THE CURE …
It was meant to be a simple pre-election news conference, replete with wide-eyed pharmacy students who clapped dutifully as Alberta’s Health Minister praised their profession.
Pharmacists are a pillar of patient care, Fred Horne told the crowd, and will play an ever-larger role as provinces allow them greater powers, such as renewing prescriptions and ordering lab tests.
By taking on these roles, pharmacists will help ease clogs throughout the overstretched health system, the minister said. Applause rang out in the University of Alberta atrium as students leaned out over railings to watch from several floors above.
But behind the cheers, a battle is brewing as the patchwork regulation of Canada’s pharmacy profession is overhauled. Pharmacists are indeed being handed more powers, but they are also seeing, in many cases, their lucrative funding model whittled away.
… BECAME THE PROBLEM …
It’s all a murky system tucked away behind the tall counters and white coats, but it boils down to this: Governments want your pharmacist to play a much larger role in routine care, but are making cuts pharmacists say will instead force them to roll back services. The new funding models also tend to attach government money strictly to prescription counts, not to consultation, meaning pharmacists only earn more money by handing out more pills, whether they’re needed or not.
Foremost among the cuts is a clampdown on subsidies paid to pharmacies by drug companies. It goes like this: Mr. Horne announced on Feb. 13 that Alberta would save $85-million annually by lowering its cap on generic drug prices, thereby lowering what it pays to cover the cost of those drugs for certain groups, such as seniors. Other provinces, including Ontario, have also lowered their caps.
The moves will, however, slash drug-company profit margins and, as such, reduce the “rebates” those companies send back to pharmacies – effectively, bonuses for selling their drug. Those rebates form a pillar of pharmacy income, with much of the rest coming from a dispensing fee of about $10 per prescription.
… AND THE PATIENT PUSHED BACK.
Although the complex changes sailed over the heads of many, they raised the ire of pharmacy owner-operators. In the atrium, Kit Poon stood up when Mr. Horne asked whether students had questions. But Mr. Poon wasn’t a student. Instead, he’s a 32-year-old pharmacy owner who had a bone to pick.
Mr. Poon told Mr. Horne, a veteran health-care consultant who entered politics four years ago, that pharmacy owners would be out tens of thousands of dollars because of the changes. (“I’m not an expert on how this is going to affect individual pharmacists,” Mr. Horne replied.) Mr. Poon thinks he’ll have to lay people off.
The standoff is a sign of the broader battle being waged nationally in quiet meetings over the fate of the profession. Alberta pharmacist Jody Shkrobot, who serves as the head of the Canadian Pharmacists Association, called Mr. Horne’s announcement a “slap in the face.” But other provinces are in the midst of similar changes.
Ever more, pharmacists say they have become a front line of health care, spending more time on routine cases than a doctor. They say they often catch errors in prescriptions and refer patients back to a doctor’s office. Pharmacies have been able to hire staff, who spend more time with patients, because they were rolling in cash - one of Alberta’s richest men, after all, is billionaire Rexall Drugs mogul Daryl Katz. A first-year pharmacist can command $90,000 annually in Alberta.
Now, some warn services will have to be cut and the future of the industry remains unclear. The new Alberta system will also not encourage pharmacists to be front-line health professionals – it pays them only to dispense pills, and not to consult with patients. Pharmacists say they should be paid for assessments, not prescriptions.
TAKE MR. POON, FOR EXAMPLE …
“If this is the end result, the end point of what they’re announcing, it really diminishes the role of the pharmacist,” Mr. Poon said of the Alberta system. “It’s actually a step back.”
A half-hour drive from Edmonton, the main drag of Stony Plain, Alta., has clung to a distinctly small-town feel. Parking is free and traffic moves at a snail’s pace as citizens, mainly seniors, run their daily errands.
In the heart of it all is Mr. Poon’s Mainstreet Home Health Pharmacy, which he opened two years ago. It’s one of a dying breed of independent shops.
Inside, he knows many patient files by name – a young girl with concussion-like symptoms, a dog in need of a powdery medication, a suicidal person hoarding pills. In each of his cases during a winter Monday afternoon, he did more than fill a pill bottle. He identified symptoms, referred patients to doctors, talked at length with customers and flagged incorrect prescriptions. All without being paid by the system for it.