October 31st, 2020

Prescription for frustration


By Lethbridge Herald on May 27, 2020.

Herald photo by Ian Martens - A poster in the window of a local pharmacy provides notice to customers regarding a 30-day dispensing limit on prescription drugs. @IMartensHerald

Editor’s Note: Since this story was first published, The Herald has clarified with Saga she is referring to the former Alberta Blue Cross limit of $25 per drug pouring fee here. She was using this as an example to illustrate how the fees could potentially compound for a senior when comparing a 30-day prescription to a 90-day prescription. As mentioned later in the story, Alberta Health has recently capped that pouring fee at $8 per drug for most Alberta Blue Cross clients.

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.”
That dispensing fee, she points out, used to be up to $25 per drug under the former Alberta Blue Cross pouring fee. Alberta Health recently capped that pouring fee at $8 per drug for most Alberta Blue Cross clients.
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.
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 then asked about a larger province like British Columbia,
where the BC Pharmacy Association is recommending that 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 said 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 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. According to Saga most were also charging the upper end of 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 says, “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 shipping. 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.”
Follow @TimKalHerald on Twitter

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darrenerickson

I would like to address a statement made by Bobbie Saga that you printed in your paper. It reads, “That dispensing fee, she points out, used to be up to $25 per drug under the former Alberta Blue Cross pouring fee.” The inaccuracy of this statement tops the list of journalistic blunders put into print by your newspaper. The Seniors copay is 30% of the prescription to a maximum of $25.00. This amount, since the implementation of the Covid 30 day prescribing limits, has been reduced to a cap of $8.00 per prescription, saving Seniors $1.00 in a three month supply of many medications.

Saga’s description of our dispensing fee as a pouring fee is disrespectful of our profession. Putting it at $25.00, more than twice Alberta Blue Cross’s recommended dispensing fee, is absolutely false. It appears that since Saga went into retirement her journalism research skills have also lapsed.

In the preamble you clarified this inaccurate information as being fact and printed it. In our interview you ensured me that you would print a balanced article but instead printed inaccuracies and fallacies without checking any facts. What does this say about the integrity of your paper?