Archive for the ‘Healthcare’ Category
Triple Eye Agreement to Build New Hospital in Hai Duong, Vietnam
Analysts Dim on ‘Traditional’ Pharmacy and Once Mighty SDM
In the wake of pharmacy reform and massive rebates still flowing to retail chains and independent pharmacy buying groups, the one time darling of the pharmacy world SDM’s future as a investor bet is being openly challenged.
The one time SDM “cheerleader”, analyst Perry Caico of CIBC World Markets, who had been referred to by politicians as THE unbridled stock promoter for SDM, has said he is “concerned” for the once great stock investment.
He claims pharmacy reform and government strong-arming has and will compromise the viability of SDM as the perfect investment.
As the former CEO of the largest professional association of pharmacists in Canada and, immodestly, as a go-to resource for government and private sector organizations on drug plan reform and augmentation, I submit that the issue is not government – it’s a flawed business model in pharmacy.
There is a disconnect between what the public wants and what traditional retail pharmacy in Canada is begging to keep.
In fact, the pall on traditional pharmacy in Canada is not the fault of government. Governments across the country have been and remain concerned that rebates to pharmacy from generic manufacturers artificially keep prices for generic medicines the highest in the world. Pharmacy has been slow to react to government reform from the outset, catering to the notion of staying “whole” rather than adjusting their business models.
I make speeches across North America on drug reform. Audiences tell me they become enraged at what they hear about the massive profits being made by pharmacy when costs continue to rise year over year on private sector plans. It doesn’t make sense in my opinion. With demographic increases in numbers of prescriptions being dispensed, the patent cliff making generic drugs more prolific, one would assume prices and costs would decrease. So how does it work that costs are increasing?
In the work we do, we can confirm that the public and government are ahead of the curve on pharmacy reform and will talk and walk with their feet when confronted with high prices for drugs, variable fee structures from one pharmacy organization to the other and an increasing understanding of how this drug system has set pharmacy up as the biggest beneficiary.
The US, UK, Italy, Spain, Australia, New Zealand and even Ireland have undergone real drug reform. One that doesn’t hide the fact that designing a system means realizing lower costs and prices.
With governments leading the charge on making real change in prescription drug plan reviews and retail pharmacy still playing the game of introducing schemes and ‘blueprints’ to maintain their position – little wonder analysts are turning on the once and mighty chains!!
The beneficiaries are undoubtedly the public and plan members who may see new models considered and introduced.
Economic Club of Canada
Upcoming appearance on Family Caregivers Unite! Podcast.
I will be speaking with Dr. Gordon Atherley from Family Caregivers Unite! for a podcast on how to help with diabetes for diabetics and their families.
You can get the latest information on the podcast by visiting VoiceAmerica.com.
Marc Kealey is a lead voice in North America on health reform, integrated health and drug benefit plan enhancement, and healthcare policy. John Wunderlich is an independent information and privacy consultant in Toronto who describes himself as a middle-aged guy with Type II diabetes who’s active in a political party. They discuss diabetes-related challenges. They say how well these challenges are being met by the healthcare system, healthcare professionals and persons with diabetes and their families. For improving the way the challenges are being met, they explore the responsibilities they see for the healthcare system, for healthcare professionals and for persons with diabetes and for their families. Then they say what they would see done to improve responses to the challenges of diabetes, and what would change if their prescriptions for change were implemented.
Tune in on July 26th at 1PM EST.
Host of Family Caregivers Unite! on the VoiceAmerica Variety Channel interviews Marc Kealey
What healthcare reform should mean for family caregivers.
May 3, 2011 – Hosted by Dr. Gordon Atherley
Marc Kealey, Chief Advocate, Kealey & Associates, is a lead voice in North America on health reform, enhancement of health and drug plans, and healthcare policy. He describes his own experience with family caregiving, and way this has influenced his views on healthcare reform. He explains the three toughest challenges for healthcare reform in North America. He talks about the challenges for family caregiving, the ways family caregivers help the healthcare system, and the help family caregivers get, and don’t get, from the healthcare system. He identifies the health conditions for which family caregivers particularly need more help, and about the help they need. He explores the help for family caregivers that healthcare reform currently visions, and tells us what he would like to see done through healthcare reform to get more help for family caregivers, and from where and how the help should be provided. He suggests ways in which family caregivers can influence healthcare reformers.
Listen Online – http://www.voiceamerica.com/voiceamerica/vshow.aspx?sid=1669
Ontario Alone Acts On Drug Costs.
Interesting article in Benefits and Pensions Monitor:
Ontario is the only Canadian province trying to protect the public from drug prices, says Marc Kealey, an expert on healthcare reform and governance. Speaking at the International Society of Certified Employee Benefits Specialists Toronto Chapter’s ‘Leveraging the Benefits of Rx Drug Reform,’ he said since Bill 102 in 2006, it has taken measures to ensure the drug costs are transparent and fair for public and private payers. In fact, he said the province plans to appeal a recent court decision by an “uninformed” judge which would allow one retail chain to sell private label prescriptions from a generic drug manufacturer it owns. Part of the problem is that most plan members really don’t understand or care about their drug benefit plan. As long as they can go to the drug store and get a prescription filled, they are content. However, they fail to understand that escalating drug costs are a demotivator for businesses which can lead to layoffs and even businesses closures. “We have to educate the public because this is going to really hurt and if it doesn’t stop, government will step in and try to control it through legislation.” And that, he said, is the last thing that major pharmacy chains want.
You can read it here: http://www.selectpath.ca/EARC/articles.php?action=display_article&article_id=150
The Aftermath of Reform
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!
Leadership When We Need It Most
This week newly minted CEO Michael Cloutier, of the Canadian Diabetes Association, spoke at the Economic Club of Canada in Toronto.
It was a sell out crowd of over 300 people for a breakfast no less.
For the pedestrian observer Diabetes is a dreadful disease. It causes untold health disaster to those afflicted with it and there are any numbers of celebs schlocking for health related companies whose target audience is a person with Diabetes. Blah blah blah… so why the enormous media coverage?
Well, in my view, there are two reasons.
The first is the message and the second is who delivered it.
Let me start with the second. Michael Cloutier is a leader – point finale. He has presence, style and a network of politicos, health execs, patient advocates and opinion leaders across the country. He is a superb developer of human capital and motivates the hell out of those with whom he interacts.
The Canadian Diabetes Association made a brilliant choice making him its CEO. At a time prior to his appointment, the organization was floundering. Its leadership role had faded and it appeared to be concentrating only on its fund-raising rather than its historic and hallowed role as a champion for diabetes management and the key opinion leader for strategies to manage what it calls the tsunami of diabetes to plague the country. In short, the CDA had lost its way.
A one-time leader in the development of the Ontario Diabetes Strategy – an enormously aggressive plan by the government of Ontario to tackle the scourge of Diabetes – the CDA was virtually invisible from late 2007 to Cloutier’s appointment.
So, enter Cloutier. His mantra is always “show your brains off” – and he did so right away. Assessing his team, he reached out across the country to put them and all their target audiences on notice that Diabetes is an issue that requires the leadership of Canada’s most definitive voice on the topic. He then moved quickly to deliver messages to information thirsty audiences.
This brings me to the first reason. The message.
Cloutier delivered a passionate speech rife with admonishment to government for not acting fast enough on the imminent increase in diagnoses of Diabetes across the country. In the case of the Economic Club speech, he directed his appeal to three areas; identifying the root causes of Diabetes, getting programs to patients and preventing Diabetes altogether.
He lamented the fact that heretofore lip service was basically the order of the day and he issued a challenge to the health community to dig in and work together to produce the kinds of outcomes that, if done properly and collaboratively, will produce better results.
He wasn’t using platitudes or rhetoric. He provided tangible evidence on the cost of Diabetes ($4.1 billion today with a forecast in years to come of $7 billion) and offered solutions for government, patients, providers and industry to consider.
In all it was a powerful message.
What was not surprising was the applause Cloutier received from the sell out crowd. They had been waiting for someone to take the dais – and that he did.
Cloutier IS a leader. Cloutier will lead a charge and motivate his team, industry, government and patients to work together for what will be an epidemic in future if left unchecked.
The work of the CDA will go on record in years to come as a catalyst for ridding Canada of the insidiousness of Diabetes and it will be due to his selfless leadership in bringing about that end.
Drug reform and what’s the buzz!
I was a key note speaker this past week at the International Foundation of Employee Benefit’(IBEF) Conference on Public Sector Pensions and Benefits. It was a well attended conference in picturesque Whistler BC, with delegates from across Canada and Chaired by Murray Gold – the most experienced legal expert, in my opinion, in Canada on pensions and benefits.
My message was clear – the sustainability of drug benefit plans is in jeopardy IF plan sponsors, consultants, employers and employees don’t recognize that the status quo with respect to drug pricing, plan design, formulary management and prescription drug distribution is no longer an option. There are other ways to look at predictable and sustainable savings for plans – and they my include some tough medicine for traditional business approaches to the practice of pricing, dispensing, adjudicating and distributing generic prescription drugs.
The thesis I purport is that the current practice of two tiered drug pricing (one for the public sector and one for the private sector) and one which I may have helped to initiate on the first place in my former role, is the rationale for the reform measures under consideration and adopted in several provinces. The measures are not unique to Canada – several G20 nations have adopted drug reform to manage burgeoning costs of prescription medications. In Canada, the increase of generic medications to replace branded medications whose patents have expired has created a profit boon for chain pharmacy. What was widely unknown or ignored by plan sponsors or designers is that, in some cases, the massive rebates paid to chain pharmacy actually contributed to the higher costs Canadians paid for the generic medications that they believed would help save money. The head of the Competition Bureau of Canada reckoned that some $800 million (Cdn) is paid to pharmacy to dispense certain generic molecules over others. The net result is that annualized increases in drug benefit plan premiums and drug prices have plagued the system across Canada for years. Finally, governments are waking up to that reality and doing something about it. The province f Ontario passed legislation in June to lower generic drug prices over tome to 25% of the brand. The province of BC has followed suit with an agreement to lower prices to 35% of brand in a similar timeframe. Obviously these reforms have jurisdiction in the public sector plans and, in the case of Ontario, the private sector too. The truth is, the rebating game may never end. What ever organization controls the means of distribution and dispension controls the price(s) plans and organizations will pay.
The IBEF is on the right track rigorously educating its membership as to this reality and the options available to them. For my part I will continue with advocating on behalf of private sector multi employee organizations – it’s the right thing to do.
New G-G the picture of health
The appointment of David Johnston has certainly attracted opinion from Canadians. I am one Canadian who heralds his appointment as progressive. David Johnston represents energy and dynamism. He represents the adage that 70 is the new 50. After all he spends the greater part of his waking days hanging around thousands of young people in a university setting — that keeps anyone young and current.
One need only spend an hour or so with David to gain an appreciation of how regimented he is about his physical fitness, his love of Canada, its people and its future. I’m sure when Canadians get to know David as they most assuredly will — they will acknowledge that this governor general will likely go down in history as the most energetic. I hope we can keep up with him.
