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?"
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.
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.Posted on June 8, 2010
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.Ontario’s Community Pharmacies to Minister: Patient Services and Care Still at Risk
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.Originally posted hereHere'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.
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 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 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 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 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 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.
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.
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
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.
