To be or not to ODB

I consider myself as someone with quite a bit of pharmacy experience. Although I still learn new things on a regular basis, it is rare that I am downright shocked by a situation or piece of information I come across. Normally, when I try to come up with a topic for this blog, I use personal experiences where I have gained wisdom or advice that others may find useful. This topic, however, is not one of those lessons.Now that I work for an independent pharmacy, I am much more involved in financial reconciliation. What I hadn’t realized until recently, which stunned me, is how significantly ODB is causing pharmacies to suffer financially. In an effort to keep this concise and avoid the frustrated rant this topic inspires, I’ll try to skip right to the point. Read: Why are Manulife patients still being sent to Bayshore HealthCare and Loblaw-owned pharmacies?One of our patients recently qualified for coverage through Trillium. At the same time, she was granted an EAP approval for an expensive injectable drug. Once both of these were in place, I had her prescription transferred to us. I now regret that immensely. The first time I filled the prescription I was given the error “reduced to generic cost.” Sure, I’ve seen that a thousand times. Who hasn’t? But how could that be the case when this drug has no generic equivalent and the EAP is DIN specific? I thought it must be an error with a simple, straightforward solution. Boy, was I mistaken!Confused, I decided to call the ODB help desk. The lady I spoke to explained that ODB has an agreement in place with the manufacturer, AstraZeneca, and that they are required to sell the drug for $1,938.46. She said if I were to purchase the drug directly from AZ, then they would sell it for the “ODB legislated cost” which is $106.45 cheaper than our wholesaler. Read: Ottawa signs $3.7B health deal with QuebecI then contacted AstraZeneca. It was immediately explained to me that they do not sell direct and haven’t for the last 18 years. The AZ rep suggested calling our wholesaler and discussing the situation with them. A few phone calls, a few days and zero progress later, our wholesaler confirmed that they do, in fact, purchase this drug at the ODB cost but that they are not required to sell it to us for that price, and as a business that aims to generate a profit, their pricing stands. Another call to ODB with a representative who had no answer, no explanation and no solution resulted in a suggestion to email the Formulary Department to see if they could adjust the ODB price. This was accompanied by her opinion on the futility of this endeavour, but since there were no other options I figured it was worth a try. Based on the ODB reimbursement model, we should be getting the drug cost ($2,045.08) + markup (6% for drugs over $1,000= $122.70) for a total of $2,167.78.Although my email to the formulary department did question if they could adjust pricing, it was primarily a plea for assistance in acquiring the drug for the ODB price. My request for help wasn’t even acknowledged and I was told that the amount we’re being reimbursed is $1,938.46 + $116.76 (6% markup) = $2,054.76. After being given the breakdown that I was already clearly aware of, the email was concluded with the sentence “The reimbursement amount is above the quoted acquisition cost of $2,045.08”.Yes, this is above the purchase price. By $9.68. Now factor in the 16% ODB was taking back based on their reconciliation “agreement.” The 0.004% markup we were actually making just vanished. We officially lost money each time this prescription was filled. Quite a bit of money, in fact.So where does this leave pharmacies? Especially independent ones, where the money lost on this one prescription alone could mean the difference between being able to pay employees or cutting staff. Do we now have to check the ODB drug benefit price and compare it to our wholesaler price before accepting prescriptions for high-cost drugs? Personally, I see no other alternative. Pharmacies are already on the losing end of “government funded” services. Will the government’s greed now put patients on the losing side? Only time will tell. Alicia Levman is a pharmacy technician at Lancaster Wellness Pharmacy, a compounding pharmacy in Kitchener, Ontario.

To be or not to ODB

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