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The Aftermath of Reform

Sunday, November 21, 2010 @ 05:11 PM

Recently articles have been written about the aftermath of the drug reform legislation in Ontario and on the eve of the Canadian Foundation for Pharmacy’s Annual Meeting, I wonder if  pharmacy officials attending  will address the issue of their behaviour during the legislation period.

In mid 2009, the government of Ontario made public overtures that it intended to review the Transparent Drug System for Patients Act ( legislation that was originally passed in 2006 to save costs to the public drug program in Ontario). Written in the Act in 2006 was a provision that government will review the Act every two years.  In the intervening years since the original Act was passed, Pharmacy was noticeably absent from any positive discussions with government on how it (pharmacy) could impact positively on patient care and save dollars to an ever-increasing cost for drug plans in both the public and the private sectors.

The review of 2009 was meant to assist private sector drug plans to manage cost increases on their formularies and match the savings realized in the public sector.  It should be noted that when the Transparent Drug System for Patients Act was originally passed in 2006, its jurisdiction extended to both the public and the private sectors.  However, the enforcement of the Act, at that time, never extended to the private sector.  This issue, in and of itself, created a two-tiered drug plan system where drug plan and actual drug costs in private sector plans were double digit higher than in the public system.  It was an untenable proposition from 2006 to 2009 and plan designers (among others) in the private sector appealed to government to right the legislation.

Pharmacy’s reaction to the proposed legislation in the months after 2009 was not only surprising, it was shockingly out of touch with the current economic thinking of Ontarians.  There were mass protests by pharmacy and intellectually dishonest comments made by pharmacy  officials(some suggested that stores would close, others suggested that service would be impacted and some even called the government reckless).  Pharmacists did not stand up for their profession during this time.  In fact, many protested in the face of government suggesting that the end was near.

I was a delegate at a public policy conference in the summer of 2010 in Collingwood where two bus loads of pharmacy students protested against those in attendance.  When pressed as to why they were protesting, there was a flurry of dramatic and factually incorrect comments from them. It was a shameful exercise – largely because none present had an open mind to the reasons why government needed to enact these changes –  it was, in the minds of these students apparently, only about them and their economic futures.

Pharmacy is a lucrative business.  In Canada it amounts to over $25 billion in annual sales.  Fees for pharmacy service in the public sector amount to about $700 million annually (it’s similar for private sector plans).  So what’s  the beef?

It has everything to do with how professions manage when public policy changes occur.  When I was CEO of the Ontario Pharmacists’ Association, I told pharmacists time and time again that the ONLY way to manage through the changes of the Transparent Drug System for Patients Act was to be actively and positively involved with government.  Pharmacy rebuked that exhortation and designed what they called “an opposition strategy”  (in short to use the opposition MPPs to attack the government).   Those who remember the election of 2007 know that pharmacy failed miserably in that fight.

Again, three years later, the sector is stymied as to why government distrusts pharmacy and why several stakeholder organizations, including CARP and CLIHA, have lined up against them.  And what is pharmacy’s response?  They punish their professional association (the Ontario Pharmacists’ Association- OPA).

It’s astonishing that Shopper’s Drug Mart, the apparent leader for the profession in Canada, would make public statements suggesting that it would no longer support its pharmacists who wish to belong to the OPA.  This kind of short sighted thinking fans the flames of mistrust between public policy framers and the professions with whom they aspire to collaborate on the future of the profession.

The outcomes of the drug reform measures introduced by Ontario have taken hold across Canada and helped this country come of age in world where drug costs are spiralling out of control and this has been a boon for patients.

Pharmacists need to embrace the notion that public policy is the purview of government and that people govern people!  When an entity pushes, the pushed either ignore the pusher or push back themselves.  Pharmacists as a profession need a lesson in how to manage through public policy debates in a positive manner.  Without the support of their member organizations –  like Shoppers –  they are destined for a rebuke from government!

- Marc Kealey
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