While I appreciate the journalistic efforts of Kaisha Thompson to present the government’s side of its battle against pharmacists, I don’t believe she can even begin to understand the complex remuneration system to pharmacists and the reasons for which the proposed cutbacks will be toxic to rural community pharmacies.
She mentions that enalapril is priced 22.1 times higher in Ontario than in New Zealand. This is an example that has been cited many times in the media over the last few weeks. It is essentially a non-issue as generic enalapril is not on the Ontario formulary which is set by the government. Recipients of Ontario Drug Benefit receive the brand name of enalapril – Vasotec.
If a pharmacy chooses to dispense generic enalapril it is dispensed at the price legislated by the Ontario government. Pharmacists do not set prices – the government does. Pharmacists are selling drugs at a price of only 8% higher than what they are buying them for – a very small margin compared to other industries.
Kaisha also writes that pharmacy consultations offered to the public should not suffer as the government is investing $100 million to compensate for these services. First of all this money is only proposed at this point. Cutbacks are scheduled to begin May 15, 2010 with not even a mention of any provisions as to how to claim any fees for pharmacy services provided. Secondly this $100 million is a far cry from the $750 million the government is eliminating.
The government does propose to raise our fee to $8. The government has increased the fee a total of $0.53 in 25 years from $6.47 in 1985 to $7.00 in 2010. Let’s compare this to a cabinet minister’s salary in 1985 which was $50 000, now in 2010 it is $165 000. If we use the same measuring stick our fee today should be $22 not $7.
Professional allowances (not kickbacks) were developed by the Liberal government to help compensate for the lack of increase in fee over the years. All prescription products on the pharmacy shelves are approved by the government. We are paid the same professional allowance from the generic manufacturers regardless of which brand of product we stock. This money was legislated by the government in 2006 to be used for professional services only. It helps pay for services such as these and many others as well.
Free delivery: $35 000/year
Discounts (waiving of $2 co-pay) to seniors and social services recipients: $60 000/year
Dosette filling: $39 000/year
Clinic days / Presentations to community: $12 000/year
Free measuring spoons, pill splitters, disposal of old medications and syringes: $2000/year
Without professional allowances or an increase in fee approaching $14 the cost of services will be either passed on to the patient who will be reluctant to pay or the pharmacy will go out of business.
It is projected that 30 – 40% (500 – 650) of Ontario’s small, rural pharmacies will close. This will cause a ripple effect on the economy. Thousands (5900 – 7800) of jobs will be lost. This will create increased Employment Insurance payments, loss of tax revenue for municipalities and income tax for the provincial and federal government. Is this what we need in a time where there is already such a shortage of jobs?
The remaining pharmacies left in business will have to trim their business operations – cutting out free services, having shorter hours and laying off staff. When pharmacy hours are reduced and patients cannot call their pharmacist they will have to go to emergency, see their doctors or call Telehealth Ontario. Even if one extra person per pharmacy per day in Ontario visits the ER, this will cost up to $200 million. Extra doctor’s visits will cost the province $30 million. Each call to Teleheath costs $39 where a call to the pharmacist costs nothing.
As you can see, these proposed cutbacks will not save the health care system as much as projected. This bill will hurt rural communities the most and represents a download in cost to people who can least afford it. Recipients of Ontario Drug Benefit and others will not see a decrease in cost of prescription drugs and may end up paying more due to an increase in fees for previously free services.
Pharmacists have agreed to the reduction in price of generic drugs and elimination of professional allowances but need to be reimbursed fairly for services provided to allow them to continue to deliver high quality health care. All we ask is for the Minister of Health to meet with the profession to arrive at a fair solution to allow the pharmacy business to remain viable.
Furthermore many professions, most notably doctors, nurses and teachers have been involved in lobbying campaigns in the past – pharmacists are not unique in this. I would certainly not call this “money thrown away” – in fact we are investing in the future of our services for our patients. It is a small price to pay to educate the public and government to help save our profession of which we are so passionate.
Kristin Davies, Pharmacist, Muxlow Pharmacy, Meaford
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