These are my thoughts in response to the recent series of events in the news about the Canadian pharmacy landscape.
Background: the general public and pharmacists are unhappy about the cold calls coming from mostly shoppers employees, and CBC news has picked up the story, spreading the issue widely for awareness. As a pharmacist, this has been difficult to respond to in my practice setting.
This has been a long time coming. Even before COVID, SDM had quotas. Still, I imagine executives in the Ministry of Health, SDM head office, and Loblaws running into a meeting room together in desperation, saying "shit shit shit this is bad" then throwing together a pizza lunch disguised as an informal town hall. (And then pointing fingers afterward.) Obviously I don't have a very rosy impression of working in a corporate setting.
Quotas are not a problem at the front line staff pharmacist level, but a problem with the overall lack of funding to pharmacies at the government level. Since COVID restrictions were lessened, the need for in-store symptomatic testing for patients and prescription extensions (occasionally netting the store a $15 fee per prescription) disappeared, resulting in reduced billing of professional services to the government and thus less profit entering the pharmacy owner’s pockets. SDM corporate wanted to minimize this profit drop after the pandemic, so started emphasizing the billing of Medscheck services at this point in time due to their profitability. This all happens because the government only reimburses the cost of the drug at the cost the pharmacy buys it at and returning a marginal profit back into the store owner’s pocket (*). Drug pricing in canada is another can of worms currently open to debate as well (look up PMPRB drug pricing reforms).
(*) this actually depends on the class of drug (high-cost biologics vs. non-biologics) and is subject to changes in drug pricing and changes to the government formulary.
(*) ALSO, this doesn't take into account the NEW updates to the Executive Officer Notice: Change in markup effective April 1, 2024: https://www.ontario.ca/files/2024-03/moh-executive-officer-notice-change-mark-ups-en-2024-03-28.pdf
TLDR: A Volume-based funding model is not profitable enough for corporate since the pandemic occurred, so they supplement it with additional services enforced with quotas. So you can see it is a chain reaction or a series of events that has led to the current state of pharmacy. The quotas issue does not exist in a vaccum. The ON government and OCP were doing nothing to address this issue, and unfortunately our voice is not heard.
General Timeline
July 2013
Loblaws acquires Shoppers.
Maple health gets funding from Loblaws and Jeff Leger used to be on their board of members (this is public knowledge). Loblaw also owns Medeo. And a lot of different grocery stores (another complaint).
The big question is, how close are Loblaw and the Ontario government?
From 2019 to 2022
Proof #1 - Loblaws literally lobbies the Ford govt re: selling recreational weed at groceries/retail stores
March 2020
Proof #2 - SDM lobbies the Ford govt during pandemic times
Proof #3 - ON Govt makes deal with SDM re: free menstrual products in schools
Additional proof? I got tired of looking for evidence and fear that this post is veering off into conspiracy land. But there is proof (an easy google search) that a) Loblaws is lobbying the government and making contact and b) these lobbying efforts are seen as changes to policy in real-time.
2024
Feb 5
Manulife reversed the deal to cover specialty care drugs at select Loblaw-owned pharmacies (PPNs). CPhA (our national pharmacy advocate group) issues a statement on legislation concerning PPNs.
Feb 28
CBC publishes an article about noise from current + past pharmacists of SDM on pressure to conduct medschecks. Jeff Leger (CEO of SDM) denies the truth about corporate targets for professional services.
March 1
- Associates make cringy linkedin posts stating the value medschecks and pharmacists have on patient care. No one buys it.
- Jack Hauen, The Trillium reporter, posts on reddit asking for proof and information from pharmacists.
March 5
OCP, our regulatory body, conducts an anonymous survey about medscheck targets and plans to host a town hall for this issue. Ongoing negative sentiments about Jeff Leger and SDM online.
March 11
OCP opens registration for town halls from March 11-18.
Notes after the recent town hall: OCP oversees malpractice, and the patient-related side of pharmacy practice, and should not care about the financial wellbeing of pharmacists and their corporations. But they have a direct role in pharmacy accreditation and regulating scope of practice, such as the ability of pharmacists to conduct virtual medschecks. It feels like a gray area, well summarized in the article, "Jurisdictions across North America are struggling to address the tension between profit and patient protection."
March 14
New article about how SDM continues to deny targets, as well as additional proof of targets from internal emails and associate testimonials. In one week, SDM stores in Ontario billed ~$1,400,000 worth of medschecks; each store conducting an average of 30 to 35 medscheck interviews during that week. To date, OCP has apparently received 4,000 responses to their anonymous practice survey and expects more than 500 attendees for the series of virtual town halls.
March 19
CBC reports on Telus and its new PPN policy. Employers that purchase Telus health insurance now must make their employees abide by its new policy of filling prescriptions at virtual pharmacies. I learned that ODB (healthcare branch of ON government) also uses Telus as its adjudicator.
Mar 25 - OCP Board meeting focused on these 2 major issues
package
re: PPNs
Recommendations: the board will be directing college management to move forward with a phased, multi-modal approach to addressing PPNs including short, medium and long-term regulatory initiatives:
short-term action: position statement → PPN policy be integrated with broader business regulations (placeholder recommendation) → long term action: meet PPN regulatory goals; nothing we can do today to prevent pharmacies from entering into existing PPN contracts, but OCP's focus is the longer term for bigger impact
"PPN models were last discussed by the OCP Board in 2018. At the time, despite its concerns, OCP did not have the authority to intervene in the negotiation of PPN agreements by pharmacy owners and benefits providers. OCP raised the issue with the Minister of Health. No changes were made to the regulatory environment that would have increased OCP’s jurisdiction. Following an initial announcement earlier this year about a PPN between Manulife and Loblaw, and as indications suggest such models appear to be having an impact on more patients, this topic will be discussed at the March OCP Board meeting. In its most recent strategic plan, OCP committed to doing what it can to protect patients from the impact of any business model that increases risks to patient safety or gets in the way of a pharmacy professional’s ability to provide care in accordance with standards and their ethical responsibilities. OCP will re-examine its jurisdiction and the impact it can have within its mandate and will work with government and other partners to explore how to achieve this goal."
re: Corporate Quotas on patient/provider safety
How did we get here? College aware that this is a long term issue
esp. since 2017-2018 ESA call for change (pharmacist lunch breaks) were not changed
- OCP wanted to ensure autonomy of pharmacists to allow flexibility in practice
- the ongoing noise and concern about business decisions impacting pharmacy practice became Strategic Goal #1 for OCP's 2024 operational plan; OCP not ready to implement actions yet but needed jurisdictional environmental scan - will start this year
- OCP aware of the media and questions about why OCP wasn't doing anything.
- Scope of OCP may be limited in this regard; OCP has jurisdiction over pharmacists and pharmacy accreditations; OCP can also propose legislation to government around scope of practice quality assurance, and registration.
The survey results were accurately summarized at the board meeting, and OCP is brainstorming session outcomes.
March 25
OCP issues a zero-tolerance statement on business practices that interrupt pharmacy/patient care, as part of the short-term
March 27
CBC article on the outcomes of OCP's board meeting.
******
And now it is April 2nd! In the hopes of publishing this timely blog post soon I have stopped doing research. Although the journey of reading through all these news articles and reddit posts was fun, it also brought me an underlying anxiety about the future of the profession. The future is uncertain, for now.
Extra reddit posts:
https://www.reddit.com/r/ShoppersDrugMart/comments/1anjst5/professional_services_in_pharmacy_has_gotten_out/
https://www.reddit.com/r/ontario/comments/1aznclx/how_can_ordinary_people_refuse_the_spam/
