Pharmacist sets record straight on drug costs

By Lethbridge Herald on May 29, 2020.

Herald photo by Ian Martens - Stubbs pharmacist Doug Bennett shows some of the drugs that are on low supply, as well as his order sheets which list a number of drugs as unavailable. 30-day drug prescriptions limits remain in place to help avoid medication shortages, say pharmacists. @IMartensHerald

Tim Kalinowski
Lethbridge Herald
tkalinowski@lethbridgeherald.com
A Lethbridge pharmacist is taking exception with a recent Herald article addressing 30-day drug prescriptions and the costs associated with dispensing fees in Alberta on a per drug basis.
“There are two types of prescriptions pharmacies in Alberta will fill,” explains Doug Bennett of Stubbs Pharmacy. “Any tablet-type prescription will apply under that (maximum per drug) $12.15 model. If I bill $12.16 it would be rejected, and not be paid for it.”
The Herald has since clarified the $25 per drug dispensing fee alluded to by a senior interviewed in the previous article was an example being cited based on the old limits allowed under Alberta Blue Cross, and not about local pharmacies’ current dispensing fees. Alberta Health has also recently changed that maximum allowable Alberta Blue Cross per drug dispensing fee and capped the billable amount at $8 per drug.
“And then there are specialty compounded prescriptions where there are a different set of rules in terms of the fees associated with that,” continues Bennett. “I think it is around ($18.45), that is the maximum Alberta Blue Cross will allow for. Typically, the way insurances work in Alberta is Alberta Blue Cross sets the standards, and then the other private insurances will follow those guidelines to a greater extent.”
That being said, Bennett acknowledges individual pharmacies have discretion on what they will charge clients on a per drug basis up to that standard $12.15 or special compound $18.45 limit.
“There is a variation in fees,” he states. “The vast majority of pharmacies will align at that $12.15, but the bigger corporations who have different business models, which get away from the health-care model a little bit in my opinion, will vary those rates.”
He says for those who have insurance at either 100 per cent coverage or on a co-pay basis amount the percentage of the dispensing fee the client will pay will be covered to the same degree. So if someone has 70 per cent coverage, he says by way of example, on that $12.15, they will only pay $3.65 per drug.
For those without insurance, he acknowledges, they often will have to pay the full $12.15 per drug themselves, and that can be costly depending on how many drugs the person may need.
He also acknowledges for those who have multiple drug prescriptions that those dispensing fees, even for those with co-pay insurance or Alberta Blue Cross, can add up when having to pay them out monthly instead of on an every-three-month basis as in previous years. He admits it is a common complaint he hears from seniors who come into his pharmacy.
But Bennett rejects the notion that pharmacists are somehow deciding to retain 30-day prescription limits in Alberta instead of allowing 90-day limits because they simply want to make more profit from their clients by charging more dispensing fees.
He suggests people visit the website drugshortagescanada.ca to see the long list of drugs currently in short supply to fully understand the situation.
“What people need to know is it is being done on a community, population business level, not on a personal level,” he states. “What I tell patients all the time is when you come into my pharmacy, and I have a three-month supply, and I give you that three-month supply, the next person who comes in doesn’t get any. Whereas if I give you that one-month supply, the next two people that come in can still get access to their medication.”
“I believe most pharmacists, if you have that open discussion with them, they would understand why, and be willing to make exceptions if there is a plausible reason for it,” he adds. “If your reason for it is, ‘I’m going away to quarantine for 14 days.’ Lots of people are, and that 14 days is covered by the one-month supply. I have had at my pharmacy a number of patients where cost has been a concern, and I have had that discussion with them, and I have made some exceptions. But it is definitely on a case-by-case basis; I can’t blanket it to every single thing.”
Bennett says the core of his difficulty with The Herald article wasn’t necessarily the cost clarification which was needed after the initial article was published, or the fact seniors in the community may be upset about monthly, multiple, per drug dispensing fees for those with complex health needs. He knows they are, as he has heard from several of them directly on this issue.
However, Bennett says the fact that due to policies largely beyond its control, the pharmacy industry in Alberta has been increasingly painted in a negative light by some; when all your average pharmacist wants to do, he says, is to help his or her patients.
“At the core of my frustration with the article I read, it’s not the cost (discussion),” Bennett confirms. “I understand people being frustrated by having to potentially pay more. The core of my frustration was the light it sheds on pharmacists, particularly, and the damage that could do to the pharmacist-patient relationship, which in recent years has been challenged and is currently fragile in some cases because of changes from the government and changes to what pharmacists can and cannot do. All the stuff pharmacists have traditionally been doing versus what they want us to be doing now. That has really changed that dynamic of the pharmacist-patient relationship.”
“In years past,” he adds, “we have always been one of the most trusted health-care providers, and that is starting to wane a little bit as pharmacists are made out to be greedy villains.”
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