Canadian Pharmacists Association responds to Health Minister's letter on the
Ontario drug reform proposals

OTTAWA, May 3 /CNW Telbec/ - On April 12, Ontario's Minister of Health and Long-Term Care, Deb Matthews, sent letters to provincial health ministers regarding the drug-reform issues in Ontario. By doing so, Minister Matthews has effectively shifted the issue to the national stage making it necessary for the Canadian Pharmacists Association (CPhA) to comment on behalf of pharmacists in Canada.

We believe that longer-term issues have been overlooked and that government and pharmacy need to work together to find a better solution.

About the Canadian Pharmacists Association

The Canadian Pharmacists Association is the national organization of pharmacists, committed to providing leadership for the profession and improving the health of Canadians.

    
    May 3, 2010

    Ms. Deb Matthews                        by email: [email protected]
    Minister of Health and
     Long-Term Care
    Hepburn Block, 10th Floor
    80 Grosvenor Street
    Toronto, ON M7A 2C4
    

Dear Minister Matthews

Your recent letter to provincial health ministers has come to our attention. Your decision to shift the issue to the national stage makes it necessary for the Canadian Pharmacists Association (CPhA) to comment on behalf of Canadian pharmacists.

All pharmacists support the values mentioned in your second paragraph: "to deliver the highest quality care for patients; to ensure the sustainability of our health care systems; to be accountable for public finances; and to stand up for the most vulnerable." Pharmacists meet these values every day.

Much of your letter focused on the proposal to eliminate professional allowances which are characterized negatively as you propose to "clean up the system". We object to the negative implications this statement has for pharmacists. As Grootendorst(1), a respected health economist, clearly described in his paper prepared for the Competition Bureau, these allowances have been created in response to successive policies of the Ontario government, since the introduction of the Ontario Drug Benefit (ODB) program. The Ontario government has further compounded the issue by failing to significantly increase the professional fee for pharmacists for services provided to ODB. Both the government and private payers have been content to have generic manufacturers subsidize the provision of pharmacy services for the past 20 years. In short, the Ontario government carries a lot of responsibility for the current situation.

You have also overstated the issues of compliance with the audit of professional allowances. Section 1(8) of Ontario Regulation 201/96 clearly allows for professional allowances to be used for salaries. It should be of no surprise to anyone in health care that salaries comprise the bulk of the costs of providing a service. Also, a non-compliance reporting rate of only 3% is hardly astounding. The recycling issue was perpetrated by only a handful of pharmacies, and it is wrong to condemn the entire profession based on the actions of a few. Pharmacists by nature and practice are extremely law abiding. Their professional regulations and Code of Ethics demand nothing less.

As outlined, the proposals for reform will have a negative effect on people in Ontario. In 2003, the government in South Africa introduced a similar scheme that eliminated all forms of rebates and discounts and failed to properly provide replacement funding for pharmacies. As a consequence, over 500 community pharmacies closed(2).

At best in Ontario, the public will experience significant reductions in access to pharmacists and will have to pay for services that are currently funded through the regulation of professional allowances, introduced by your government in 2006. Furthermore, the proposed increases in professional fees do not close the widely recognized funding gap that exists between the cost of providing services and the fee paid. If you do not believe that the funding gap exists, then a step in the right direction would be for your government to partner with pharmacy to determine the size of the gap.

There are also long-term consequences that we would like to bring to your attention. An essential step to ensuring a sustainable health care system in the future will be the successful introduction of a universal, interoperable electronic health record together with electronic prescribing. Given the devastating blow the proposed reforms will have to pharmacy, such developments will require full government funding.

There are other options. First, lower generic drug prices and a system of professional allowances for pharmacy are not incompatible. The best current example is in Britain. Generic prices are among the lowest in the world. This has been achieved by government and pharmacy working together, where the contract is structured in such a way as to incent pharmacists to buy generics at a low price and retain some of the savings. This so-called "retained medicine margin" scheme was recently reported upon favourably by the National Audit Office(3) in Britain citing savings of (pnds stlg)1.8 billion and increasing pharmacy productivity by 8%.

As a health care association, we recognize the need for reform of the drug system. We have been strong supporters of the need for a National Pharmaceutical Strategy and have been disappointed at the failure of the FPT process to make progress on this initiative. We have also advocated that generic prices should be regulated through a scheme similar to the Patented Medicine Prices Review Board.

Since 2006, we have led a major national initiative to prepare pharmacy for the future. The Blueprint for Pharmacy(4) initiative has been supported by 78 pharmacy organizations, including all of the large pharmacy chains. Reform is needed in pharmacy human resources; legal regulation and liability; education and training; the adoption of information technology; and most importantly, these developments must take place in a framework that maintains the financial viability and sustainability of pharmacies. Simply changing one piece of the puzzle will not work and will not realize the potential gains for the public. Your proposal to provide additional funds for new professional services is very welcome and is a step in the right direction, but it will not work if the other proposals completely undermine the existing funding model.

It is easy for government to toss an issue out into the court of public opinion, but true government provides leadership and there is clearly a need for further discussion. The people of Ontario value and respect the high-quality services they receive from their community pharmacists. Government and pharmacy must work together if we are to maintain this high-quality and ensure that we will have a viable and sustainable health care system that meets the needs of future generations.

    
    Yours sincerely

    (Signed)
    Dwight Ball
    President

    cc     Dennis Darby, CEO, Ontario Pharmacists' Association
           Nadine Saby, President & CEO, Canadian Association of Chain
           Drug Stores
           Ben Shenouda, President, Independent Pharmacists of Ontario


    References
    ----------

    1.     http://individual.utoronto.ca/grootendorst/workingpapers.htm
    2.     Personal Communication, Johan Bothma, Community Pharmacy Sector,
           Pharmaceutical Society of South Africa
    3.     www.nao.org.uk/publications/0910/communitypharmacy.aspx
    4.     www.pharmacists.ca/blueprint
    

For further information: Jennifer L. Hood, Communications Specialist, Canadian Pharmacists Association, [phone], 1-800-917-9489 x219, [email protected]