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The recent legislation on drug reform in Ontario.

Sunday, June 13, 2010 @ 07:06 PM

Major media outlets have covered the legislative process quite fairly over the past few months as the government of Ontario has moved to stabilize drug prices in Canada’s biggest province.  Nothing new here, the costs of public sector formularies have been increasing at anywhere between 5% to 15% annually.  When I was CEO of the Ontario Pharmacists’ Association, I implored the Board at the time to work with government and insisted that we play the Pharmacist as health care provider card when tackling the issues associated with the original reform brought in by the McGuinty Liberals in 2006.  The tack we took was to demonstrate the value of pharmacists and the work they do in community pharmacy, long term care pharmacy, specialty pharmacy and hospitals across the province.

The initial legislative framework (Bill 102) had taken draconian and, frankly, chaos inducing steps to transform the drug program in Ontario. The steps we took in 2006 to counter these moves proved fruitful and beneficial to pharmacy and pharmacists.  In fact, the initial financial impact of Bill 102 was some $680 million dollars out of pharmacy.  Our efforts at Ontario Pharmacists’ Association, at the time, was to appeal to the issue of fairness, integration in healthcare, a new reimbursement model and the use of collaborative efforts such as Information Technology to increase competition among pharmacies.  Our efforts paid off and instead of the initial $680 million dollar hit, we got back in programs and other concessions some $450 million dollars.  The unintended consequence of these efforts was the establishment of a two-tiered drug pricing regime that has taken hold across the country.   This means that private sector plans would pay more for the exact same drug and services as provided to public sector plan members (ODB for example).

In the ensuing years after Bill 102 was passed as the Transparent Drug System for Patients Act (TDSPA), the government has moved to integrate pharmacists into their health teams with minimal uptake from the pharmacy sector.   The Meds Check program which was announced coincidentally to the TDSPA was supposed to provide some $50 million dollars to pharmacists to provide extra service to patients on their drug regimens.  The program was initially a success, but pharmacy more or less blew it off in many parts of the province.  The Pharmacy Council, which was also announced in the TDSPA has now become a joke.

In the ensuing years since the TDSPA was made law, there have been charges laid against pharmacies, wholesalers and manufacturers for fudging required reporting to the Ontario Public Drug Program’s Executive Officer. The Canadian Association of Change Drug Stores (CACDS), which is the de-facto negotiating body for pharmacy, or the Ontario Pharmacists’ Association have barely attempted to licit potential models that could benefit patients and the customers they serve with ways to improve the  drug system. This  noted, quarter after quarter publicly traded pharmacy
organizations have seen average double digit profits  this in an era of economic austerity.

The trouble is that patients, plan members, formulary designers and public drug plan providers remained afflicted with cost increases. In the TDSPA there is a provision that the government will review the Act every 2 years.  Last summer (2009) the then Minister of Health in Ontario announced a review of the TDSPA.  Stakeholders were invited to provide their views on how to better the system.

Many stakeholders took the process seriously.  It was sad to see that pharmacy did not. When the government moved to enact legislation in 2010, it seemed to take pharmacy by surprise and they reacted with faux indignation. In fact, had they been more engaged , more attuned to the needs and wants of the patients and customers they purport to cherish, they world not have used them as pawns in this massive game of chess that they have lost so publicly.

The latest polls have suggested that Ontarians overwhelming (some 93%) support the government’s initiative. So enough bitching.  Here’s the deal  pharmacy should stop immediately their diatribes on how they will 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”.  It is sad to see that THIS rhetoric would be their response rather than engaging the public in a dialogue about an increase in cognitive services fees.

The government has announced some $100 million dollars in cognitive service fees with an additional amount for Meds Check and diabetes management.  In an era where medical models of treatment are becoming teams (like a Family Health Team) pharmacists can and should integrate themselves into these models.  This could prompt a call for an additional, say, $300 to $400 million in cognitive services fees.  Who’s leading these pharmacy organizations? They seem to have hit every stupid button and made asses of themselves throughout this whole process.  The sad reality here is that instead of looking to modernize an antiquated drug distribution process and embracing the trend of integrated healthcare, these pharmacy organization seem to think that the patients and consumers and shareholders they purport to care about are treated like lemmings and  will, unfortunately, continue to fight  to their own bitter end.

- Marc Kealey
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