July 7th, 2020

Prescription for frustration

By Jensen, Randy on May 28, 2020.

Tim Kalinowski

Lethbridge Herald

tkalinowski@lethbridgeherald.com

A Lethbridge senior and former journalist is raising concerns about 30-day dispensing limits on prescription drugs, and what she says is a clear conflict of interest between the profit motivations of pharmacists and the public interest of Alberta’s medically vulnerable seniors.

“My concern is (30-day limits) have basically tripled the dispensing fees since being imposed,” says Bobbie Saga. “When you get a prescription, for example myself, I get four different drugs. Each drug has a dispensing fee attached to it each time I go to the pharmacy. The dispensing fee is up to $25 depending on where you get it filled, and that’s for each drug.”

Saga says up until a few years ago Alberta had allowed 90-day prescriptions, which obviously reduced the amount of dispensing fees you needed to pay to pharmacists.

“If I am getting a one-month supply and that dispensing fee at the max is $25; that’s $100 in dispensing fees every month,” she explains. “That’s $300 every three months where it used to be $100.”

She acknowledges generic drug shortages at the time made the 30-day limit necessary, but what upsets her, and all the other seniors she knows in her social circle regardless of their political affiliation, is the fact Alberta seems to be lagging behind other provinces in revisiting the issue now many of those shortages seem to have cleared.

“It’s true in certain circumstances, but what pharmacists have done in this circumstance is create an open-ended policy that smacks of conflict of interest,” she says. “The policy was put in place, and they were supposed to be working with the public -but that is not happening.”

According to Alberta Health, each pharmacy decides what dispensing fee is appropriate for their own business based on either a flat fee for generic drugs, or a fee which takes into account a percentage of what the ingredient cost is when the pharmacist has to mix a special prescription for a client.

New Brunswick, Nova Scotia, Manitoba and Saskatchewan have in recent months begun the process of offering 90-day prescriptions for generic drugs again, with most stating shortages are no longer a concern. The Herald asked Tofield pharmacist and Alberta Pharmacists’ Association president Darren Erickson why Alberta has been, thus far, slow to follow suit.

“We’re not behind,” he says “In Ontario they announced just a few days ago, they are continuing their 30-day supply; they specifically note it is to prevent shortages. Ontario is probably our biggest user of medications in Canada. These other provinces are kind of smaller. They are jumping back in, but they don’t know if they realize the amount of product that is on our shelves and we are only using a 30-day supply now. That is what is helping our supply right now.”

Erickson was asked about a larger province like British Columbia, where the BC Pharmacy Association is recommending its pharmacists move toward a case-by-case blended model where drugs that have no shortages can be sold under a 90-day prescription and those that do are still limited to 30 days.

Erickson responds if all pharmacies across the country followed suit to adopt a 90-day prescription model then there would be drug shortages again.

“Take epi-pens,” he explains, citing a medication which was in desperately short supply a few years back and partially prompted the current 30-day policy. “They are a critical medication and they are not something we want to run out of. So if we open up the floodgates on epi-pens, and I have patients that get three at a time, they get one for at home and keep one or two in their vehicle. I start giving out three of them, and every pharmacy in Canada does the same thing, we are going to be short on epi-pens again. I don’t want to take the chance. I do believe if we open it up to 90 days, we’re going to be short on a whole bunch of things.”

Saga is cynical of Erickson’s statement that all this is being done for the public good. She called around to various pharmacies to ask if she could get a 90-day prescription due to her doctor-ordered need to medically isolate during COVID-19, and what she found were some pharmacists falsely telling her it was government policy they could not offer more than 30-day prescriptions.

Still others told her flatly they would not, and still others said they might if she could prove her need sufficiently to satisfy them. Most were also charging the upper end of $25 fees for dispensing the drugs while a few others charged lesser fees.

It really is completely in the hands of the individual pharmacy in Alberta, Saga says, with no public oversight. She believes there should be a role for government in monitoring pharmacists to ensure what they are doing is fair for everyone, and not just what is best for their bottom lines.

“When these other provinces were putting things back in place, they decided to set up monitoring groups in at least three of those provinces,” Saga explains to prove her point. “New Brunswick, Manitoba and Nova Scotia all set monitoring groups rather than rely on the discretion of the pharmacists. Pharmacists, as far as I am concerned, are an interest group. They represent the pharmacists, and not the general public. So why are they allowed to make public policy?”

The Herald asked Saga’s elected MLA Shannon Phillips this very question. Phillips said it is the role of the provincial government to ensure there is balance in these matters.

“It is exactly the role of government to make these judgments,” she said, “and balance off those sometimes competing interests in the public interest. At this time, because people have different challenges going outside of their homes and accessing medications because they are in a vulnerable health group where mobility can sometimes be an issue, transportation, and so on during a pandemic, we should have that flexibility, and the government should be ensuring it is there for people.”

Alberta Health did move this spring to subsidize some vulnerable seniors to offset dispensing fees, capping those who have Alberta Blue Cross at $8 per drug, points out Erickson. He acknowledges it was only for those who have Blue Cross, but he also states government policy is part of the problem in the first place for many pharmacists.

“For about the last 10 years we have been short of generic medications in Canada, and people don’t see it,” he says. “They think medications are a given and should always be in stock. A lot of people are very surprised if I say this product is not in stock, it is back-ordered, and we won’t be getting it right away.”

“We have had real supply problems,” he adds, “and we have talked to the government about it. They can’t seem to solve the problems that we have. Because the Canadian government controls pricing of generics, and they keep it very low, a lot of this product is being shipped to the States.”

He also points at other circumstances affecting that supply besides cross-border shopping. Shortages of key ingredients at times with factories shut down in China and India due to COVID, some big drugs being pulled from shelves in recent years after finding contamination from carcinogens in them, and recent pressures put on the drug system due to the COVID-19 crisis.

Erickson feels it is better to be safe and than sorry because the drug-supply system in Canada can be extremely unstable at times.

“If we start giving out a 90-day supply to everybody, I truly believe there will be no medication left,” he says.

Saga feels Erickson’s answer seems out of step with what other pharmacy associations and governments in other provinces have been saying in recent months.

“I can see continuing a 30-day limit for select medications,” she acknowledges. “I have no problem with restrictions on any drug that is in short supply due to COVID-19. But I would hope there is some kind of a blended system, and this province rescinds, as the other provinces did, allowing the pharmacists to dictate public policy. For the general public it matters. That 30 days versus 90 days, it matters for somebody on a fixed income that doesn’t qualify for Alberta Blue Cross.”

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