Local Pharmacist Needs to be Careful What He Dials Up
| 5/11/2010 | Posted by Patti under Canadian News |
In the last couple of weeks, on the Sundays to be exact, I’ve received a phone call which appears to come from an 800#. As I do during the week, I let calls like that go to the answering machine. When one arrives on Sunday though, I get rather irritated along the lines of do those bloody telemarketers have no limits!!
The two calls I’ve received came from a pharmacist in Port Hope which is west of where I live. I’m not and never have been a customer of his. I definitely will NEVER now be a customer of his. It’s bad enough he’s calling on Sunday but it isn’t even about whatever mundane specials he happens to be running in an effort to expand his business.
In an article in Northumberland Today the pharmacist indicates the calls could continue indefinitely. I’ve sent him an email from his website to advise him in no uncertain terms to stop making those calls to my home. He will do his cause more harm than good doing so.
In his call he urges people to call the local MPPs office to protest the cuts. I called to leave a message urging the MPP to hold the line and support the cuts. I called again today to inquire if others did the same. The lady in his office said yes, often, but was diplomatic enough not to say which was the greater numbers.
The pharmacist’s calls are about the current political battle between the Government of Ontario and the pharmacists. The government is moving to eliminate the ‘professional allowances’ the pharmaceutical firms pay the pharmacies for carrying their product. The pharmacies are claiming this move will amount to cuts in frontline health care.
Nice try but a pharmacy is not a frontline health service. Frontline health is the doctors, nurses, hospitals, clinics etc. Those are directly funded by public health dollars. Pharmacists receive some public health dollars particularly for those covered under social programs and for providing programs like MedCheck and for the ‘counselling’ you receive when you go into pick up a prescription.
A pharmacy is a private business which includes dispensing medications. It is the part of the business which dispenses medications which is done so under government regulation as to the amount of money can be charged the consumer. That same part also receives money directly from the government for delivering what amounts to customer service each time they ‘counsel’ a customer.
I had a doctor who was very thorough when prescribing medication to me in that she was careful to review with me what to expect on the medication, what the possible side-effects were and if it would impact any of the supplements I take. I expect that from my doctor.
I expect a pharmacist to fill the prescription and receive their payment. If I have questions and the pharmacist is able to answer them, that is a bonus. What I usually encountered was a pharmacist insisting on attempting to discuss my medication (often in front of others) over my objections. Turns out there was a reason for that, the pharmacist bills the government for doing this.
The professional allowances generic drug companies were paying to the pharmacies were supposed to help cover those costs which would have helped keep costs down for the government. What has happened is they have artificially inflated the costs of the drugs while the allowances were being used to boost the bottom line of these private businesses.
I don’t know about you, but I’ve always considered customer service to be something that is done to build customer awareness and loyalty. It isn’t usually something which directly adds to the bottom line but overall helps it. For a pharmacist, apparently they consider it to be the bottom line.
For more information on the cuts and the disinformation from the pharmacists you can read here. In the interest of giving voice to both sides, you can read more about the pharmacist’s side of things here. Personally, I found that site heavily on the side of baffle’m with BS but your mileage may vary.
Ontario has one of the largest buying power of any jurisdiction in the world yet we pay considerably more than many jurisdictions. For example, a diabetes medication called Metformin costs 9.7cents in Ontario, 6.9cents in the US and 1.6cents in New Zealand per dose. There is no excuse for that wide of a gap, Ontario should be considerably lower and will be after the cuts are fully implemented.
Pharmacies need to rethink their business plans. You ever been in a pharmacy which only sells medications? I haven’t yet, to listen to the wailing going on, you’d think that was their only income stream.
They can either keep up their complaining or they can look for opportunities this presents. Those who find the opportunities will thrive, the others — well have you heard of the law of natural selection?
I am a pharmacist and we are frontline healthcare. In fact, we are the most accessible healthcare professionals of all and are often the first person patients talk to. I've often been in situations where my decisions have decided whether or not a person should go to emergency room or if the situation can be treated at home. Just one example, a patient accidentally took an extra dose of their anti-depressant and wondered if they should go to emergency. In that particular case it was unnecessary but warned the patient they may experience greater side effects and told them what to expect. In that circumstance I directly saved the taxpayer money.
Bryan, I'm sure from your perspective you feel on the frontline at times. However I don't know of anyone in my circle of acquaintances who would call a pharmacist before their doctor or the emergency room. They would discuss a medication with a pharmacist or if an over the counter would be appropriate if they were in the pharmacy but to turn to the pharmacist first, wouldn't happen.
That maybe true in your circle of friends. Maybe they should consider calling a pharmacist for med related questions more often? I do this for a living and I have no shortage of people asking me about drug related questions. There is nothing wrong with contacting your physician for these questions. The problem is Doctors are often very hard to reach and an emergency room wait can be a very long one. A pharmacist can often answer many of these questions and if we can't we will refer to other healthcare professionals. Pharmacists are trained in doing triage like nurses. My point is there is a definitive need there and I know that pharmacist can fill that role very well.
Another of your point you brought up is YOUR doctor is amazing and goes over all your meds with you. That is fantastic. Not every doctor has time to talk about medications to their patients. Even if they do, despite the best of intentions people, even doctors, make mistakes. I've seen doctors incorrectly prescribe opiate painkillers that would have flat out killed people. I've made therapeutic changes to an antibiotic when a patient would have run a very high risk of bleeding because of their warfarin and had it changed to something just as effective and much safer, the patient never knew I did this for them. Also, when counselling people on medications I have often discovered errors that way. Your implying pharmacists have little value to offer our healthcare system, I know for a fact that is false.
Bryan: I learned from an earlier life experience if as a patient I don't demand care from my doctor, it wont always come. My doctor has the most complete picture of my current medical condition by virtue of the record sitting in front of her. She knew, because I told her in no uncertain terms, if I wasn't convinced of the need for the medication and didn't also have my questions answered on possible side effects and interactions she might has well not waste her time writing the script, it wouldn't be filled.
Doctors are the primary care people, pharmacists having the knowledge and expertise to provide secondary oversight on a doctor's choices of medication has an important value and without doubt has likely saved lives. To me it is absolutely silly and costly in many ways for a doctor to be able to get away with not making careful choices about what they prescribe because they can ride on lack of time.
One other point you made is that pharmacies have other revenue streams and that is true to varying degrees. Larger chain drug stores typically have larger front shops to subsidize the pharmacy services. However, many smaller independent pharmacies which represent just over half of all pharmacies in Ontario rely more on their pharmacy services. What the government is essentially asking pharmacists to do is dispense medications for the Ontario Drug Plans at a straight up loss. Pharmacists are not against lower drug prices but want to be fairly renumerated for the services we provide so we can continue to provide for our patients.
Pharmacists are frontline healthcare workers. Even the liberal government that you support also considers us so. As a matter of fact we are the most accessible health care workers in the province. You have to wait weeks to see a family doctor, and if you don't have one you have to wait weeks to get one. You have to wait an hour to call a nurse on telehealth. You have to wait months for an MRI, and even up to a year to see a specialist. But you can walk into a pharmacy or call and expect to talk to a pharmacist within minutes. Also, you seem to have no idea about how many services pharmacists offer. We counsel patients on which over the counter products work for them. We triage patients who call us with their problems and either recommend self management, a visit to their doctor, or to quickly rush to the ER depending on our assessment of their symptoms and their urgency, relying on years of training and experience that we receive. In case you didn't know, we are regulated under the Regulated Health Professionals Act, carry our own liability insurance, self-governed by our own Ontario College of Pharmacists, and we have to meet strict quality control and continuing education criteria every year to remain licensed. We also counsel patients on their prescription medications including how to take these medications, their purpose, what they should expect, any side effects and drug interactions and how to manage them, any restrictions regarding food or drink or exposure to sunlight while on this medication, and all sorts of other information. Just a few days ago, I advised a patient taking pantoprazole and methotrexate to stop taking the pantoprazole daily and take it only when needed for heartburn. She was started on the pantoprazole in the hospital as a precaution to prevent heartburn, but she was not complaining of any symptoms of heartburn. regular use of pantoprazole can reduce the elimination of methotrexate and lead to unwanted side effects of methotrexate. We also intervene and refuse to dispense if there was a drug interaction serious enough to risk patient safety, for example a patient who was taking a beta blocker for blood pressure was prescribed a second beta blocker for hand tremors. I refused to dispense and contacted the doctor who cancelled the prescription. If I dispensed the medication, the patient's heart rate would have slowed down to dangerous level. We also fax doctors for refills or limited use codes on behalf of patients, consult with doctors on the best therapeutic alternative to give to patients, we deliver for free for people who are bedridden and unable to leave their homes. We offer enhanced consultation on managing chronic diseases such as asthma and diabetes, and offer services such as monitoring blood pressure and blood sugar. And yes, we also offer MedsChecks which are detailed counseling sessions with patients regarding all their medications and medical conditions. We also offer compliance packaging (dossettes) so that people on complicated medication regimens have an easier time taking their medications as prescribed and staying compliant. During the recent H1N1 pandemic, pharmacists were on the front line triaging people into and out of ER rooms, advising people on strategies to avoid infection with the virus and how to manage an infection once it occurs. We were on the frontline dispensing the provincial stockpile of Tamiflu to sick and vulnerable patients to protect them from the H1N1 infection. We were also compounding the capsules into liquid formulations for pediatric patients to swallow easily, a service that took at least 15-20min of a pharmacist's time yet the government paid us a mere $2 for. Also note that we offer these services F-R-E-E of charge. What other health care professional does that? A call to telehealth costs the taxpayers $39. A doctor's visit costs the same. Doctors even bill the government $11 to fax a refill to the pharmacy, while the pharmacist who faxed the refill request does not get paid a penny. It is obvious you do not take a pharmacist's serivce seriously. However, seniors and vulnerable people with chronic conditions and disabilities who rely extensively on the services of a pharmacist appreciate the work we do. How else do you explain that we were able to get over half a million signatures on our petition in less than a month?
part 2:
Professional allowances were in fact created and legislated by the same liberal government in 2006 to fund pharmacies so that they can keep servicing patients without having the government come under pressure to pay greater dispensing fees. Ontario has the lowest dispensing fee for its public plan among all canadian provinces. This fee is currently $7 and will only go to $8 for most pharmacies under the proposed regulations. The actual cost to fill a prescription is closer to $14 on average. It is this funding gap that caused pharmacies to be reliant on professional allowances as a method of indirect funding. Now the government wants to eliminate indirect funding without adequately replacing it with direct funding. The government's plan to slash $800 million from pharmacies overnight means the average pharmacy would lose $200-300 000 dollars of revenue annually. This is enough to bankrupt most pharmacies immediately unless they reduce their costs, reduce their services, increase dispensing fees, and charge patients fees for previously free services. Many pharmacies will shut down even then. Patients will have greatly reduced access to pharmacists and their services. What will emerge will be US-style prescription factories that emphasize large volume and discourage providing health care services to patientsm such as the services mentioned above. Statistics have shown that the leading cause of hospitalization is medication misuse, noncompliance, drug interactions, and overdosing. Pharmacists are in an ideal position to prevent these complications and the burden they pose to the health care system. Pharmacists save the health care system hundreds of millions of dollars annually by counseling and advising patients on self management of their conditions F-R-E-E of charge. If it wasn't for pharmacists, these patients would have used telehealth, visited their doctors, or crowded hospital ER rooms instead, increasing the burden and cost to our public health care system. Pharmacists support lowering generic prices, and we also support lowering brand name drug prices since they eat up over 75% of the $4 billion drug budget even though only 37% of ontario's prescriptions are for brand name drugs. Surprisingly, the government has no intention of tackling brand name prices, possibly due to the kickbacks they get from big pharma to list their products on the ODB formulary. Note that the average generic prescription costs $26 while the average brand name prescription is closer to $70. Pharmacists also support the elimination of professional allowances. Pharmacists have already made proposals that would save the government $1.3 billion over the next 3 years. Pharmacists are committed to working with the government to reduce health care costs, expand accessibility, expand the scope of practice of pharmacists, and get Ontarians a fair deal on drug prices. What we do oppose is the reckless and unilateral government plan to slash pharmacy funding, slash frontline healthcare budgets, bankrupt pharmacies, destroy the livelihood of tens of thousands of pharmacists, technicians, delivery drivers, and other support staff employed by Ontario's 3300 community pharmacies, and ultimately deny patients access to the valuable services of the most accessible health care worker in the province.
Gotta agree with Bryan here. Im not an expert in the field, not a pharmacist nor i don't live in same country (just a stumbler) but i've worked in it company that did a software for pharmacies for good portion of my adult life. And during those years, i've come to learn that most general doctors do not know much about the drugs they are prescribing to their patients. Specially for elderly people who have multiple medications for various reasons. How well do they work together, what are the side-effects, and all sorts of stuff like that are not pieces of information that are not always available for a doctor – even to a good one. Then, how about self medication on smaller diseases and what not where a visit to a doctor is not really necessery? You think thats not Front Line healthcare?
-Who implemented this "profession allowances" method of payment? Wasn't it the Liberal government? I believe they introduced it because they realized after 20 yrs that pharmacists were overdue for an increase & were quite happy to have the generics pay that for them. Has anyone actually counted the number of pay increases MPP's have received since 1986? …taxpayers money…..
-The comparison of metformin being cheaper in the U.S is not an accurate portrayal of the whole picture as that is only 1 of a small handful of this exceptions. Many americans come to Canada to buy their medications. I have relatives in the U.S & they fail to see the accuracy in this statement
-Wouldn't the "rebates" that the provincial government receives from the name brand manufacturers for including their drugs in the ODB formulary artificially inflate the prices of those medications for other insurance companies & cash paying customers? Has anyone looked at the profits of Roche, Merck Frosst, Pzier, Glaxo….?
-Why are my tax dollars being used for mail outs to individual citizens to defend the Liberal governments actions. To top it off, all the letters we received said the exact same vague things that are being constantly repeated to the press–absolutely nothing new or informative . My home alone received SIX of these, one of which was an empty envelope! That is only 1 residence, how many others received the same. I understand the pharmacists are using their own resources to defend their profession.
-"a pharmacy is not a frontline health service"???????? My independent pharmacist provides IV medications to a 60+ miles radius to keep patients at home & out of hospital. My mother receives dispills prepared by our pharmacist as she has trouble keeping track of her meds. They even call her if she hasn't picked them up (because she has forgotten to get them). Then they offer to deliver them! That comment is almost laughable, except I realize you are serious.
-How awesome that your doctor has the time to be so thorough in this day and age. Mine refers me to my pharmacist for everything from counseling & recommendations to having them fax him for repeats because his receptionists are too busy to take phone calls for repeats.
I don't know what pharmacy you have been frequented but you have my sympathy. My pharmacist has become like family. I cannot even put a dollar figure on the services my mother receives for her $6.11 prescriptions or the "attention to detail" my brother receives since his kidney transplant. One specialists prescription would have put my brother back on dialysis if his pharmacist hadn't caught the potentially lethal dose of medication prescribed to him in error. Best value I can think of for my tax dollars. I feel insulted for the pharmacy profession that you place so little value on them. They are highly educated, honorable individuals that you see as nothing but businesses.
I understand Ms Matthews is speaking of many upcoming "opportunities" for pharmacists. But in the meantime while they wait to see what she deems them worthy of, she will be taking their professional allowances & hopefully my independent pharmacy will be able to keep his head above water until she decides if and/or when she will show him some light at the end of the tunnel. I hope that if you do ever need the services of a pharmacist as members in my family have, that there is one available for you that is as accessible and caring as the ones I have come to know at my local independent pharmacy. Beyond the pharmacy, this store really doesn't sell much else. It's too hard to compete with Walmart with all of it's buying power. It represents over 80% of their business.