October 30th, 2020

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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Dennis Bremner

I think Bennett would understand better if he was on the receiving end. The way this article is put together it looks like there is no other option, which if they had bothered to explain, may have been accepted.

So lets do what most Albertans are doing

You have 90 pills of X
In normal times those 90 pills would have been dispensed for $12.00 (too keep things simple)
In COVID times those 90 pills are being dispensed for $36.00 because you are dispensing them 3 times

So if the Pharamceutical is interested in helping seniors who have high costs. Why are you not dispensing the same 90 pills for $3.00 per 30 pills?

Now if you say, you can’t pay your staff on that basis, then again Math comes into this.
————————————————
If over a 3 month period you dispense X of 90 pills you bill 12.00
You see that patient once ever 90 days
You get $12.00
You pay your employees and pocket the rest.
——————————————–
In scenario 2
In one month you dispense 30 pills of X for $12.00
You see that patient once every 30 days
You get $36.00
You pay your employees and pocket the rest
—————————————
In scenario 3
In one month you dispense 30 pills of X for $4.00
You see that patient once every 30 days
You get $4.00 (total compensation over 90 days is the same as Pre-COVID $12.00)
You pay your employees and pocket the rest
——————————————-
So instead of the rant above, explain why you are NOT doing Scenario 3
The fact is, you are allowed to bill $12.00 for dispensing, so you are! Based on the lack of content in your letter, a trained monkey with a slide rule can easily rationalize you are profiting from COVID and the “patient” is losing his/her shirt if on fixed income and needs multiple fills for various drugs.

The mere fact you digress to the point where you say “by the way if the person has 70% insurance, he only pays $3.65 as if his/her insurance is somehow, yours to calculate, any “you” determine the extent of the strain its putting on a persons budget! Insurance is not yours, its the person that earned it however like all good insurance claimee’s you rationalize your charges by suggesting the “person” has insurance, and after all, “you are ALLOWED to charge them”, right?

So now you raised it, what is the Pharmacists doing for the non-insured senior, after all you are obviously cognizant of “insurance”…so you must be also very familiar with the uninsured, are you giving them a 70% break during this crisis?

Seems to me Pharmacists are earning their complaints and, your comments above do not help one iota, in fact, it clearly indicates you are not among the suffering at all. So if you are not, one should not attempt to be the squeaky wheel.

You did not even bother to have the author explain why you are NOT profiting from COVID! ie extra PPE, extra safeguards, etc etc it seems, you just wish us to guess, which leads the reader to one conclusion. 3 times the traffic, 3 times the charges = “profiting from COVID”! Not quite sure when defending the industry, why you would forget that rather important point?

Yet somehow from the comments above, we, the Alberta Public are supposed to figure out that you are “not a Toilet Roll reseller or some derivative thereof” with not one comment from you to the contrary?

Mr. Bennett, YOU write the Lethbridge Herald this time, rather the snippet interview and try a little empathy this time! Explain how its affecting you and how you are personally in the same boat as the rest of us and not profiting from this crisis! Explain why we should believe you, because you have said nothing in these comments that would lead the reader to believe otherwise, absolutely nothing!

RhondaW

Suppose you run a service delivering prescription medications as a one-person show. You have a regular route delivering once to each household over the course of 3 months. You are busy and your workday is full every day. You have been doing this same route for years and you know most of your clients and are friendly with many of them.You are paid, of course, based on providing a service, and you charge $6 per delivery.

Now during Covid, the government says you HAVE TO deliver to all of your customers once each month instead of once every 3 months. So suddenly your workload triples. You are doing 3 times the deliveries and you are thinking you will have to work lots of extra hours or maybe hire new drivers to help you out.

For simplicity in this scenario, suppose you are paid by the people you deliver to. Some of them pay the $6 out of their pocket, some have delivery fees covered by their insurance. Many of them are elderly, vulnerable, struggling with finances, or not in good health. Some have relatives who live in other provinces telling them they are still getting their deliveries once every 3 months.

So they ask you to please only charge them the same as usual – $6 every 3 months or $2 once a month. You feel compassion for your clients and do not WANT them to have to get a delivery once a month and therefore pay 3 times, but you are told you cannot deliver once every 3 months as before. You are required to do 3 times the work.

So do you work for free for 2 out of every 3 deliveries ?

Dennis Bremner

RhondaW, can I presume you contract too pharma companies? If so, the answer is simple, the pharmacies decided to only fill prescriptions lasting 30 days. They chose to do so because of “shortages” and to ensure everyone got an adequate supply. Your business tripled, but your income remained the same because it was mandated by the Pharmacy because of COVID. So you apply for compensation for the extra expenses you have incurred for COVID so you do not have to work for free 2 out of 3 deliveries. Contact the pharmacy and apply for Prov/Fed compensation.

That said, that is a different problem, COVID has created cash flow for Pharmacies, where it has reduced cash flow for you. Pharmacies would be hard pressed to justify a subsidy for COVID, where you would/should not have an issue.

In the same token, the Gov has just issued $300 to seniors to assist them in their expenses and low income another $200. That compensation should give you some compensation from your clients, and you should ask for it.

RhondaW

Dennis – But I actually CAN increase my cash flow to match my tripled business. All I have to do is charge $6 for each monthly delivery and I will be compensated for my work. It is just that there is pressure to NOT do that because my clients are vulnerable due to health or financials. They are asking me not to charge them $6 every time, only $2 per month to make total $6 per 3 months as before. What if I cannot get government assisted funding ? Should I then charge the fees to stay in business?

raincouverite

Don’t bother wasting your breath Rhonda – it’s clear that Dennis and his ilk believe that pharmacy staff should perform triple the workload with triple the risk of contracting COVID while working for free (by eliminating dispensing fees). It’s obvious that pharmacy staff are simply being greedy when they’re asking to be compensated for their time and efforts, all while implementing new guidelines and practice changes in the middle of a pandemic.

Dentists, barbershops, nail salons are all charging “COVID19 surcharges” – all necessary for the businesses to stay afloat and pay their employees. But a pharmacy charges a couple extra dispensing fees to protect the national drug supply – and everyone loses their minds.

Pharmacy staff – stop being so greedy, work for free.

RhondaW

THIS , raincouverite !

Dennis Bremner

No idea who you are raincouverite because of course you prefer to post under an alias so you can rant about something you know nothing about.
I never suggested anyone do anything for free. I just find this article rather strange in that this person who was being interviewed in this article decided to set the record straight, and then, did not set the record straight. Are you any smarter as to why $12.00 becomes $36.00?
You can assume pharmaceutical assistants are working 18 hour shifts if you want to make the story sound better, but I do not see que’s of endless people 6 feet apart pounding at the desk demanding refills and because I don’t I would assume so does the rest of the population.
So Mr/Dr Bennett had his shot to explain why he is not doing as people are suggesting. In fact he was stating he is upset that people are assuming what they are…… which would lead a person to believe that he would make the extra effort to show that they are wrong.

raincouverite

“Something you know nothing about” – says the person that has likely never stepped foot in a pharmacy dispensary.

$12 becomes $36 because a dispensing fee is a flat fee. If you fill a 3 month supply, that means the tech runs a 3 month supply, the assistant counts a 3 month supply and the pharmacist does the final clinical and technical check for a 3 month supply. You have to do that work 3x instead of once – guess what? You’re going to be paid 3x. If you want that $36 to stay $12 even with monthly dispensing – then YES, you are asking the pharmacy to do the work for the other 2 months for FREE.

So tell me again how you “never suggested [that] anyone do anything for free”?

“I do not see que’s of endless people 6 feet apart pounding at the desk demanding refills and because I don’t I would assume so does the rest of the population.” — as for this quote, I’m glad you’re not harassing pharmacy staff. You’re honestly one in a few. A national survey during the pandemic shows that 73% of pharmacists are experiencing an increase in verbal and/or physical harassment. People will call pharmacy staff and yell at them for being out of medications (no refills, Rx expired, Doctor refuses fax renewal). Imagine that, yelling at someone for doing their job because YOU can’t take responsibility for your own health. Of course everyone takes it out on the “greedy” pharmacy.

Dennis Bremner

Again, Rhonda, seniors have received $300 or $500 depending on their status, thats what it was for, it was too assist Seniors with paying extra bills associated with COVID. If you do not want to charge it because you are a good hearted person, good for you. You asked me a question, I gave you an answer, its entirely up to you as to what you do and how you handle this situation.

AbigailC

Dentists are billing patients and/or their insurance plans for PPE – no uproar about that!

You visit your doctor once a year and get a prescription for one to three months even though you are not scheduled to see your doctor again for another year. You ask your pharmacy to fax your doctor for refills every few months (which they do for free) and your doctor bills Alberta Health for signing their name on the request – any uproar about that?

Nurses make pacts to all ignore first call OT requests when a coworkers calls in sick. Then when another OT call goes out offering double pay they take turns volunteering for this to maximize income. The amount of health care dollars spent on OT is absurd – still no uproar?

Jetbee

I agree, Dennis Bremner. The other issue in question here is that British Columbia has gone back to dispensing again on a three month basis so, if there is truly concern for drug shortages right across Canada, why is ANY province allowed to do this? Something smells fishy to me. Dispensing rules need to be standardized so that everyone is treated the same no matter where you live in this country.

raincouverite

Do you realize that healthcare is not federally funded?? It is provincially funded – in other words, each province picks and chooses what is on their SPECIFIC drug formulary.

You are also grossly misinformed if you think BC is back to 3 months for ALL drugs. That is absolutely not true. Drugs that are still on manufacturer shortage or on allocation by distributors are still being and will continue to be dispensed monthly.

Jetbee

So, my pharmacist is lying to me and grossly misinformed me? She told me that BC has been back to the three month regimen for a couple of weeks now but you are telling me that’s not true? Yes, I fully realize that the provinces are in charge of healthcare funding and if/when they change from 1 month back to 3 months but, let’s be honest, if there is a drug shortage, it will affect every province in Canada. Or, is that a lie, too? Back to my original statement… if the drug shortages affect ALL of Canada, then ALL of Canada should be on the same regimen. It should be either one month or three month for each province, not a pick or choose situation. Because, ultimately, we will all suffer the same fate if some drug supplies become short and, if that happens, the reason should not be due to BC or any other province doing whatever they want regarding refill frequency.

raincouverite

Yes you’re pharmacist is not telling the truth. Most drugs are back to normal; however, there are still about ~1900 drugs that are on a shortage. That list would likely be double or triple IF pharmacies had not acted as quickly as they had by implementing monthly dispensing only.

All of Canada CANNOT be on the same regimen. For example, what if BC has a higher population of people using… an ACEi medication vs people in Ontario?? Ontario’s lobbying power for ACEi medications is then DIFFERENT from BCs. Because Canada does not have a national PharmaCare, each province individually negotiates with drug companies – therefore drug companies (via distributors) can and will decide which province can get a higher supply of a specific medication.

For the most part, typically it’s not too drastic of a difference between provinces. But these aren’t typical times. We’re living in a pandemic and rules have changed. Its funny how people have accepted that in every facet of their lives EXCEPT when it comes to pharmacy and their medications.

In a time where pharmacies and their staff are dealing with unprecedented levels of work – the general public is doing a great job kicking them while they’re down.

Montreal13

Called my pharmacist about this and I was told: it is the provincial government that is requesting or making them only fill prescriptions for one month at a time. I pick up my prescriptions ,I don’t have them delivered. Many drugs are not on short supply so why can’t you get a three month supply ,of those drugs for one dispensing fee if you want?

I find that now and in the past when I have asked pharmacists about dispensing fees,they get threatened. It has amazed me for years that they do not have to list separately on the sales slip ,the dispensing fee from the cost of drugs. I think that is very sneaky.. A few years ago ,I called different drug stores and asked them about fees. I was told that they donot disclose fees over the phone- unreal. Why the special rules or procedure?

raincouverite

You’re either outright lying or you’ve dealt with some shady pharmacies. Pharmacies don’t hide their dispensing fees – in fact, the break-down of actual drug cost, dispensing fee, total cost, provincial coverage, third-party insurance coverage, and finally the patient’s actual co-pay are ALL listed on EVERY single receipt. Its mandated by law.

gs172

The pharmacare industry in Canada is complicated and varies depending on which province you live in and which pharmacy you use. I recommend everyone to watch the fifth estates episode on pharmacy kickbacks and have your eyes opened. Pharmacies are a business and the dispensing fee set by the province is a maximum and is up to the individual operator to charge what they want up to that.

Some businesses are charging a surcharge and some are not, again up to the operator. Drug prices and availability definitely depend on where you live and where you shop. I have changed pharmacies depending on these factors. The one I go to now is wonderful and the pharmacist actually sent me to a competitor when he couldn’t fill one of my scripts. Some criticism is warranted and regretfully some people don’t have a lot of options on where they get their prescriptions filled.

The pharmacists opinions in this story are his and taking into account provincial regulations his alone.