‘Abusive is an understatement’: Pharmacists angered by Ontario’s plan to clawback payments for another year

Ontario is proposing to continue clawing back—for another year—part of what the province’s pharmacies earn from dispensing fees and markups, much to the dismay of the pharmacists already decrying the idea. The clawbacks over the year could add up to an estimated $57 to $60 million, according to the Ontario Pharmacists Association (OPA). “That’s no different than me going to Tim Hortons, ordering $200 worth of coffee and snacks, and then coming back the next day and asking for $40 back because I went over my budget,” Kyro Maseh, pharmacist owner at Lawlor Pharmacy in Toronto, told Pharmacy Practice + Business. “It was bad enough that the (Ontario) government has been doing this for the last three years, but now they want to extend it for another year?” After asking pharmacists to take on the larger load of vaccinating and testing Ontarians for COVID—not to mention fill in the other health system gaps left when hospitals were overwhelmed and many doctors closed down their clinics during the pandemic—the province’s plan to continue taking money from pharmacies is a downright insult, he added. “Abusive is an understatement at this point,” said Maseh. Media relations for the Ontario Ministry of Health, as well as the office of Health Minister Sylvia Jones, have not so far responded to inquiries from Pharmacy Practice + Business. Read: Point-of-care testing pilot shows need for pharmacist intervention OPA CEO Justin Bates said that, after all the discussions with the Ontario government during the pandemic, “we felt the narrative had changed and we were hopeful they would not be proceeding with this.” So he was surprised when, in late January, the province started “hinting” about the possibility of extending the clawbacks, which were introduced on Jan. 1, 2020 as “reconciliation adjustments” to pharmacy payments. The understanding at the time, said Bates, was the adjustments were temporary, “hence, we put in the sunset date of March 31 (2023).” The OPA immediately went into “proactive mode” when it learned of the province’s plans to extend the reconciliation adjustments, he said. “We explained this was ill-advised,” said Bates. “We made calls to a number of people in government to explain the current state of pharmacy in Ontario with respect to the challenges of increasing operating costs and the overall health and wellbeing of pharmacy professionals. We need more investments, not cuts.” The cuts in question come from a percentage that the government takes from the dispensing fees and markups it pays to pharmacies. For drug costs equal to or over $1,000, the province takes 16% of dispensing and markup fees. That's reduced to 4% for drug costs under $1,000. Over a year, these reductions would translate to around a $16,000 hit, per pharmacy in Ontario, said Bates. “That’s a lot for independent pharmacies and it’s coming at a time when their margins continue to go down,” he said. “Pharmacies today continue to face inflationary pressures on everything from the cost of pill bottles and technology to labour costs.” At the same time, ongoing efforts by generic pharmaceutical companies to lower the prices of their drugs will likely make it even harder for pharmacy owners to recuperate their costs. “It’s a perfect storm for pharmacists, who are working hard to deliver the same level of care—even trying to add to it—in the face of all these challenges,” said Bates. On the OPA’s website, the association has set up a letter that pharmacy professionals and members of the public can send as part of a formal response to the province. “Talk to your MPP and engage them on why cutting pharmacy fees is not advisable,” said Bates. “Talk to your patients and encourage them to submit their opposition through our website. Patients are the voters, and we know this will not sit well with many of them.” Read: Paxlovid prescriptions in Ontario double after pharmacists allowed to prescribe Kristen Watt, pharmacist owner at Kristen’s Pharmacy in Southampton, Ont.,— about a three-hour drive north of Toronto—responded to the province’s move by resigning from two of the three Ontario Ministry of Health committees where she has worked as a volunteer. “I just cannot work for free!’ she wrote in an email. Watt has also been posting on Twitter about the proposal. In one Tweet, which she ended with the hashtag #SHAME, Watt equated the proposed clawbacks to 4.3 million COVID vaccines, three million appointments for minor ailments, 2.2 million consults for hospital discharges, one million pharmacist working hours nd 392 “pharmacies like mine” letting go of a full-time pharmacist. She also wrote that the clawbacks essentially negated the additional payments made to pharmacies during the pandemic. Bates at the OPA said that while he understands the need to find cost-efficiencies in the healthcare system, taking it from healthcare professionals who are already struggling to cover their costs is not the answer. “Why not look to other areas for savings, like formulary management?” he asked. “There are ways to come up with better solutions, and it should not come from the bottom line of pharmacies.” Read: Are pharmacists of value as independent prescribers in long-term care facilities?

‘Abusive is an understatement’: Pharmacists angered by Ontario’s plan to clawback payments for another year

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