLTC indicated that they have intentions to meet with pharmacy on LTC in the upcoming months. For now the higher fee with no transition fee applies.

AUDIO: Explanation of new regulations

2010-06-08T21:14:00.001-04:00

Posted on June 8, 2010

Play audio to hear coalition leader Jeff May explain the new regulations and what they might mean for your pharmacy and your patients.

This clip is an excerpt from the June 7th Tele-Forum.

OPCh to Minister: Patient Services and Care Still at Risk

2010-06-08T21:08:00.001-04:00

Ontario’s Community Pharmacies to Minister: Patient Services and Care Still at Risk

Pharmacists react to new regulations and vow to fight for patient care

TORONTO, June 8 /CNW/ – Ontario’s Community Pharmacies Coalition are extremely disappointed by yesterday’s announcement by Health Minister Deb Matthews and the posting of amendments to regulations under the OBDA and DIDFA as it all but assures that Ontario patients will be less able to freely access the front-line community healthcare they have come to rely on. While pharmacists continue to support the need to lower generic drug prices and eliminate professional allowances, it is regrettable that the Minister chose not to work with pharmacists to find a solution that would preserve front-line healthcare. Pharmacists are disappointed by the complete lack of transparency in the consultation process, the failure to understand the profound risks to front-line community healthcare and the continued unwillingness by the Minister to meet with all key pharmacy stakeholders.

“Sadly, pharmacists will now be forced to make very difficult choices, as they evaluate the level of care they provide to all patients, especially seniors and the chronically ill,” said Rita Winn, RPH, BSCPhm, general manager, Lovell Drugs. “We deeply regret having to make choices that impact these patients and will resist having to do so. Unfortunately we have little choice.”

The government’s decision to expand the MedsCheck program and establish a transition fund for pharmacies are sound concepts but the funding level is woefully inadequate to help offset the impact to front-line healthcare of the massive $750 million healthcare cut. The cuts mean that patients will have less access to front-line healthcare and the final regulations indicate that the government really wasn’t interested in consultation with pharmacists and their patients to consider alternative solutions to deliver on their policy objectives.

Ms. Winn observed that, “The extended consultation period set out by the government resulted in very little consultation with all pharmacy stakeholders. In fact, one has to question the legitimacy of the entire process and why the guidance and expertise of those who lead the industry was outright ignored?”

Pharmacists maintain that the McGuinty government has, since April 7, waged a calculated campaign to continuously malign and vilify pharmacists with dishonest and misleading portrayals of the facts regarding professional allowances and their legitimate, regulated use in funding the patient care that pharmacists provide. “This is offensive to all pharmacists and a betrayal of the trust of Ontario voters,” says Winn.

Over time, patients will experience reductions in clinic services, evening and weekend pharmacy hours and direct access to pharmacists will be limited as a result of the cuts. Pharmacists deeply regret and resist having to make these kinds of cuts.

“Pharmacists refuse to accept such poor outcome for patients and will continue to advocate for continued patient care. Less healthcare for the people of Ontario is unacceptable.” said Winn.

Pharmacists are particularly concerned about the post-regulatory implementation period, which has historically been accompanied by a host of transition-related questions and unexpected practical and operational consequences that need to be resolved. The Coalition believes the new regulations under the ODBA and DIDFA, being numerous in scope, quantity and magnitude, will result in significant transition challenges.

The Minister has a real opportunity to work with all pharmacy stakeholders who bring the experience and operational knowledge that will help to ensure the best possible outcome as the new regulations take effect.

“On behalf of patients from every corner of the province, pharmacists remain committed to fighting for front-line healthcare in Ontario,” said Winn.

URGENT: DRUG SYSTEM REGULATIONS

2010-06-08T21:01:00.007-04:00

June.7, 2010

Click here for an overview of the provincial regulations as outlined on the Ministry of Health's Website.

KEY FACTS

- Pharmacists are devastated by Health Minister Deb Matthews’ announcement. It confirms that front-line healthcare remains at serious risk. It further confirms that the voices of patients and pharmacists across Ontario have been ignored.
- The McGuinty government has, since April 7, waged a calculated campaign to continuously malign and vilify pharmacists with dishonest and misleading portrayals of the facts regarding professional allowances and their legitimate, regulated use in funding the patient care that pharmacists provide. This is offensive to all pharmacists and a betrayal of the trust of Ontario voters.
- Pharmacists refuse to accept such a poor outcome for patients and will continue to advocate for continued patient care. Less healthcare for the people of this Ontario is unacceptable.
- There has been a complete lack of transparency in this so called consultation process, together with a failure to demonstrate any concern about protecting access to front-line community healthcare that pharmacists provide, and the continued unwillingness by the Minister of to meet with all key pharmacy stakeholders on a workable solution.
- The government’s decision to expand the MedsCheck program and establish a transition fund for pharmacies are sound concepts but the funding level is woefully inadequate to help offset the impact to front-line healthcare of the massive $750 million healthcare cut.
- The massive funding cut means that patients will have less access to front-line healthcare and that the government had no intention of using their consultation period to listen to pharmacists and consider alternative solutions to deliver on their policy objectives.
- Sadly, pharmacists will now be forced to make very difficult choices, as they evaluate the level of care they will be able to continue to provide and try to keep their doors open. Pharmacists deeply regret and resist having to make these kinds of choices buts because they ultimately affect those who need them the most and are the most vulnerable in our communities - including seniors and the chronically ill.
- Over time, patients will inevitably experience reductions in clinic services, evening and weekend pharmacy hours and direct access to pharmacists will be limited as a result of the cuts.
- Pharmacy offered a number of workable solutions to the government’s policy objectives and negotiated in good faith for nine months. We showed the McGuinty government how they could save hundreds of millions of dollars through lower generic drug prices, the elimination
of professional allowances, the implementation of better drug utilization management practices, all while protecting front-line healthcare services pharmacists provide with fair and transparent funding.
- Ontario’s Community Pharmacists continue to call on the Minister to meet with all pharmacy stakeholders to plan a responsible reinvestment in direct funding of front-line healthcare and a transition implementation processes that won’t pose a larger risk to front-line community healthcare.

PILLS PRINTED SPECIFICALLY FOR YOU

2010-05-28T22:05:00.001-04:00

Originally posted here

Here's a dirty little secret about the little pills you pop: nearly 99.9 percent of the tablet is useless. Only a thousandth of a pill contains the active ingredients that are supposed to make you feel better.

The rest of the pill is just filler so it's large enough for you to pick it up.

If you think that sounds wasteful, you're not alone. Researchers at the University of Leeds, Durham University, and GlaxoSmithKline have teamed up to create pills that are made to order, or perhaps I should "printed to order."

Printing pills means literally printing the active ingredients of a medication onto the side of a tablet. To understand the concept of "printing," think of the active ingredients as tiny droplets that can be printed onto a surface the way ink is printed onto paper, but instead of paper, it's a tablet. That means pills could be individually made for each patient to fit their medical needs and one pill could potentially hold more than one type of medication.

Right now, medications are manufactured by the millions in a one-size-fits-all way. Printing pills would change all that. Instead of the active ingredients being encased somewhere inside the pill, they would be on the side of the pill and in a dosage suitable to the patient's needs.

And since the active ingredients are on the outside of the pill, the active ingredients will act more quickly. That's more accurate than the current system, where a small sample of each batch of pills is checked post-production to make sure the dosage is correct.

Eventually, printing pills will be particularly helpful to anyone who prescribes several medications. If your grandparents (or parents!) are anything like mine, they probably have one of those pill boxes to keep track of which pills they are supposed to take on which days of the week. There are some days when my grandmother has to take almost a dozen pills. Printed pills could put the active ingredients from all of those medications onto just one pill for her to take each day.

This process can now only be applied to less than one percent of all pills on the market. But researchers hope to one day increase the number of printed pills to 40 percent.

Article: Ontario’s backroom deals make for drug-policy chaos

2010-05-26T21:48:00.001-04:00

Posted in the Globe and Mail today

The heated battle between the Ontario government and pharmacists over the pricing of generic drugs seems to have cooled a bit.

The new rules were supposed to be in place already, but the provincial government has quietly delayed their implementation. Not coincidentally, the province’s powerful drug czar, Helen Stevenson, is set to step down, setting the stage for some concessions.

Under the system that’s to be replaced, the government drug plan negotiates (or, more precisely, imposes) a price it will pay to pharmacies for generic drugs – 50 per cent of the price of the equivalent brand-name drug. Pharmacies, in turn, buy generic drugs from manufacturers at that fictional price, but then receive “rebates” in the 40- to 80-per-cent range.

The province has decided that this system – which it created and endorsed – is too expensive, and that the drug plan will only pay 25 per cent of the price of the equivalent brand-name drug, and eliminate the rebates (or kickbacks to use a cruder term).

The change will cost Ontario pharmacies about $750-million.

But the government has softened that blow a bit with new rules that will provide pharmacies with about $250-million: These include a slightly higher dispensing fee and an extended scope of practice (pharmacists will be able to offer vaccinations and bill for such things as drug counselling).

Before the new rules take effect, there will likely be another hike in the dispensing fee, and the big pharmacy chains such as Shopper’s Drug Mart and Rexall will get the right to manufacture their own generic drugs, which could be a cash cow.

While Ontario may be able to buy peace with pharmacies, drug policy in the province remains abysmally confused precisely because it consists of grandiose promises that are watered down by backroom deals.

The current mess dates back to 2006, when the Ontario government adopted Bill 102, the Transparent Drug System for Patients Act. It is a name that, as you will see, is rich with irony.

Bill 102 gave birth to generic drug prices set arbitrarily at 50 per cent of brand-name prices, which was a fiction because it allowed the (nudge-nudge, wink-wink) rebates/kickbacks. (A generic company would sell drugs to a pharmacy for the 50-per-cent price, but only on paper. It then give the pharmacy a “rebate” for dispensing its product rather than a competitor’s.)

The new rules set the price of generics at an equally arbitrary 25 per cent of the brand-name drug’s price and do not allow rebates except for volume discounts.

By doing so, Ontario scored a lot of points in the public-relations war by painting pharmacists as greedy beneficiaries of kickbacks when they were actually following the government’s own rules.

The reality is that the current government is shamefully hypocritical in this domain, as it continues to insist on similar “rebates” to pharmacies from manufacturers of brand-name drugs.

Since 2006, Ontario has been negotiating secretive (or, if you prefer, non-transparent) deals with pharmaceutical companies in exchange for listing their drugs on the Ontario Drug Benefit formulary.

In Canada, new drugs are approved (or not) by Health Canada and prices are set by a federal agency. Provinces and private insurers, in turn, decide if a drug will be included in their formularies – meaning the patient will be reimbursed. There is also an agency called the Common Drug Review that makes recommendations in the hope that the provinces will have similar policies.

Prices of brand-name drugs are regulated by the Patented Medicine Prices Review Board. Generally, Canada pays the median price among the Organization for Economic Co-operation and Development countries; we have neither the highest nor lowest drug prices, but middle-of-the-road ones.

Those prices are public, as they should be.

Government drug plans can negotiate discounts for bulk purchases, a power they do not exercise nearly often enough.

But Ontario is doing something else entirely. It is demanding that brand-name manufacturers discount the price set by the prices review board or see their drug excluded from its formulary. Drugs such as Fosavance and Cipralex were rejected by the provincial Committee to Evaluate Drugsbut subsequently placed on the formulary after a “pricing agreement.”

The appropriate name for this practice is a kickback.

It is not clear how often this occurs, but it reeks of a backroom deal.

Initially, Bill 102 allowed for practices called generic substitution and reference pricing (policies that meant the drug plan paid only for the cheapest drug that worked). But brand-name companies lobbied successfully to get them removed. One can assume that “rebates” were the price paid.

Since the longstanding, secretive practice was exposed earlier this year by Globe and Mail columnist Adam Radwanski, there has been much political fallout but not nearly enough public outcry.

The Quebec government is furious because it has a deal with brand-name manufacturers that it will pay the lowest price in Canada for drugs – not just the lowest published price. (Quebec, the home base of most big drug companies in Canada, has a rule that its drug plan will pay for brand-name drugs for 15 years after a generic is listed, a gift worth about $120-million annually to Big Pharma.)

The Patented Medicine Prices Review Board, obviously, is not too happy. It sued one company, Pfizer, to get information on its deal with the Ontario government, but the courts ruled the information was proprietary.

The province seems happy to keep this all hush-hush. So much for transparency and public accountability.

Instead of whaling on pharmacists, perhaps the Ontario government should be turning some of its scrutiny – and its anger – inward because some of its drug policies are, frankly, malodorous.

Article: Civil servant at centre of bitter Ontario pharmacy feud set to resign

2010-05-26T21:46:00.001-04:00

See the original article from the Globe and Mail

The high-profile bureaucrat at the centre of the Ontario government’s battle with pharmacies is calling it quits.

In three years as an assistant deputy minister and executive officer, Helen Stevenson has presided over massive changes to how the province buys prescription drugs. Now, as the bitter fight to lower the cost of generic drugs nears its end, multiple sources say she has informed the government that she is leaving the post, likely to return to the private sector.

“This is not unexpected,” a senior government official said in response to Ms. Stevenson's decision. But it will nevertheless leave a large void to be filled, and cast uncertainty over future cost-saving efforts.

Ms. Stevenson, the first person appointed full-time to the position of drug czar after it was created by 2006 legislation, was pivotal to the province’s efforts to rein in health-care spending – enjoying unusual leeway for a provincial civil servant.

She was the point-person for negotiations to cut generic drug prices in half by banning professional allowances – the payments manufacturers make to drugstores in return for stocking their products. That made her extremely unpopular with pharmacies, but earned effusive praise from Dalton McGuinty’s Liberals, who appreciated both her steely behind-the-scenes resolve and her communications skills in dealing with the media.

It also captured the interest of other provinces, whose officials have sought her advice as they prepare for similar fights over generic prices.

Ms. Stevenson’s dealings with brand drug manufacturers have received less public attention. But that’s where she seems to have had the greatest autonomy, deciding which drugs the Ontario Drug Benefit would cover – a responsibility previously left to the provincial cabinet.

The former health-care consultant has wielded that authority to achieve “volume discounts,” refusing to list some drugs until manufacturers reward Ontario’s buying power with prices below the going rate. The discounts are provided via undisclosed rebates, so their cumulative value is unclear, but it’s believed to total hundreds of millions of dollars annually.

Controversy over those rebates may have contributed to Ms. Stevenson’s decision to leave her job. Brand companies were furious earlier this year when, after freedom-of-information requests and acting on the instructions of the province’s Information and Privacy Commissioner, she released a chunk of related records. The release caused other provinces to realize they were paying higher prices, and an ensuing backlash (notably in Quebec) may jeopardize future rebates in Ontario.

Provincial Liberals contended that Ms. Stevenson had been planning to leave for some time, once the generics fight was over. They pointed out that, although she earned $280,000 last year, she took a pay cut to work in government.

A senior industry representative noted the difficulty of the work, calling it “a tough job without enough resources.” It’s also a job that has placed Ms. Stevenson under constant personal attack, and prompted her to travel with a security detail after complaining about threats of violence.

Ms. Stevenson is expected to leave this summer, by which point the lower generic prices will likely have taken effect. Her successor is not yet known, nor whether that person will enjoy the same degree of trust from the government.

MPP Craitor: We can't lose the services that pharmacists provide to the community

2010-05-21T20:09:00.002-04:00

Read the original article from Niagara This Week

Pharmacists in Niagara have a prescription and it’s one only the Ontario government can fill.

Last Friday, more than a dozen pharmacists, pharmacy employees and concerned citizens gathered outside of Niagara Falls Liberal MPP Kim Craitor’s office to thank him for his support so far in their fight against cuts in the pharmaceutical business and to encourage him to keep pushing for their side.

The Ontario government has announced cost-cutting measures in an effort to reduce the annual growth in health-care spending by half, from the current amount of six per cent to roughly three per cent.

This reduction would be achieved by reducing the price of generic drugs by more than 50 per cent, making them available for 25 per cent the cost of the original brand name drug.

When phased in over the next three years, its expected to save $500 million through the Ontario Drug Benefit program.

Deb Matthews, health minister, also stated that a reduction will be achieved through a 50 per cent reduction in professional allowances given by generic drug manufacturers to pharmacies, with complete elimination by April 2013.

The Transparent Drug System for Patients Act, which was passed by the province in 2006, states generic drugs could be priced no more than half the price of their brand-name equivalents and that generic drug companies could not offer pharmacies discounts in exchange for carrying their products.

However, it did allow for professional allowances which are to be used for patient care and to help offset the cost of health-care services.

There is more than $750 million in professional allowances paid out per year to pharmacies in Ontario, with the money being used to cover services that pharmacies offer and as contributions back to the community.

Craitor wasn’t at his office when the contingent arrived, but speaking to The Crier later in the day, he said he’s supported the pharmacists in the past and will continue to support them in the future.

“Until I started investigating what these cuts would mean to the pharmacists, I had no idea the extent of the role they play in the community,” he said. “I’ve been visiting pharmacists in Niagara Falls, Virgil and Fort Erie, trying to understand exactly what these cuts will mean to them.”

Craitor said while he firmly supports the pharmacists, he does believe that the cost of drugs need to be reduced.

“I have people coming into my office and telling me they’re spending hundreds and hundreds of dollars on prescriptions a month,” he said. “There’s got to be a way to balance this out, drugs have to be made available for a lower cost, but we can’t lose the services that pharmacists provide to the community.”

Sean Simpson is a pharmacist at Simpson’s Pharmacy in Virgil. Along with his father, Ward, and sister Lisa, the three pharmacists now operate out of two locations in Niagara-on-the-Lake. Simpson said he’s glad Craitor’s been supporting them but they need to know that support will continue.

“We need to know that he’s on our side in this,” he said. “If these cuts go through, we’re going to have start examining what services we can afford to offer and which ones we’ll have to cut.”

Gale MacKinnon has been a pharmacist for 49 years. He has been operating his pharmacy, MacKinnon Guardian Drugs, on the corner of Drummond Road and Dunn Street in Niagara Falls for 42 years. He said that he had planned to retire in a few years, but now with these cuts looming, his pharmacy won’t be very valuable.

“My retirement plan is going down dramatically,” he said.

Pharmacists aren’t the only one concerned about these potential cut. Bob Wilson, a retired firefighter and Niagara Falls resident, turned up on Friday because, he said, he’s a concerned citizen who wants to know what’s going on.

“My wife and I, Marion, are concerned with how this will cost us and affect us health wise,” he said.

The couple has been going to the same pharmacy for a number of years and rely on their pharmacist not only for their prescriptions, but for his advice as well.

“We couldn’t live without him,” said Marion. “He takes a good amount of time to speak with us and make sure we understand everything clearly, and he’s open late, working much longer hours, just so he’s always available.”

Brenda Morden, a pharmacy technician at MacKinnon Guardian Drugs said that for the first time in the 25 years as a technician, she’s concerned for her job safety.

“If there has to be layoffs or job cuts because of this, the technician will be the first one to lose their hours,” she said. “The services offered at pharmacies will be cut and then it affects the patients.”

- With files from Eddie Chau

UPDATE: BILL 16

2010-05-20T09:39:00.002-04:00

On Tuesday, the Liberal government once again voted for a $750M cut to front-line healthcare by allowing the third reading of Bill 16 to pass.

In the last 4 weeks, pharmacists have publicly called on Health Minister Deb Matthews to come back to the negotiating table and work with pharmacists to find a solution that would find all the savings that the government was looking for without compromising local healthcare.

Pharmacists have received no response to date.

While pharmacists have read in recent media reports that there has been a delay in the implementation of the proposed regulations, some reports indicate that the extension is only for a one-month period, others suggest that it is a one-year extension.

Pharmacists and the Coalition have not had any formal notice of the actual duration of this extension.

Whatever the exact extension, this is not enough. We need the government to stop massive healthcare funding cuts that directly impact our local communities and our ability to service those communities.

We are once again calling on the government to come back to the table to negotiate with all pharmacy stakeholders during this extended consultation period.

To be clear, we have said from day 1 that we want to work with the government to eliminate professional allowances, bring down the cost of generic drugs and find a solution that will not compromise front-line healthcare.

UPDATE: BILL 16

Article: Paying Pharmacies Properly

2010-05-16T20:12:00.002-04:00

I stumbled across this article on www.themarknews.com, check out the original article here

Generic drugs have Robin Hood-like status among drug-plan managers: they compete with Big Pharma and pass on big savings. But as the ongoing fight over generic drug prices in Ontario drags on, it’s clear both the government and the pharmacies think they’re the “poor” in the story that should get these savings.

The current debate centres around the Ontario government’s proposal to cut the amount paid for generic drugs in half. While people have been talking about what this means for pharmacy services and profits, there has sadly been little debate on whether we should completely change our approach to buying drugs.

Historically, Canada allowed generic drugs to play Robin Hood more than any other developed nation. Up until the late ’80s, we let companies make generic drugs even when a Big Pharma company held a patent. Even though these generic drugs likely cost just a small fraction of the brand-name prices, provincial governments happily covered any generic drug that offered just 30 per cent off of the brand-name price, because we were the only ones in the world getting those savings.

Times have changed, however, and now federal laws prohibit generic manufacturers from making generic versions of brand-name drugs still under patent protection. But our provincial policies regarding generic prices stayed the same. While 30 per cent off might have been a great deal in the past, it’s a terrible deal today. Provincial governments realize this and have been trying to change the rules. Yet, Canada continues to have among the highest generic drug prices in the world.

This is not because generic manufacturers do not compete with each other. Indeed, evidence suggests that they compete intensely to have their version of the generic drug stocked in pharmacies. In return for being chosen as the pharmacy’s supplier, they return a confidential “rebate,” or “professional allowance,” to the pharmacy. So unlike in Robin Hood, the rewards are not passed on to the general public.

Rebates are big money: estimates of the total amount are as high as $2 billion per year. These funds may support the dispensing function of pharmacies, ancillary patient services such as free delivery, blood-pressure checks, and extended hours, or pharmacy owners and shareholders in the form of take-home income and company profits. We don’t know how much is actually going to each, but some indication of the truth is likely found in the plummeting share prices for chain pharmacies.

Now Ontario is pushing back and demanding both that drugs be priced below 25 per cent of the brand price and that rebating be brought to an end. It appears the days of Friar Tuck-like excess may be over for Canada’s retail pharmacy sector.

The real question should be whether this method of paying for generic drugs will result in Canadians getting the right mix of drugs and pharmacy services at a fair price. Chances are it won’t. There is no reason to continue trying to tie payment for a product with payment for a service. Paying inflated prices for generic products in the hope of getting valuable services in return lacks accountability, transparency, and the possibility of strategic direction. We don’t know where the money goes, we can’t check whether it’s actually being used for services, and we get very little say over what services are actually provided.

Our pricing model has become outdated. Generics are happily competing in Canada, and we should take full advantage of that. We also have a wealth of highly trained pharmacists in Canada who we should engage more appropriately and reward more directly as health professionals.

It’s time to move beyond debates that simply confuse generic pricing with professional remuneration. What’s really needed – and is conspicuously missing from the current debate – is meaningful discussion about what we want from pharmacies and pharmacists and how best to pay them for it.

Article: Can the province be fair to both community pharmacists and taxpayer?

2010-05-14T20:43:00.004-04:00

This is probably the best article i've read that has to do with pharmacy and government! Read the original editorial from the May.14th edition of the Tribune here

Written By BARRY RAY

As a semi-retired pharmacist who has 40-plus years of retail experience, I have seen the evolution of pharmacy including the development of drug insurance plans including the Ontario Drug Benefit plan in the 1970s.

Prescription drug insurance is now the norm for about 85% of the population of which perhaps 50% is based on provincial government coverage. Similar to any public benefit, we Ontarians have developed a sense of entitlement to prescription coverage paid by the province which even I look forward to the day I am 65 years of age.

What we usually ignore however is the growing cost of such benefits and like all health care provided by the government, they have become a political football. Since provincial deficits have began to mushroom, government bureaucrats are looking for ways to chop expenses. The Ontario Drug Program (ODP) is a large part of provincial spending and this number has grown enormously since inception but especially in the past ten years. This growth is certainly not due to pharmacists' dispensing fees which have changed little (far less than inflation) since the plan began. Expanded numbers of those covered, increased and perhaps over-utilization and the spiralling cost of new drugs are the real reasons. Pharmacists are providing more and higher quality input to patient care than ever before. Pharmacists are also the most accessible member of the health care system.

Despite the superficial appearance of being windfall revenue, generic rebates have been part of the pharmacy revenue model for a long time and were not conceived by pharmacists. They were a product of the pricing structures developed by the generic manufacturers and the government and due to a fusal by the province to allow even an inflationary increase in the Ontario Drug Programs dispensing fee, these rebates became a necessary part of the operation of a pharmacy. Indeed, pharmacists probably could have managed the professional side of their businesses all along without the rebates had the wholesale mark-up on cost remained about 10% and the fee properly adjusted to account for increases in operating costs. A fee which some consultants suggest should now be at least $14.

Pharmacy is one of the few businesses where a significant percentage of the professional advice is given free of charge. This can be result of face-to-face discussion with the patient or via telephone consultation with patient or the physician. This advice can include prescription medication, over-the-counter medication, treatment of minor ailments and first aid, possible allergies to food or medications, and drug interactions.

Most pharmacies provide free training on a number of medical devices including blood glucose monitors and blood pressure meters. It is definitely worth noting that this advice and training saves the health system time and money and allows many other health professionals to address more important priorities. When was the last time you spoke in person to your doctor or dentist for advice without a third party paying the bill?

Pharmacy staff perform several other services for which no compensation is received. As often as several times per day, the technician or the pharmacist must clarify validity and

coverage issues with a third party drug plan before the prescription can be processed. This process can amount to five to 10 minutes on the telephone and in reality is a free service to the patient and the insurance company.

In many instances this advice is given at a time which could be considered "off hours" because the physician's office is closed or the emergency department is doing what it should be: dealing with true emergencies. This would not happen if a large number of pharmacies closed or if many reduced their operating hours to a more cost effective level to compensate for reduced revenue.

Despite the fact that many non-pharmacists including some in the news media have the impression that pharmacies are hugely profitable businesses overall. Pharmacy gross margins are usually around 25% to 28% with the pharmacy alone generating 18% to 22% excluding generic rebates. If the rebates are included pharmacy margins would climb by perhaps 5 to 7% to no more than 30%, not an unreasonable figure given the department's high labour costs and large inventory investment. Do not forget that these numbers are gross margins before expenses not net margins. Like any retail business today, a pharmacy's real expense numbers can surprise a lay person. Rents from $50,000 to $500,000; utility costs of $25,000 to $100,000; business and realty taxes of $10,000 to $120,000. These are realities even before wages. Small prescription only stores may have smaller numbers but as a percentage of revenue the numbers are often the same or sometimes less favourable.

Most members of the public are unaware that some ODP prescriptions are filled at little or no profit. Medications for HIV, injections for rheumatoid arthritis and cancer drugs can fall into this category. It is not unusual to see a $1,500 to $2,000 prescription for such meds go through the Ontario Drug plan where the profit amounts to only the $6.47 dispensing fee. Perhaps the profitability of generic drugs makes supplying these newer and vital expensive medications more feasible.

Perhaps some of the responsibility for the large increase in prescription drug costs to the government should be borne by those involved in waiving or reducing ODP co-pays of $2 or $6.11. Receiving prescription medication at no cost may create a lack of financial accountability. The nasty health care concept of a user fee may be necessary after all in our province. Overutilization of health care services in a public system is a key factor in the cost of that system.

If current proposals become the norm, generic manufacturers may take a hard look at their business model, too. Setting the generic price at 25% of the brand name price could cause some to discontinue some drugs because they are uneconomic to produce and market thus driving patients and physicians back to the brand name at a much higher cost. Shortages and back-orders would be another result thus inconveniencing patients, physicians and pharmacists. In what other industry are manufacturers told what to charge?

Usually competition and the free market sets the price. What happened to the government's clout if they are one of the highest payers for prescription drugs in North America? The government designed the current system not the community pharmacist.

With brand names comprising about half of the drug usage on the ODP even name brand manufacturers contribute to the spiralling costs. High research cost is usually the brand name manufacturers' answer to the high price of new medications and they do deserve a decent return on their investment. Whatever the case, big pharma companies have always been stock market darlings for their growth and profits. Do economies of scale mean that Lipitor (the world's highest volume drug) should still cost the pharmacy 25 cents per tablet? Should they be promoting their products in the mass media such that Cialis is on television more often than Florida orange juice?

The public insists that new medications, especially those for serious illness, be brought to market as quickly as possible perhaps rightly so when existing treatment has proven ineffective. There is a growing cost to this especially to the Ontario Drug Program and it is not surprising that big pharma probably spends more on litigation to protect their interests than they do on research.

Citing generic rebates as the key contributor to the province's drug cost problem is really ignoring the bigger picture. Changes are necessary but it is totally unfair to assign so much of the amount to community pharmacy. The health minister has only focused on cost reductions with little regard to potential negative impact on patient care and the significant benefits provided by your community pharmacist.

The province's proposals require another look before being implemented.

Barry Ray is a semi-retired community pharmacist practising in Welland.

Excellent Op-Ed From Windsor Star

2010-05-14T06:34:00.001-04:00

ALFIE MORGAN writes to the Windsor Star

To reduce the cost of Ontario drug benefit programs, the province is cutting the price it pays to generic drug companies by 50 per cent. The province will save $750 million, but numerous other costs will ensue, perhaps exceeding this savings. First, numerous small businesses, namely independent pharmacies, will have to go out of business. Second, “new” health care costs will spring up if we are to keep health care near what it is now.

The price cut will translate into a loss of revenue of about $228,000 for each independent pharmacy as it eliminates the so-called professional allowance given to them by generic drug companies as legislated by the province’s Bill 102 in 2006 (not a “kickback”). It covered numerous operating expenses — estimated by an industry insider as follows:

- Covering the difference between that actual prescription filling cost of $12-14 and the reimbursement of $7 from the government (increased only 59 cents over 20 years). That $5-$7 difference amounts to an average revenue loss of $125,000 for each pharmacy (given an average government-paid 25,000 prescriptions per year).

- Free delivery, about $35,000 a year.

- Discounts to seniors and social services recipients, to the tune of $60,000 annually.

- Dossett packing (packing numerous medications for seniors by time of day), costs $39,000 a year.

- Clinic days to provide customized consultations for the public, $12,000 per year.

- Medicine supplies (medicine measuring spoons, droppers to patient and disposal of old medicines and syringes), about $2000 a year.

Total: $273,000. The intended cut of the $228,000 allowance is 83 per cent of such expenses. Clearly, removing this allowance will create havoc in the independent pharmacy’s financial position — given a net of profit, with the allowance, of 1.8 per cent on sales, according to Industry Canada)

Remove the allowance and this tiny profit is gone and many pharmacies will be in the red. Pharmacies can either pass on the cost to customers who will be reluctant to pay, or go out of business.

Because of their vulnerable financial position, conservatively, 30 to 40 per cent of Ontario’s 1,634 small pharmacies will have to go out of business — about 490 to 653 pharmacies. This will cost Ontarians quite a bit:

- 490 to 653 small enterprises will be lost forever along with the ripple effect on the economy.

- Thousands of direct jobs –5,880 to 7,836 — since the average pharmacy employs about 12 employees. They will not be absorbed by larger pharmacies because they will also be cutting staff to make up for the loss of the professional allowance.

- The loss of direct jobs will have ripple effects; unemployment insurance payments, loss of tax revenue for municipalities, declining spending and consumption of goods and services, and so on.

- Losing these enterprises will mean loss of property taxes for the municipalities and income tax for the province and federal government.

Then there are the “new” health care costs: Pharmacies, independents and chains, will have to trim their business operations to make up for the loss of the contribution from generic drug companies, cutting out extra services, having shorter hours, laying off staff. How will this affect people who need pharmacy services, especially seniors?

When pharmacy hours are reduced and patients cannot call their pharmacist, they will have to go to emergency rooms or see their doctors — another added cost for the province. Even if one extra person per pharmacy visits the emergency room, the potential increase in health care cost adds up to $ 200 million (one per day from each of Ontario’s 3,268 pharmacies at $200 per visit). Seeing a doctor will cost the province $30 million (one per day from each pharmacy at $30 per visit). That means $230 million new costs per year, thus far.

This calls into question the economic viability of the province’s decision. The trade-off is just not worth it. On one hand, it will save an estimated $750 million, but it will create negative impacts exceeding the savings by far. What is the logic here? The province is proposing a modest reimbursement to pharmacies of $100 million — far from the hole left by the $750 million removed from pharmacies.

Clearly, the powers that be need to rethink this decision: Consider the trade-off and the potential direct and ripple effects. As Churchill said, “The road to hell is paved with good intentions.”

So, where do we go from here? Some say, let the generic drug companies provide distribution discounts to pharmacies. Wishful thinking: The proposed law prohibits this practice. Additionally, with their margins cut so thin, they will be in no mood to dole out money to pharmacies. And the pharmacists, I am told, do not particularly want this allowance practice anyway.

Rather, they would prefer a new funding model that will allow them to cover the cost of delivering high-quality health care services. Is that too much to ask? A reasonable course here will be for the minister of Health to meet with the profession and arrive at a fair and equitable, win-win solution. This is not an open and shut case.

Alfie Morgan is professor emeritus of business administration, University of Windsor.

Ontario vs. the pharmacists

2010-05-09T07:16:00.004-04:00

Macleans Magazine by Sarah Scott on Thursday, April 22, 2010

Ontario vs. The Pharmacists

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.

Drug makers seek relief from price cuts

2010-05-09T07:03:00.001-04:00

Article Posted in the Totonto Star May.7, 2010 by Rob Ferguson

The manufacturing costs of some generic drugs are too high to slash prices by 50 per cent under Ontario’s controversial reforms, Health Minister Deb Matthews acknowledged Thursday.

Negotiations have been taking place for weeks with generic drug makers to work out exceptions to the rule, Matthews said after generic giant Apotex Inc. sent a letter to pharmacies warning of trouble ahead.

“The extent of the cuts announced by the government of Ontario could undermine our ability to keep some existing products in the market and potentially impact our ability to develop and bring to market new cost-saving drugs,” said the two-page letter signed by Apotex president Jack Kay.

The letter, dated Wednesday, did not specify which drugs could be in jeopardy because that information is viewed as sensitive in the cutthroat generic drug industry, sources said. There are about 10 generic companies in Ontario.

Matthews said exceptions to the 50-per-cent price cuts were “always part of the plan” because it’s in the government’s best interest to have more generic drugs on the market.

“When generic drugs come on market, we all save money, so we are working with the generic companies to make sure that we’ll continue to get their drugs coming on market,” Matthews added.

A senior Apotex official said there are no products being discontinued “at this point.”

“Where the real pricing issues are is for future products where it might not make business sense to develop them,” Elie Batito told the Star.

All generic drug companies that now do business in Ontario are making health ministry officials aware of what medicines need to be exempt from the 50 per cent price cut, which is intended to lower the price tag for generics to 25 per cent of the equivalent brand name drug.

“Some of the active ingredients in these drugs cost more than 25 per cent of the brand name,” said Jeff Connell of the Canadian Generic Pharmaceutical Association.

The drug reforms announced a month ago have infuriated pharmacists, who fear losing about $750 million a year paid to them by generic manufacturers as “professional allowances.”

Matthews intends to ban the payouts, saying they make generic drugs in Ontario up to 80 per cent more expensive than in other jurisdictions, and has proposed a $100 million fund to compensate pharmacists for professional services they provide. Pharmacists say that’s not enough.

2010-05-08T16:36:00.002-04:00

I encourage everyone to watch these 2 videos regarding the current situation between the government and pharmacies.

PART 1

PART 2

Stay up to date by checking out the following sites regularly:

Stopcuts.ca

Ontario Community Pharmacies

Ontario Community Pharmacies Facebook Page

Thanks!

T.A.P.T

(The Angry Pharmacy Tech)

2010-05-08T13:17:00.002-04:00

500,000 patients signed out petitions!

There was a great turnout at Queen's Park

yesterday, but we could do better!

Let's continue getting patients to sign

the petitions and informing them of

what is really going on!

Lies spread fast and truth spreads slowly.

Our side of the story is slowly getting out

there, we can not give up now. Getting the

public on our side will give us the upper

hand against the Government. It takes time!

Regardless of what company you work for,

your job and reputation are on the line. Will you let the government push you around

like they have in the past? Or will you step up and be a leader and fight back with all you

have? In the end, after all the smoke settles and the battle is over, you will know in your

heart if you did the right thing and if you put up the best fight that you possibly could!

When one door closes another door opens; but we so often look so long and so regretfully upon the closed door, that we do not see the ones which open for us.

Ontario Pharmacists Protest Fee Cut

2010-05-08T12:37:00.002-04:00

Below is an article that was posted on CBC.ca yesterday. I posted the article, but more importantly, you should see some of the comments written by mis-informed people of Ontario. Please check them out and leave your opinions....

Ontario pharmacists protest fee cut

The Canadian Press

About 100 pharmacists rallied outside the Ontario legislature Friday to offer an alternative to a plan to eliminate $750 million in professional allowance fees.

The pharmacists presented a petition with 500,000 signatures calling on the government to stop cutting health care by phasing out payments made by generic drug companies to pharmacists.

Ben Shenouda, president of the Independent Pharmacists Association of Ontario, says they could live without the professional allowance fees if they received $260 million a year in direct government funding.

He says that would allow them to support the elimination of the fees and a reduction in price of generic medications.

Shenouda says the pharmacists also want to see the dispensing fee rise from $7 to $11.25 for each prescription, but the province is offering only a $1 increase.

The Liberal government says Ontario pays much higher rates for generic drugs than many other jurisdictions and wants to eliminate the professional allowance fees to lower prescription costs.

COMMENTS

Zeno27 wrote:Posted 2010/05/07
at 12:50 PM ET -These professional allowances seem to be nothing more than a kickback from the drug companies.

TAPT- These PA's are not kickbacks! They are legitimate allowances that have been set in place by the government to help pharmacies pay for services that the government has not been paying us for. I am 100% positive that the government receives "kickbacks" from Big Drug Companies but of course they don't want to tell the Ontario people that part. Where is the transparency? The government is doing a great job making pharmacies look like complete money hungry vultures, when in fact, all we want to do is give the best service possible to our patients and get reimbursed for our time. That sounds fair to me!

Oh_Oh_Canada wrote:Posted 2010/05/07
at 1:02 PM ET- I can't go 2 miles in any direction without driving past a Shoppers Drug Mart. My small neighbourhood has 3 pharmacies. It appears that the market needs to slim down a little.

TAPT- I think you are over exaggerating just a little! Sure, there are a good number of SDM's in Ontario, but over 51% of the pharmacies in Ontario are small independent pharmacies. I go up north to Sudbury a lot and there are 6 SDM's in that whole city (a population of about 158,000) people. There are about 39 pharmacies in TOTAL in this city so i suggest you stop saying there are too many SDM's around since you are clearly over-reacting. SDM is not as popular as you think in rural and smaller towns.

Mectron wrote:Posted 2010/05/07
at 12:54 PM ET- So they want 11$+ to fill a bottle with pills?
They want to keep receiving BRIBE from durgs manufaturers?
Since they are aleady making a profit on the pills... they should be ZERO bribe and NO dispensing frees at all.

TAPT - In a perfect world i am sure this would be an excellent idea! A world where you don't have to pay employees for their work, a place where you don't need to pay rent or a lease, utilities are free, education is free, no taxes! Wow, what a world that would be! Only in that world could you get your medication for free. Pharmacy is a BUSINESS, we are there to make PROFIT just like every other business out there.

toetag wrote:Posted 2010/05/07
at 4:39 PM ET- the petition numbers came from Shoppers employees ramming a pen and petition in front of every elderly person I saw there... they didn't bother asking me to sign.... i would have given them a peace of my mind lol. but they did encourage the senile old woman in front of me to sign..a.nd even offered to post it for them .... such good caring corporate nazis.

TAPT- And you stood at the pharmacy counter for 8 hours to come to this conclusion? You probably saw ONE person sign the petition and you are coming up with conclusions. Pharmacies target the older people to sign the petition because their services are most at risk. Seniors rely heavily on Pharmacists and pharmacy services as opposed to you who are just probably picking up a package of birth control. One day when you are old, you may actually need your pharmacist and they won't be there for you. At that point, you will realize that maybe you should have signed that petition back in 2010 instead of being selfish and only thinking about your own self and not the overall health of others.

Pharmacists give final push

2010-05-06T15:13:00.004-04:00

VIEW ORIGINAL ARTICLE

----------------------------------------------------------
The clock is literally ticking on Ontario pharmacies' attempt to save professional allowances from the province's axe.

On the website of Ontario's Community Pharmacies, a digital clock marks two days until the government wraps up public input on Bill 16 -- a piece of legislation that would halt the system of professional allowances, and in turn, prescribe the loss of direct patient care services, according to Ontario pharmacists.

Locally, pharmacies are putting their final push together to raise public awareness about the bill's potential pitfalls for patient care. They have collected thousands of signatures on petitions that will land on the desk of the provincial government. Pharmacists will be hand delivering them to Queen's Park on Friday.
"We're right down to the wire to get the information out to the public," said Blair Snow, co-owner and pharmacist with the local Roulston's franchise.

However, the public has been receptive to the plight of pharmacies, he says. He has already shipped off the bulk of his petitions.

"Down in this neck of the woods we're getting great support and I'm assuming across the province," he added.

Port Rowan pharmacist Glenn Coon has also seen an optimistic outpouring of support. He has fielded plenty of questions and seen his petition sheets be "filled up like crazy."

"Hopefully, there will be enough signatures there to show the (health) minister that they can't ignore small town healthcare," he said.

He has calculated that 87% of his business comes from filling prescriptions. And 70% of those prescriptions are doled out to users of the Ontario Drug Benefit plan. Those include seniors who often rely on direct patient care services, from convenient blister packaging through to counselling services, that are on the chopping block.

"There won't be one pharmacy in Ontario that won't be hit," Coon said of the cuts, "but especially the small independent pharmacies will be hardest hit."

He has even delivered this message personally to Queen's Park. He and fellow Pharmasave owners presented to the Standing Committee on Finance and Economic Affairs. He feels that the committee, on which local MPP Toby Barrett sits, understands "the devastating impact that this will would have on small independent pharmacies."

The provincial reform would end the industry's professional allowance system, resulting in the loss of $750 million annually to Ontario pharmacies. These funds are provided to pharmacies from the pockets of drug companies to finance direct patient care services. While the reform would initially only impact the Ontario Drug Benefit plan, it would later rolled out to individuals, employers and insurers.

The Ministry of Health and LongTerm Care has touted the bill as a method to ensure fair drug prices. The prices of generic drugs will be slashed by 50%.

To offset some of the loss, the ministry will roll out increased dispensing fees initially for Ontario Drug Benefit prescriptions. Rural or underserviced pharmacies could have their dispensing fees increased by up to $4. But what constitutes either rural or underserviced has yet to be seen.

"They can change the rules any time," Coon said, "and I'm fairly upset they're not talking about what will replace professional allowances."

Ontario's Community Pharmacies will announce details of its recommendations to the standing committee at Queen's Park today. The provincial government has declared May 8 the final day for public input to its pharmaceutical reforms.

Stop Cuts Student Tour Blog

2010-05-04T06:50:00.003-04:00

Hey everyone and thanks for visiting my blog! 2 students who just completed their second year at the University of Toronto, and are members of the Stop Cuts Student Tour. They are a group of 50 pharmacy students from U of T, traveling around the province of Ontario for the next 15 days to spread their concerns about the McGuinty government's proposed cuts to pharmacy services. Their blog will serve as a recap of their days in each city. I highly recommend that you all check out their blog on a daily basis and leave them comments of encouragement to keep the spark alive! A list of the cities can be found on their blog. Check it out!

STOP CUTS STUDENT TOUR BLOG

For patients / public who are checking out this blog, please go to www.stopcuts.ca for more information on the current events in the battle between Community Pharmacies and the Ontario Government!

There is also a facebook group which has over 12,000 active fans and rising! You can get up to the minute comments from pharmacy staff regarding their concerns with the drastic cuts imposed by the government. Search "Ontario Community Pharmacies" on facebook and become a fan!

Canadian Pharmacists Association responds to Health Minister's letter on the Ontario drug reform proposals

2010-05-04T06:47:00.000-04:00

Dear Minister Matthews

Your recent letter to provincial health ministers has come to our attention. Your decision to shift the issue to the national stage makes it necessary for the Canadian Pharmacists Association (CPhA) to comment on behalf of Canadian pharmacists.

All pharmacists support the values mentioned in your second paragraph: "to deliver the highest quality care for patients; to ensure the sustainability of our health care systems; to be accountable for public finances; and to stand up for the most vulnerable." Pharmacists meet these values every day.

Much of your letter focused on the proposal to eliminate professional allowances which are characterized negatively as you propose to "clean up the system". We object to the negative implications this statement has for pharmacists. As Grootendorst(1), a respected health economist, clearly described in his paper prepared for the Competition Bureau, these allowances have been created in response to successive policies of the Ontario government, since the introduction of the Ontario Drug Benefit (ODB) program. The Ontario government has further compounded the issue by failing to significantly increase the professional fee for pharmacists for services provided to ODB. Both the government and private payers have been content to have generic manufacturers subsidize the provision of pharmacy services for the past 20 years. In short, the Ontario government carries a lot of responsibility for the current situation.

You have also overstated the issues of compliance with the audit of professional allowances. Section 1(8) of Ontario Regulation 201/96 clearly allows for professional allowances to be used for salaries. It should be of no surprise to anyone in health care that salaries comprise the bulk of the costs of providing a service. Also, a non-compliance reporting rate of only 3% is hardly astounding. The recycling issue was perpetrated by only a handful of pharmacies, and it is wrong to condemn the entire profession based on the actions of a few. Pharmacists by nature and practice are extremely law abiding. Their professional regulations and Code of Ethics demand nothing less.

As outlined, the proposals for reform will have a negative effect on people in Ontario. In 2003, the government in South Africa introduced a similar scheme that eliminated all forms of rebates and discounts and failed to properly provide replacement funding for pharmacies. As a consequence, over 500 community pharmacies closed(2).

At best in Ontario, the public will experience significant reductions in access to pharmacists and will have to pay for services that are currently funded through the regulation of professional allowances, introduced by your government in 2006. Furthermore, the proposed increases in professional fees do not close the widely recognized funding gap that exists between the cost of providing services and the fee paid. If you do not believe that the funding gap exists, then a step in the right direction would be for your government to partner with pharmacy to determine the size of the gap.

There are also long-term consequences that we would like to bring to your attention. An essential step to ensuring a sustainable health care system in the future will be the successful introduction of a universal, interoperable electronic health record together with electronic prescribing. Given the devastating blow the proposed reforms will have to pharmacy, such developments will require full government funding.

There are other options. First, lower generic drug prices and a system of professional allowances for pharmacy are not incompatible. The best current example is in Britain. Generic prices are among the lowest in the world. This has been achieved by government and pharmacy working together, where the contract is structured in such a way as to incent pharmacists to buy generics at a low price and retain some of the savings. This so-called "retained medicine margin" scheme was recently reported upon favourably by the National Audit Office(3) in Britain citing savings of (pnds stlg)1.8 billion and increasing pharmacy productivity by 8%.

As a health care association, we recognize the need for reform of the drug system. We have been strong supporters of the need for a National Pharmaceutical Strategy and have been disappointed at the failure of the FPT process to make progress on this initiative. We have also advocated that generic prices should be regulated through a scheme similar to the Patented Medicine Prices Review Board.

Since 2006, we have led a major national initiative to prepare pharmacy for the future. The Blueprint for Pharmacy(4) initiative has been supported by 78 pharmacy organizations, including all of the large pharmacy chains. Reform is needed in pharmacy human resources; legal regulation and liability; education and training; the adoption of information technology; and most importantly, these developments must take place in a framework that maintains the financial viability and sustainability of pharmacies. Simply changing one piece of the puzzle will not work and will not realize the potential gains for the public. Your proposal to provide additional funds for new professional services is very welcome and is a step in the right direction, but it will not work if the other proposals completely undermine the existing funding model.

It is easy for government to toss an issue out into the court of public opinion, but true government provides leadership and there is clearly a need for further discussion. The people of Ontario value and respect the high-quality services they receive from their community pharmacists. Government and pharmacy must work together if we are to maintain this high-quality and ensure that we will have a viable and sustainable health care system that meets the needs of future generations.

Yours sincerely

Dwight Ball
President

FACT SHEET - Ontario Community Pharmacies

2010-05-02T19:23:00.001-04:00

Let’s be clear. Pharmacists are not against lower drug costs - provided it doesn’t threaten the front-line pharmacy and health care services Ontarians have come to rely on and deserve.

- Ontario’s Community Pharmacies represent independently-owned stores, as well as large and small pharmacy chains: more than 51% are in fact independent pharmacies.

- The McGuinty government is slashing $750M out of front-line health care in this province per year. The cuts are reckless given their size and the timeframe in which they are being implemented.

- These deep funding cuts will force pharmacies to reduce service hours, lay off pharmacists and other staff, and reduce health services for seniors and people with chronic health conditions. Inevitably, some pharmacies will be forced to close permanently.

- The McGuinty government’s deep healthcare funding cuts average out to approximately $300,000 per pharmacy – that represents up to three pharmacists per store.

- As pharmacy funding has declined significantly against the cost of inflation, professional allowances from generic drug companies made up the funding gap.

- We have negotiated with the government in good faith. We were at the negotiating table for 9 months and we came close to finding a solution – a solution that would have saved the government hundreds of millions of dollars and not compromised our front-line health care.

- Specifically, we put forward three distinct proposals to the government. The final one had net savings of $260 million and we were told we were $50 million apart. Our proposals sought to lower the cost of generic drugs, eliminate professional allowances, pay pharmacists for an expanded range of services and raise dispensing fees to be closer to their true value.

- The government has chronically underfunded pharmacy for decades, and many of the services we provide are not compensated. Dispensing fees have only been raised 56 cents in 20 years.

- Professional allowances were designed by the Ontario government in 2006 – they are audited, regulated and supervised forms of payment to pharmacy that government is now seeking to eliminate and not put adequate funding back in. Pharmacists have agreed with the elimination of professional allowances and have advocated for a more direct funding model.

- The Professional Allowances are spent in pharmacies under four strictly defined patient care categories: 1. patient education including clinics and patient materials 2. patient counseling areas 3. specialized, compliance packaging 4. pharmacy staffing costs

- While proposals to pay pharmacists for specific health services makes sense, the government has proposed to add just $1 of funding for every $3 they cut. You can’t impose huge funding cuts and promise Ontarians better health services. The math doesn’t work.

- The government-set dispensing fee for ODB patients such as seniors is $7. The actual cost of dispensing a medicine – including pharmacist salaries, technology costs and other expenses – is almost $14.

- There has been a 4% increase in the number of pharmacies in Ontario in the last three years. During the same period the prescription volume has increased by 15% - more than three times the increase in pharmacy capacity.

KEY FACTS

2010-05-02T19:21:00.001-04:00

Key Facts

Pharmacy funding cuts are dramatically going to affect patient care in Ontario.

- We consider them reckless given the size --$750 million a year and the time frame of implementation of only a few weeks.

- $300,000 per pharmacy – that represents up to three pharmacists per store

- We are not against lower drug costs - provided it doesn’t threaten the front-line pharmacy and health care services

- I’m not sure now how I will be able to stock the pharmacy with a full range of medications

- We also want to evolve to another model of funding were we get direct adequate funding for what we do. We are not fighting to keep professional allowances

- $1 of funding for every $3 that is cut, doesn’t work. The math doesn’t work.

- The real cost of dispensing is $14.00 not $7.00

- Professional allowances were designed by the Ontario government – they are audited and regulated. We have advocated for a more direct funding model. PA’s are governed by a strict code of conduct and must be used for patient care.

Pharmacy has been chronically underfunded in Ontario.

- Dispensing fees have only been raised 56 cents in 20 years.

- More than 51% are in fact independent pharmacies.

We negotiated in good faith

- We negotiated with others in good faith – 3 proposals in 9 months saving the government $260 million dollars per year

- The government did not budge in 9 months of negotiating

Pharmacies are the hub of community health.

- Patient stories – anecdotes

- 2/3 of seniors are on 5 medications or more

- A natural role in triaging patients. Many people don’t have a family physician and we provide a range of services

- The government was highly reliant on us during H1N1 when Telehealth Ontario was overloaded

- Users of pharmacies reflect users of the health care systems – seniors, families with young children, people with chronic diseases such as diabetes, asthma and heart disease

- Diabetics use pharmacy 7 times more likely to use a pharmacy in fact they visit a pharmacy on average 46 times a year, nearly once a week

- Prescription volume has increased by 15% - more than three times the increase in pharmacy capacity.

The Dispensing Fee in Ontario: “A Case for Change”

2010-05-01T19:02:00.003-04:00

This was written by a Kitchener Pharmacist Willly Schill and i thought it was the best paper ever written on this issue!! Please get as many people to read!

In order to fully comprehend the impact that these proposed cuts by the Ontario Liberals will have to the health care of Ontarians, the public needs to understand how pharmacies are reimbursed in this province. Only then will the public be able to see through the propaganda and political rhetoric the Liberals are trying to pass off as fact. There is a HUGE misconception that pharmacies dictate what prices they can charge for prescription medications. The reality is, and this is absolutely critical to understand, GOVERNMENT DICTATES THE PRICES OF DRUGS IN ONTARIO. So when Health Minister Matthews asks in question period, "I would put the question to pharmacists: Please explain why Ontarians are paying so much more ... It’s a remarkable inflated price we’re paying”, I would reply "As Health Minister for this province, how can you possibly not know that you are the reason".

In 1986 the Ontario Drug Benefit Act established a mechanism for negotiating a maximum dispensing fee with the Ontario Pharmacists’ Association (OPA) and created a drug price policy based on a Ministry of Health-defined “best available price” (BAP) plus 10% markup. The intention of the 1986 legislation was to clearly show the public the drug cost to the pharmacy (including a modest amount to cover inventory carrying costs) and a fee to cover the professional services AND all the operating costs. Over time, one would expect that the fee paid by the government would increase since, even though the amount to cover the professional services may not increase significantly over time, operating costs (rent, hydro, wages, taxes, etc.) inevitably do. That has not been the case and these are the reasons why.

For Pharmacy, the ODB fee started at $6.47 in 1986. During Bob Rae’s tenure in 1994 and with his introduction of the “Social Contract” (remember “Rae Days” anyone?) that fee was reduced to $5.86. With the Mike Harris government came an “increase” in the fee in 1997 to $6.11 (still less than the $6.47 in 1986), a number that every “higher income” senior is very familiar with to this day. Why? Because that is also the year that, for the first time in the history of ODB, recipients had to pay for a portion of their medication. The amount paid was determined by income, essentially creating a “two-tier” system. That is, welfare recipients, people on disability, and “lower income” seniors were to pay $2.00 for their prescriptions (essentially reducing the fee the government paid pharmacy to $4.11) and “higher income” seniors were to pay the first $100 of their medication cost and then $6.11 for each prescription after that (reducing the fee the government paid to pharmacy to $0). So now the government had found a way to reduce the amount of fees it paid Pharmacy - pass it on to the end user. Sound familiar?

It wasn’t until 2003 that the fee paid by ODB surpassed the 1986 number when it was increased to $6.54. Keep in mind that data for 2001/02 shows that “higher income” seniors represented 44% of the beneficiaries for ODB. So, for every “higher income” senior, the government paid a $0.43 fee to the pharmacy and the pharmacy had to collect $6.11 from the senior to get the full $6.54 ODB fee. Similarly, they were paid $4.54 by the government for everyone else on ODB and had to collect the $2.00 from the recipient if they were to get the full $6.54 fee.

Let’s recap the funding model up until this point. The government regulates dispensing fees in 1986 and says that they are to pay for BOTH the professional services AND operating costs involved in filling a prescription medication. It starts at $6.47 in 1986, decreases in 1994 and doesn’t surpass its original value for 17 years. In that time, operating costs (rent, hydro, wages, taxes, etc.) have all increased. Up until this point, fees on the private side haven’t increased considerably either. In 1993, my first year as a licensed pharmacist, the usual and customary fee (U&C fee) charged to non-ODB recipients by the pharmacy I worked in was $9.99. In 2003, I was working in pharmacies all over Southern Ontario as a “locum” or relief pharmacist. Fees at that time ranged from $8.95 to $10.99. Why haven’t fees on the private side increased to compensate for the lack of fee increases on the public side? Something doesn’t add up. The answer is, of course, rebates.

So how did rebates come to be a part of the funding model? It was during negotiations with the provincial government (who, for now, shall remain nameless) and OPA for an increase in the dispensing fee. Government said that there was no money for fee increases in the budget. However, they said there was money in the system for pharmacy - “go find it” (nudge, nudge, wink, wink). It seemed a win-win solution at the time. Fees do not have to increase and overhead costs get paid for. Pharmacies continue their business as usual and it doesn’t cost the government or the private side any more than what they are already paying. The other important factor to consider is the generic industry in its relative infancy at this time and companies are looking to establish market share for their products. There haven’t been any “blockbuster” brand name drugs yet (i.e. Losec (the first), Lipitor (the latest)) so costs are still relatively low compared to what we saw in the late 1990’s.

In 2006, the government changed the game forever with Bill 102, or, the Transparent Drug System for Patients Act (TDSPA). Bill 102 in its original form was very much like the proposals announced on April 7th. However, the difference in 2006 was that the government was willing to listen to and work with Pharmacy’s proposals to save money. On a positive note, they increased the fee they paid Pharmacy to $7.00, which as I have mentioned earlier, meant a net payment to pharmacy of $0.89 in the “higher income” senior and $5.00 for everyone else on ODB. Even with the fee increase, with the concessions that Pharmacy made the government was still able to save over $300 million dollars per year. How did they do this?

They legislated that the price for any equivalent generic product could be no more than 50% of the brand name product (previous to that it was 63%). The government also negotiated “volume discounts” or “rebates” with brand name pharmaceutical companies. Let me rephrase. Because of their buying power, government was able to negotiate rebates with brand name manufacturers. So, if rebates artificially increase the prices of drugs like the government says then, by their own argument, the government artificially inflated the prices of brand name drugs by taking rebates from brand name manufacturers and not passing those savings on to the general public. They won’t give specifics but have said it is in the “hundreds of millions” (they negotiated a discount of $80 million dollars over three years on one drug alone). Ironically, “rebates” to pharmacies were made illegal and punishable by jail time. Instead, they created “professional allowances” which were to be used for “direct patient care”. They even established the criteria for how these allowances were allocated. It is called the Reporting Framework for Professional Allowances and we were required to submit our reports twice a year.

These allowances were capped at 20% on the public (ODB) side. Any amount of professional allowance paid to the pharmacy that exceeded 20% was considered a “rebate” and, therefore, you would be in violation of the law. Indirectly, this put a limit on the private side. That is, technically you couldn’t receive a rebate over 100% on the private side because any amount over the 100% would automatically shift to the ODB side of the professional allowance which would put you over your 20%.

When you look at the actual numbers of what the professional allowance means in Ontario, I can use my store as an example. My store is a “banner”. That is, it is part of a group of stores which collectively bargains on our behalf with the generic manufacturers to negotiate the best deal it can on the discounts (“professional allowances”) it receives for generic drugs. Typically, most independent pharmacies belong to some sort of buying group like this as it allows for the pharmacy to receive a better discount than it could negotiate on its own as a single buyer. This occurs in EVERY business model in EVERY industrialized country in the world. The amount of professional allowances paid to my store by the generic companies was approximately 10% of what I spent in total on drugs (i.e. generic and brand combined). The percentage of what these allowances represent of my generic purchases is what is known as a “blended” 37%. That is, for every dollar I spent on a generic drug I received $0.37 in “professional allowances”. What “blended” means is that in a store that does the same number of ODB prescriptions as private prescriptions (which would be representative of most community pharmacies), that would equate to 54% paid on the private side and 20% paid on the ODB side (i.e. 54%+20%=74%. 74% divided by 2=37%) – a far cry from the numbers being reported by the government, some newspapers, and the insurance industry. It is important to note also that professional allowances are considered revenue and are therefore subject to taxation.

Now the government wants to change the rules again. They have offered a fee increase to $8.00. So now the net fee paid by government is $1.89 for “higher income” seniors and $6.00 for everyone else on ODB. It is interesting to note that, 24 years after the creation of the Ontario Drug Benefit Act, the amount of the fee paid by government is STILL less in 2010 than it was in 1986 and that is in today’s dollars, not inflation-adjusted dollars. I don’t have data as to how much of a percentage the “higher income” senior group makes up of ODB recipients today. If we assume a modest 40% (remember it was 44% in 2001/02) the amount the government pays pharmacy as a dispensing fee is (40% of $1.89 + 60% of $6) or $4.36 on average. That is 33% less than they were paying in 1986 and still is not even taking inflation into account. An independent study released in September 2008 showed that the median cost of filling a prescription in a sample of 505 pharmacies in Ontario is $13.77. The results in Ontario confirm earlier findings from a smaller study conducted in British Columbia where the average cost was $13.60. So, in order to cover the professional services and overhead costs involved in filling a prescription it would require a dispensing fee of $13.77 for every prescription filled in Ontario. Yet the government only wants to pay $8 and most pharmacies are charging around $11 for everyone else. So, without something to make up the difference which is almost $6 on the ODB side and almost $3 on the private side, pharmacies would lose money on every prescription they dispense.

Until now, professional allowances made up that difference. If they are eliminated, which is what the government is proposing, pharmacies will have no choice but to adjust their business model. The only problem is the only aspect of their business that the government hasn’t regulated is the fee charged to the private payer – namely, the person with private insurance or the person without a drug plan. Let’s assume again that a pharmacy fills half its prescriptions for ODB recipients and half for everyone else. It would have to raise its usual and customary fee (U&C fee) to $20 ($11+$6+$3) to recoup the losses from the loss of professional allowances.

We’ve heard about some of the potential cost saving measures that pharmacies are looking at such as cutting hours, laying off staff, reducing services, and charging for deliveries. Let’s look at some of the other potential repercussions of the loss of professional allowances.

What if the pharmacies that “waived” the $2 co-pay for ODB recipients (which resulted in the “lower income” seniors, welfare, and disability recipients paying nothing for their medications and “higher income” seniors paying $4.11) decided that, without professional allowances, they could no longer afford to continue this practice? We haven’t heard anyone come out and say this will be the case but it is hard to envision anyone being able to lose that much on each prescription dispensed – even for those pharmacies that operate the pharmacy as a loss-leader. For some Ontarians, that may mean they have to choose between paying for their medication and paying for food or rent.

Currently, the contract that every pharmacy in Ontario has signed with ODB says that you must not refuse to fill a prescription for a person with ODB coverage or you risk having your agreement terminated. Alternatively, you could opt out of your agreement with ODB with 90 days notice. If a pharmacy terminates its agreement with ODB, it can no longer electronically bill the government for payment. The client would then have to pay the pharmacy the full price for their medication and submit the receipt to the government for payment. This way the pharmacy ensures it is getting its full dispensing fee. Keep in mind, the amount reimbursed to the client by the government will be less than they paid as it will only be the DBP price + 8% + $8 fee.

What is common amongst all of these scenarios is that the end user has to pay more out of their pocket after May 15^th than they did before. The only ones paying less will be the government and the insurance companies. People paying out of pocket will, again, subsidize the underpayment by the government. People with insurance (other than those with 100% coverage which is virtually extinct today) often have their copayment tied in to the dispensing fee. Therefore, if there is any fee cap placed on their plan, they will be charged the difference in fee from the U&C fee and their plan’s fee cap. We will have to hope that the savings will be spent in a responsible, accountable way. History has shown us that has not been the case to date (e.g. e-Health scandal cost taxpayers $1 billion, premiums and copayments in insurance industry have gone up while coverage has declined).

As business owners and health care professionals, community pharmacists have always been in the unique position of balancing looking after the needs of their clients with making a living and supporting their own families. My wife and I could have continued working as “locum” pharmacists in the area. It paid a very good wage but it came at a cost. Less time spent with our children. So when the opportunity presented itself in 2007, after some careful consideration, we decided to buy our pharmacy. Remember, this is only one year after Bill 102 was passed. The new hours were great. No more 8am to midnight shifts. No more one-hour drives to and from an out-of-town shift. Along with that, though, came quite a significant pay cut. Our first year in business, we worked for free. That is, the business lost money (even with professional allowances). The next year (last year) we worked for just under half of what we could have earned as a staff pharmacist in any pharmacy in Ontario. Again, we were happy to do it because we loved the relationships we had developed with our clients and we felt we were providing value to the health care system. The professional allowance allowed us to pay ourselves in our second year of operation. Take that away and we would have worked for free for a second year. No other health care professional in this province is asked to work for free. Why is it OK to ask pharmacists to? Yet when a government continually underfunds a health care profession for 24 years and then eliminates the subsidy, that’s exactly what they are doing.

We expected that there would be some lean years in the beginning; every new business has growing pains. But the hope was, over time, we could build our business and make a profit. Profit is treated like a bad word when talking about health care but the reality is every business needs to make a profit in order to stay in business. These reforms severely restrict our ability to do that. Why? Because if this goes through as planned, the government essentially makes it a law that every pharmacy in Ontario has to dispense medications to every ODB recipient at a loss. By legislating the prices that private industry pays they have also severely restricted a pharmacy’s ability to recoup those losses on the private side which, unfortunately, has been the solution for government under-funding in every business model. The question that every Ontario citizen (and every Canadian citizen for that matter) should be asking themselves is “What right does government have legislating pricing in private industry?”

What can you do? As a voter, you hold all the cards. You need to speak with your vote. Tell the government that they need to rethink their plan. If professional allowances are eliminated, then the fee needs to be increased to $14 and a mechanism needs to be put in place to allow it to rise with inflation. As of July 1^st, a lot of my overhead costs go up by 8% as a result of the HST. My hydro bills will be going up as a result of Liberal policymakers. Minimum wage will be going up. In order to pay for these extra costs, without an increase in the government dispensing fee, out-of-pocket payments by Ontarians for previously “free” services will be the only option left for ALL PHARMACIES IN ONTARIO.

Deb Matthews says that $100 million in funding will be made available to help offset this shortfall in funding. This is really the first semi-acknowledgement by government that there is a funding gap. As you can now hopefully see, this amount does not even come close to making up this gap (but at least it is a start). The other issue I have with this statement is there is absolutely no plan in place letting us know how we will be able to access these funds. Everything else is scheduled to happen May 15^th. The Minister says we may be able to use it to pay pharmacists to give vaccinations. I didn’t see any mention of pharmacists being allowed to do that as of May 15^th. One must conclude then that those funds will not be available immediately. If our business model is forced to change as of May 15^th we need to know these details today Ms. Matthews. I would suggest not making it as restrictive as the annual MedsCheck program. While the MedsCheck is a great idea in principle, the limitations imposed by the Health Minister at the time (some guy named George Smitherman – wonder what he is doing now?) made them less enticing than one would think. Let’s do the math. If MedsChecks are to replace $100,000 of annual lost revenue, a pharmacy would have to perform 2,000 MedsChecks per year. To do this they would have to perform sixteen half-hour MedsChecks each and every day, five days per week for 25 weeks. That is, 2000 different patients scheduled every half hour for eight hours per day for half the year. Clearly then, before Pharmacy can even consider this option they need to be reimbursed fairly for the services provided today in order to make the commitment of time and resources to perform such an undertaking.

This is not a sustainable model for anyone. Generic prices are higher in Canada than the U.S. There are many reasons for it. The most glaring difference is the U.S. doesn’t legislate generic pricing like they do here. They have a system they call “capitalism”. A large population and competition in the generic industry drives the price down. On the flip side, brand name prices here are considerably cheaper than the brand name drugs in the U.S. Government regulates prices here, the Americans don’t. So it works both ways. Americans pay more for brand name drugs but pay less for generic drugs. Deb Matthews keeps bringing up examples of how cheap certain generic drugs are in the U.S. in an attempt to mislead Ontarians into thinking that somehow this is Pharmacy’s fault. She sets the price and then says that taxpayers aren’t getting value for the money. So how can we get better value for our money?

It has been estimated that across Canada over the next five years there will be $11 billion in savings for both the public and private drug plans as well as the consumer who has no drug plan. That is if everything were to stay the way it is today. We know the system of today is not the answer, but neither is the system the government is proposing. We want the government to work with Pharmacy to maximize these savings for Ontarians while restructuring the reimbursement model so that Pharmacy and the ODB can be sustainable for generations. That has always been our goal.

Here is just one possible example of how cost savings can be shared among the industry and passed along to both the public and private plans. This example keeps the current legislation with respect to keeping generic prices no more than 50% of the brand name price. However, what if in the last year of a brand name’s drug patent, the government can legislate that the brand name price be reduced by 25% (i.e. goes from $100 to $75)? That way, for one year, everybody (public and private) gets to take advantage of the fact that a drug that used to cost them $100 is now $75. When the generic version is launched, then the price will drop to $37.50 (halfway between where it was with today’s system and the proposed legislation). This helps to address the issue of all of these blockbuster drugs coming off patent. It helps to address the issue of generic pricing. It helps to address the issue of “two-tier” pricing created by this government as private payors and government will be paying the same price. The only thing it still doesn’t address is the funding to Pharmacy. The difference with this system is the extra savings created by the sharing of responsibility amongst all the stakeholders can be reinvested in a fair and transparent reimbursement model for Pharmacy.

Ontarians have until May 8^th to have their voices heard on this issue. If the Liberal Party does not change this proposed legislation, the fallout will be catastrophic for every Ontarian.

The Liberal Party of Ontario needs to hear your voice because they haven’t listened to ours. Visit www.stopcuts.ca or call 1-866-880-6531 to connect to your MPP directly and voice your concern.

A patient's guide to pharmacy: What NOT to do

2010-03-30T23:35:00.002-04:00

1. Be sure to stare at the pharmacist wile your prescriptions are being filled. Staring at the pharmacist makes him or her work faster.

2. Never remember the name of the medications you want refilled. By calling it "the little white pill," you are sure to receive the correct medication.

3. When calling in eight prescriptions or more, always arrive at the pharmacy to pick them up within 10 minutes. It is OK to hurry pharmacists; if they make a mistake, it won't kill you or anything.

4. Feel free to ask the pharmacy staff for the exact price of your prescription before it is filled. The staff should know every co-pay for every insurance plan.

5. Wait until Sunday evening (of the day you start) to ask for your birth control to be filled when you don't have any refills left. The pharmacist can get in touch with your doctor or just fill it anyway.

6. Call the pharmacy and ask them to call your doctor for a prescription, and when asked which doctor to call and what medication you need reply "how should I know?" to both questions.

7. When you are given a prescription by your doctor, be sure to wait several months to fill it, and only do so when you are in a hurry to leave for vacation.

8. If your prescription is for something in a box or tube and you are in a hurry, be sure to yell loudly to just slap a label on it... it doesn't matter if it isn't the same thing that is on the prescription, all creams and ointments work the same.

9. When coming to a new pharmacy be sure to leave your prescription card at home and insist that the pharmacy can use your medical/dental/vision card to process your prescriptions. Yelling loudly to just put it through for what you normally pay is very helpful too.

10. Make sure that you drop of 3 pages of prescriptions and when the pharmacist tells you an hour show up in line 10 minutes later and when the pharmacist goes to hand out someone elses prescription make sure you loudly say.....shouldn't i be next I dropped off my prescriptions before her.

11. Expect your mixtures to be ready today even though they have four ingredients in them

12. Demand of the pharmacy staff to know why this medication isn't covered, we have seen your plan outline booklet, of course we know what is and is not covered

13. Ask for the brand of a medication because it works better but then when you have to pay more for it, take the generic instead

14. Don't fill the antibiotics for your kids cause they're too expensive, they didn't need it anyways.

15. Ask the pharmacist if there's more eggs/bread/milk in the back (ps I turn around when they ask for it, look at the drug shelf and say "nope")

16. Ask us if the OTC you're holding interferes with the RX drug you filled at another pharmacy

17. Bring in a vial labelled from a competitor and say "I just got this at Rexall/Pharmasave/Zellers/Costco etc and they didn't tell my about it. Can you tell me all about it and if I can take it with my other medications?"

18. Bring in all of your expired medications that are from our competitor's stores for us to dispose of, even though you have never had a prescription filled at our pharmacy.

19. If you are a nurse, make sure you let us know because you are better at our job than we are...

I'm sure i will add some more.....please leave your own points in the comments!!

The ugly truth on why your prescriptions take so long...

2010-03-30T20:51:00.003-04:00

I came across this on another blog and thought i would share it with you all!

You come to the counter. I am on the phone with a drunk dude who wants the phone number to the grocery store next door. After I instruct him on the virtues of 411, you tell me your doctor was to phone in your prescription to me. Your doctor hasn't, and you're unwilling to wait until he does. Being in a generous mood, I call your doctors office and am put on hold for 5 minutes, then informed that your prescription was phoned in to my competitor on the other side of town. Phoning the competitor, I am immediately put on hold for 5 minutes before speaking to a clerk, who puts me back on hold to wait for the pharmacist. Your prescription is then transferred to me, and now I have to get the 2 phone calls that have been put on hold while this was being done. Now I return to the counter to ask if we've ever filled prescriptions for you before. For some reason, you think that "for you" means "for your cousin" and you answer my question with a "yes", whereupon I go the computer and see you are not on file.

The phone rings.

You have left to do something very important, such as browse through the monster truck magazines, and do not hear the three PA announcements requesting that you return to the pharmacy. You return eventually, expecting to pick up the finished prescription.....

The phone rings.

......only to find out that I need to ask your address, phone number, date of birth, if you have any allergies and insurance coverage. You tell me you're allergic to codeine. Since the prescription is for Tylenol#3 I ask you what exactly codeine did to you when you took it. You say it made your stomach hurt and I roll my eyes and write down "no known allergies" You tell me......

The phone rings.

.....you have insurance and spend the next 5 minutes looking for your card. You give up and expect me to be able to file your claim anyway. I call my competitor and am immediately put on hold. Upon reaching a human, I ask them what insurance they have on file for you. I get the information and file your claim, which is rejected because you changed jobs 6 months ago. An older customer barges his way to the counter to ask where the bread is.

The phone rings.

I inform you that the insurance the other pharmacy has on file for you isn't working. You produce a card in under 10 seconds that you seemed to be unable to find before. What you were really doing was hoping your old insurance would still work because it had a lower copay. Your new card prominently displays the logo of Great West Life, and although Great West Life does in fact handle millions of prescription claims every day, for the group you belong to, the claim should go to a company called Express Scripts, whose logo is nowhere on the card.

The phone rings.

A lady comes to the counter wanting to know why the cherry flavored antacid works better than the lemon cream flavored antacid. What probably happened is that she had a milder case of heartburn when she took the cherry flavored brand, as they both use the exact same ingredient in the same strength. She will not be satisfied though until I confirm her belief that the cherry flavored brand is the superior product. I file your claim with Express Scripts , who rejects it because you had a 30 day supply of Tylenol#3 filled 15 days ago at another pharmacy. You swear to me on your mother's'....

The phone rings.

.......life that you did not have a Tylenol#3 prescription filled recently. I call Express Scripts and am immediately placed on hold. The most beautiful woman on the planet walks buy and notices not a thing. She has never talked to a pharmacist and never will. Upon reaching a human at Express Scipts, I am informed that the Tylenol#3 prescription was indeed filled at another of my competitors. When I tell you this, you say you got Lenoltec#3 there, not Tylenol#3. Another little part of me dies.

The phone rings.

It turns out that a few days after your doctor wrote your last prescription, he told you to take it more frequently, meaning that what Express Scripts thought was a 30-day supply is indeed a 15 day supply with the new instructions. I call your doctor's office to confirm this and am immediately placed on hold. I call Express Scripts to get an override and am immediately placed on hold. My laser printer has a paper jam. It's time for my tech to go to lunch. Express Scripts issues the override and your claim goes though. Your insurance saves you 85 cents off the regular price of the prescription.

The phone rings.

At the cash register you sign....

The phone rings.

......the acknowledgement that you received a copy of my HIPAA policy and that I offered the required counseling for new prescriptions. You remark that you're glad that your last pharmacist told you you shouldn't take over the counter Tylenol along with the Lenoltec#3, and that the acetaminophen you're taking instead seems to be working pretty well. I break the news to you that Tylenol is simply a brand name for acetaminophen and you don't believe me. You fumble around for 2 minutes looking for your checkbook and spend another 2 minutes making out a check for four dollars and sixty seven cents. You ask why the tablets look different than those you got at the other pharmacy. I explain that they are from a different manufacturer. Tomorrow you'll be back to tell me they don't work as well.

Now imagine this wasn't you at all, but the person who dropped off their prescription three people ahead of you, and you'll start to have an idea why.....your prescription takes so damn long to fill.

Check this out....

2010-03-21T21:42:00.004-04:00

Sorry for not posting in awhile, i have been so busy and

totally forget sometimes about my blog. I promise i will

try and post some new stories for you all to read!

In the meantime, i stumbled upon another technician's blog

and highly recommend you all to check it out! Very funny stuff...

http://www.rottenpharmacy.com/

-j

H1N1 Craze....

2009-11-07T12:11:00.005-05:00

Nov.7, 2009

So this past month has been super crazy in my pharmacy. This H1N1 craze is really getting out of hand and it's putting such a strain on all the staff in our pharmacy. We are constantly short staffed due to someone having flu like symptoms and once that person comes back to work, another is off. It is a viscious cycle of staff being sick and putting the stress on the remaining workers to run the pharmacy smoothly during this pandemic. I'm not saying I am perfect, i fell ill to the flu last week and was off for a few days. It was hell, but maybe i sorta thought it was a mini vacation away from all of the craziness in the dispensary. We have a walk in clinic about 100m from our store and the head doctor told us months ago to order 200 boxes of Tamiflu because he was going to be writing scripts for it like water. Well, we have already used that supply and just had to order another 150 boxes of the stuff. I think they are overprescibing this medication way too much! Before this year, Tamiflu was hardly ever prescribed and we maybe dispensed 5 rx's for it a year, and all of the sudden, since october, we have dispensed 500+ Rx's of it. In our area, the Tamiflu liquid for children has been on backorder for quite some time (dont even get me started on this backorder shit, like seriously, dont companies prepare for an outbreak like this?) so out pharmacy has been preparing a suspension the old school way by opening up capsules and putting it into a syrup. It takes about 20 minutes to make this suspension and we see about 30 rx's a day for them so you can imagine the time it takes us to deal with that, and the parents freaking our because they don't want to wait the 45 minutes it takes to get it ready. It is especially a huge pain in the ass because all of the other pharmacies in our area will not prepare this so they send them all over to our store with their rx's. It's not like we can prepare a huge stock bottle of the stuff, it is very expensive and is only stable for 14 days refrigerated, so that is another thing that sucks. I still prepare a 250ml bottle of it because we know we will go through that quickly, but now the syrup to make the suspension is on backorder and we ran out of it last night! For the love of god, does nothing go right in pharmacy? It seems like every time you get ahead or are finally dealing with the pandemic, another issue arrises and you go back 10 spaces. It sucks, it really sucks. I'm off this weekend thank god, but i sure hope this H1N1 shit goes away quick!! It took my health for awhile and i think it may soon take my sanity as well. I'd like to hear from you readers how you are dealing with things at your pharmacy and if you are having any problems too. Maybe you have some helpful hints in dealing with this craze? HELPP!?! is anybody out there? Well im done ranting about this, i could go on for days about H1N1 but i will spare your eyes for another time....
Stay healthy and bathe in that hand sanitizer!!
TAPT

Things You Wish You Could Say To Patients...

2009-09-04T09:08:00.005-04:00

Sept.4, 2009

Alot of the time at work in the pharmacy world, we bite our tongue alot! We try to treat the customer with respect and dignity as well as be extra polite. I wish i could say a lot of things to a patient, mainly, stupid patients. I'm sure you have all been in situations when you encounter a difficult or a weird customer and after they leave you think of things that you wish you said to them. Below are some examples of stupid patient questions, and answers that I was thinking in my head. God forbid I actually said one of these to a patient. They would probably do that stupid survey on their receipt that asks them how good their service was and I would get in shit because of customer stupidity. Fuck i hate those surveys, but thats for a future post!

Patient: "I don't get paid until Friday, I really need the medication, can i come and pay for them next friday"
Me: "I'm sorry, I can't! It's against policy to hand out medication without payment.
What I Was Thinking: "Did you seriously just fucking ask if you can pay next week? Do I go to the grocery store and get some groceries and go to the cash and ask if i can have these and pay for them in a few days?" No! Go get off your fat ass and go beg for money on the corner or sell your body to come up with the $14 you owe for your Valtrex which you probably needed for the sores in your mouth because the cashier at Walmart let you have a bottle of shampoo for free because you got down on your knees. Go away bitch.

Patient purchasing Plan B: "OMG, like seriously, like why is this so expensive, OMG, i'm not paying $39.99 for this, this is bullshit, and i'm not even sure if i'm pregnant, this is retarded!."
Me: "I understand that the price is an issue, but it is such a small investment compared to getting pregnant"
What I Was Thinking: "Yeah right, the condom broke or you forgot to take your birthcontrol, I know you are a whore, your profile is filled with antibiotics for the Clap , Herpes, Gonnerhea etc. I hope to god you buy the plan B for the sake of your future born child. Maybe if you didnt get wasted last night and screwed up on drugs, you wouldnt have been a whore and remember how many guys you banged last night. Stop complaining to me about the price, buy it or get out, i could care less if you are upset over the price.
**NOTE** Sure enough the girl always comes back later and buys it without saying a word (usually with a guy who pays who im sure she had to perform sexual favors to get him to pay for it or she guilted him into thinking he could be a daddy)
TAPT

A Year later and still counting pills....

2009-09-03T15:17:00.006-04:00

Sept.3, 2009

well everyone!
i am happy to announce that i will be making a comeback to my favorite blog site!!
i promise that i will update it with lots of new content and update it frequesntly.
i cant believe i last posted almost a year ago!!! where has the time gone?!?!?!
Well i have looots of new stories and i hope you all will stay tuned to read all about them
and leave me your comments because they are very much appreciated!!!
I am hoping to do a comeback post later today!!
TAPT

Even Techs Take Vacations....

2008-09-06T23:52:00.004-04:00

Sept.6, 2008

so i haven't written in awhile, so i just thought i would update you all on things. I am currently on a week long vacation and am enjoying my time away from the pharmacy! It is such a relief, it's just sad that my vacation doesn't last a little longer though. But for some reason, i still think about that place even when im at home relaxing. My store has started to get very busy with the fall / winter season fast approaching and it still seems that we are wayyy under staffed and that kind of sucks! There is just going to be wayyy more stress on us as well as the pharmacists who are getting more and more work pilled up on them. My store is down to two pharmacists whom together cover 9am-midnight 7 days a week so they are veryyy exhausted! One pharmacist is on mat leave and the other got surgery and has been off for well over 3 months! When the pharmacist is tired and cranky, the techs get cranky and that affects the customers big time!! Monday is my birthday and i am very happy to be off of work for it. I dont know what i am going to do but im sure something will come up. 25 is not a fun age to turn. It feels like its all down hill from here. Well i will update you all on Wednesday when i go back to the wondeful world of pharmacy!!!!
TAPT

Hello fellow techs

2008-05-30T07:27:00.003-04:00

May.30, 2008

Hello fellow techs, i have not forgot about the blog, i have just been uber busy with work and gethering many more stories to share!! i promise i will write very soon!! Don't forget about me!!!!!
TAPT

More random rants from the mind of a tech

2008-05-01T12:35:00.007-04:00

May,1, 2008

I've been working at my pharmacy for about 5 years now and i must say that (not including customers) surprisingly, i have little to no complaints about my store. I love my co-techs, the pharmacists and the owner is awesome. So right when you add customers into the mix, that's what starts to make my blood boil. One by one, customers do stupid shit like "oh i forgot to tell you i have a new drug plan" when they pick up their prescription after waiting at the counter for 15 minutes. It's just priceless when you tell them that you will have to re-bill all 10 of his scripts and it's going to take longer to see the pissed off look on his face. "I just waited 30 minutes, i need to go to work, i dont have time, could you please hurry up" Nothing irritates me more than some customer telling me to hurry up because they are in a hurry! First of all, you were standing there for 15 minutes, not half an hour, learn how to tell time (maybe you should go back to elementary school where you learn the anatomy of a clock) Secondly, why the fuck didnt you give me your new drug plan when i specifically asked you if you had a new one and you replied no and i told you i would bill them through as cash. Thirdly, you probably waited at the hospital for hours so why are you suddenly coming into my store and demanding me to hurry up. Do you go into the hospital and demand the doctor to take you next because you need to go to work? No! Go to work you little drama queen, and your prescriptions will be waiting for you when you get here....wow! Rocket Science!

Everyone im sure has at least 1 customer i'm sure that calls the pharmacy at least 10 times a day and you only hope and pray that you don't answer the phone when he or she calls because you know they will tie you up for a long ass time. There is this one lady who literally calls us ten times a day! She won't ask her question right away, instead she will ask how my shift is going, how are my cats doing, and making small talk. At first it didnt piss me off, it as nice to see a customer that actually cared, but by the third time on one shift, i could have slit my wrists and left myself to die in the middle of the pharmacy. I will admit that I have answered the phone and right when i hear her whiny voice, i hit the release button on the phone. Sure, she will call right back, but I will stay away from the phone so another tech will answer it. Smoooooooooooth! This lady is one of the most weirdest and fucked up people I have ever seen! She takes so much god dam medication, i always wonder how she is still alive! Get this, she takes 400...yes FOUR HUNDRED! Clonazepam 0.5mg every 5 days!!! and 90 codiene 30mg every 5 days!!! Not to mention her other prescriptions for Oxycontin 40mg, Oxycontin 80mg and more! The sad thing is that these are actually legit prescriptions from her doctor! She came to our pharmacy because most of the other pharmacies in town would not dispense that many to her. So you can imagine how out of it she would be when you talk to her. She'll get her Clonazepam filled yesterday and call today asking when she can get it next. Total pain in the ass!! sure, shes good for business, but she needs serious help....ISSUES! and i don't want to have anything to do with her...can you blame me? haha I have better things to do like sell a heroin addict 2 syringes for their mom's "insulin"

With all the bullshit us techs deal with on a day by day basis, it's a shame that we don't get paid a lot more considering we do just as much work as a pharmacist minus all the counseling bullshit. Maybe one day the Lord of pharmacy will realize this and compensate us technicians for our hard work and dedication.

And to top it all off, no matter how bad my customers are, there is one thing at my store that can get even worrrse........the methadone program.....Dun dun dunnnnnnnn" Yes we dispense methadone but that is a whooooooooolllle new ballgame and blog! And i'm sure I will bitch about that in the very near future!

TAPT

Ahhh Customers..

2008-04-22T20:28:00.003-04:00

April.22, 2008

So we all know that customers say the stupidest things sometimes and most of the time we hold back with all out might from responding rudely or from the heart just so we can hold our store's reputation as the best pharmacy in town. For me, it is very difficult to be polite after a customer freaks out on me because "I don't have to pay the $2.00 at wal-mart, you guys are fucking retarded and crooks" to that i wish i could respond along the lines of: "well then take your fucking prescription back, waste the $5.00 it takes in gas to go to wal-mart, wait for your rx for like an hour to be ready by a bunch pf people who i bet can barely speak english and go rot in hell you cheap bastard." You pay for the services you get. Our fee may be a little higher ($11.99) but we offer a lot of services which other pharmacies may not offer like delivery, faxing doctors offices millions of times (which isnt free) making long distance phone calls to other pharmacies for transfers or drug plan info (which isnt free to us) and lots of other shit, but thats not what my blog is about today. It's about the stupid things that customers say and the comments that really get under my skin and make my blood boil.

1. "It's going to take 20 minutes?? My baby is out waiting in the car!!" - Well then first of all, why is your baby alone in the car while you are coming in for a refill on your husbands Viagra. I see where your priorities lie. Take your little brat home, put on Dora the Explorer, dont leave the house and when your husband comes home, tell him to stop being such a pussy and come get his viagra himself.

2. "I don't have any repeats? Why didn't you guys tell me this!" I'm not your fucking slave and worry about when you are running low on your medication, i'm pretty sure that you are capable of reading a label and seeing that there is 0 refills on the label. You are one little grain of sand in the pharmacy beach so i don't have the time nor desire to worry about your last refill of vaginal cream....i have more important things to worry about, like going on lunch break!! :D

3. "Who are you? You must be the new guy" Actually no, i've been working here for like 5 years, and maybe you would realize that if you actually came into the pharmacy instead of asking our driver to pick up your rx and re-deliver it every day. Just because you have never talked to me doesn't mean that I don't know your extensive history of mental problems, re-current UTI's and your high blood pressure problem because i know that your husband is cheating on you with someone else :) he asks to not let you pick up his ED meds, take that you selfish bitch.

Ahh yes, customers....where would we be without them? Probably we wouldn't have a job, but since we all do have customers, we might as well make fun of them!

Oh yeah, another thing i hate......My store has this thing where a customer can take their reciept and go to a website and put in the code and type comments on their service and every week, the comments get posted and sometimes highlighted, most of them are good comments, but there are some bad ones....I hate that fucking program! The comments are annonymous and theres no way to fight back to the mean comments. And when the bad comment begins with "the male tech" everyone knows it's me, i can't pass the buck onto the girl tech that looks like a guy unfortunately...

Well thats all for now,

TAPT

Wait Times

2008-04-17T22:34:00.004-04:00

April.17, 2008

So i decided to write an entire blog on prescription wait times and the impatient and sometimes retarded patients who come in to wait for their prescriptions. I'm sure this issue is dear to every technician's heart and many will feel the same way as me, but some of you may not but i could give 2 shits whether you choose to disagree with me.

So when i take in a prescription at the counter, i take into consideration many things to determine a patients wait time for their Rx. Many things come to mind when i process a prescription. After all, i feel a sense of power when i can tell a customer that their prescription will take half and hour so don't fucking piss me off or it will be longer. Usually if a younger early-20 year old girl brings in a rx for her birth control I will gladly tell her about 10 minutes if that after doing a quick scan of her from bottom to top, if at any time something goes wrong with her physical scan, then her prescription may take longer than expected.....it's only fair to say that ugly girls have all the time in the world to wait since i'm sure they aren't going home to have sex so she won't be needing the birth control in the next 10 minutes.

If the patient is an asshole and say in their mid-fourties, i would generally give them the highest wait times. I may be younger than you, but at this point, i control the time until you take your first anti-biotic. Be nice to me, and I'll fill your Rx stat. Be an asshole to me and i'll "mistakenly" lose your presription and toss it in the trash. (i wouldnt really do that although i wish i could with some patients)

For some reason I am very impatient with seniors. I fucking hate when a senior brings in a prescription with like 10 things on it, i tell them half hour or so and they go sit right down in the waiting area and come to the counter every 5 minutes asking "did you call my name already?" No we didn't fucking call your name because i haven't even typed them yet. So half an hour later, turns out that the senior is 45 days too early for most of them. I go over and tell her she's early and she gets upset and yells at me that i could have told her that instead of making her wait for them for this long. Did i tell you to sit there and wait for them princess? NO! So go home, fuck off and watch your Coronation Street on tv. Like don't seniors realize that they still have half full bottles of their pills at home? Obviously not, most of their meds are paid for by the government so they might as well try and get them all and "screw" the system then go give them all to their friends at bingo. "Whoa man i took 2 extra Ramipril's last night, I had such a buzz man"

Maybe if patients paid cash for all of their prescriptions, then the wait times would not be half as bad. Think about it, no worrying about stupid messages from insurance companies rejecting to pay for the medication like "needs authorization" or "days supply exceeds plan limit" or the worst thing yet....Limited Use Codes! I fucking hate those codes in which half of the time doctors forget to write on the prescription and then the patient gets pissed at us that we are withholding their prescription from them. Why don't they shut the fuck up, we are trying to help them out, otherwise, stop being so cheap, pay cash and get the fuck out. People who have ODB don't fucking realize how good they got it, next to near free drugs and top service from the pharmacy staff all for a whopping $6.11 or $2.00. Patients should pay for extra services like faxing their doctors for refills or giving them temporary supplies. It's a pain in the ass and they don't appreciate anything. If a patient paid cash for everything, they would truly appreciate everything just a little bit more. anywho, that's all for my blog today, please leave comments and let me know how you feel on this subject!!

TAPT

Inroduction to Yours Truly

2008-04-16T23:51:00.004-04:00

Apr.16, 2008

So after reading a website i recently stumbled across (angrypharmacist.com), I thought that it would be fun to open my own blog site along the same lines but from the point of view as a technician (a.k.a. the pharmacist's slave) So a little about me yet I won't reveal too much since the last thing i want is for the world to know where I work and my real name, so from here on in, i will simply be known as "Jay"

I currently live in the beautiful province of Ontario, Canada and work full time at a major drug store chain in a small city with a population of about 50,000. I love my job don't get me wrong but I'd just like to share some stories and vent on some issues which surround the wonderful world of Pharmacy.

Being a technician is a very valuable asset in a pharmacy and i don't think that many pharmacies could survive without us. I have tremendous respect for all technicians and I'm sure that we have to deal with just as much shit as any pharmacist, if not then more!

For some reason, patients can not understand that a technician can not answer their medical questions like "what you can use for your yeast infection" or how their antibiotic isn't working since they've been taking it for 2 days and they aren't getting any better. It's not that i want to be rude to you and tell you i can not help you (i'd love to help you and recommend the wrong thing and get you out of the pharmacy as fast as i can so i can go about my job as a tech) but I tell you to go wait at the counselling area for a reason so don't fucking huff and puff at me when i can't help you. I don't have the education to help you and i certainly don't get paid the money to answer your medical questions, so go down and wait for the pharmacist and if they are busy then leave....don't waste my time with questions because there isn't going to be ANY time where i will recommend something for you, your child, or your heroin addicted girlfriend who needs something to put on her sores on her arms.

The pharmacist's at my store are very overworked and rarely have any time to do things they need to do and i have the utmost respect for all pharmacists and i realize this, that is why i di everything in my power to help them out as much as possible, because I hate to break this to you, but they are human too and can't do everything. So to all the customers who stand at the counter and have piles of groceries and demand wht pharmacist to help find something that is not on the shelf but it is in the flyer....FUCK YOU! There is a customer service sign at the front ot the store for a reason...go use it! Don't waste the pharmacist's time when they could actually be doing something important like counselling the lineup of patients on their meds that your dumb ass held up with your stupid questions.

I hate when customers call and automatically they demand to speak to the pharmacist. I'm sure I can help you with 90% of your calls. I have a hand and can write down your prescription refill numbers you can ask me if we can deliver your prescription, so don't bother the pharmacist. You don't call your doctor's office and demand to speak to the doctor to book your appointment so don't do that kind of shit to me, it only pisses me off, but pisses the pharmacist off for wasting their time on your lame ass.

Being a male technician, I find that customers don't talk back to me as much or give me a hassle. I don't know if they are scared of me (they shouldn't be, i couldn't hurt a fly) or whether it is the fact that I won't fall for their bullshit and won't let them get to me and they can see that. Maybe they mistaken me for a pharmacist since you know...all pharmacists are young men. Am I wearing a lab coat and a name tag that says pharmacist? NO! so learn to read, give me your prescription to count and come back in 20 minutes, and if you are a young attractive girl waiting for your birth control, maybe it will even be done in 5 minutes, since i know you have better things to do than wait in the pharmacy for your Rx....but yeah, i'm sure i'll dedicate a whole blog to "wait times" since that is a very complex issue to most patients.

Hope you enjoyed my first blog and please feel free to leave me comments!!! I'd love to get your points of views on certain things and see what makes your blood boil.

TAPT

The Angry Pharmacy Technician

UPDATE: Transitional Issues

AUDIO: Explanation of new regulations

OPCh to Minister: Patient Services and Care Still at Risk

Ontario’s Community Pharmacies to Minister: Patient Services and Care Still at Risk

**URGENT: DRUG SYSTEM REGULATIONS**

PILLS PRINTED SPECIFICALLY FOR YOU

Article: Ontario’s backroom deals make for drug-policy chaos

Article: Civil servant at centre of bitter Ontario pharmacy feud set to resign

MPP Craitor: We can't lose the services that pharmacists provide to the community

UPDATE: BILL 16

Article: Paying Pharmacies Properly

Article: Can the province be fair to both community pharmacists and taxpayer?

Written By BARRY RAY

Excellent Op-Ed From Windsor Star

Ontario vs. the pharmacists

Drug makers seek relief from price cuts

Ontario Pharmacists Protest Fee Cut

Pharmacists give final push

Stop Cuts Student Tour Blog

Canadian Pharmacists Association responds to Health Minister's letter on the Ontario drug reform proposals

FACT SHEET - Ontario Community Pharmacies

KEY FACTS

The Dispensing Fee in Ontario: “A Case for Change”

A patient's guide to pharmacy: What NOT to do

The ugly truth on why your prescriptions take so long...

Check this out....

H1N1 Craze....

Things You Wish You Could Say To Patients...

A Year later and still counting pills....

Even Techs Take Vacations....

Hello fellow techs

More random rants from the mind of a tech

Ahhh Customers..

Wait Times

Inroduction to Yours Truly

URGENT: DRUG SYSTEM REGULATIONS