The stage was set Wednesday for a battle between the Ontario government and organizations representing small pharmacies over reforms aimed at cutting the cost of prescription drugs.

The government says Ontario residents may see pharmacists providing some services that are currently provided mainly by doctors and nurses. But pharmacists say they can’t afford to do that and some may have to reduce hours or close, increasing wait times for prescriptions, because the price cuts will cripple their bottom line.

“Pharmacists will fight hard to stop this cut, on behalf of the thousands of patients we treat every day,” said Brampton pharmacist Ben Shenouda, president of the Independent Pharmacists Association of Ontario.

John Caravaggio, owner of Shelburne’s Caravaggio IDA Drugs, said that while larger stores such as his own will be able to cope with the expected cutbacks, “some smaller pharmacies are going to have to close.”

He said that until Wednesday the pharmacists themselves have been kept in the dark concerning negotiations that have been going on since last July, following seven or eight years in which the government has been setting maximum prices for drugs that are often below what the manufacturers are charging.

He said the dispute between the government and the province’s pharmacists isn’t news to druggists. “It’s only news to the public.”

The government’s plans were outlined by Health Minister Deb Matthews in a luncheon speech to the Canadian Club. She said it reflects a new vision of health care that is designed to stretch scarce health care dollars across more patients by forcing down the price of generic drugs.

The minister asserted that Ontario pays 50 times as much as the U.S. Veteran’s Administration for a popular blood pressure medication called amlodipine.

“That is simply not fair,” she said. “It’s not getting the best value for Ontario’s dollars.”

While the pharmacists would get less for the medicines they dispense, the government says it plans to compensate for the lost income by paying druggists a fee for doing more one-on-one work with patients, such as counselling on chronic diseases like diabetes, or giving injections like flu shots, as is done in some other jurisdictions.

Under the reforms, the government is looking to eliminate much of the $750 million annually in “professional allowances” that generic drug companies pay pharmacies to secure shelf space for their products, saying those fees make the medicines more expensive than they would otherwise be.

Sources told the Toronto Star that the allowances will be eliminated for taxpayer-funded prescriptions to social assistance recipients and seniors, while adjustments will be made to the allowances for drugs paid out for prescriptions to private customers or company drug plans.

The health minister’s speech came a day after Premier Dalton McGuinty touched on the subject, saying in part, “We think our pharmacists can do more for us. We’d like to pay them for their professional services in a way they’ve never been paid in the past. Some of the savings that we want to generate from paying less for drugs we intend to put into professional duties for pharmacists.”

But pharmacists maintain losing the “professional allowances” will be damaging.

“The massive funding cuts, estimated to be in the hundreds of millions of dollars per year, will put community health care services at risk, and directly contradict the government’s promises to make new health services more convenient and accessible through pharmacies,” the Community Pharmacy Coalition said in a statement.

“Pharmacists in Ontario fear their ability to be available to their patients will be severely reduced.”

The Coalition said pharmacists across the province have “expressed alarm for their patients given the McGuinty government’s plan to slash funding for pharmacy services. Pharmacists in Ontario fear their ability to be available to their patients will be severely reduced.”

“I’m deeply concerned that these cuts will have a severe impact on front-line health care delivery across Ontario,” said Port Colborne pharmacist Donnie Edwards. “Patients need to receive quick, helpful, and in-depth assistance from their local pharmacist – especially elderly patients and those with chronic conditions. By cutting millions of dollars in pharmacy funding, the McGuinty government is reducing access to this essential healthcare resource.”

The Coalition warned that the cuts will force pharmacies to reduce operating hours as well as oneon one patient consultations. “In some locations, pharmacies are expected to close due to the anticipated funding gap.

Extended wait times for pharmacy services will become the norm, much like those experienced for emergency services, medical specialists and other essential medical services.”

The coalition portrays itself as “the unified voice of community pharmacy in Ontario, representing independent owner-operated stores, ‘banner’ groups of independently-owned stores that work together, as well as large and small pharmacy chains. The coalition is supported by the associations and organizations that represent both the profession and the neighbourhood business of pharmacy, including the Ontario Pharmacists’ Association, the Independent Pharmacists of Ontario, the Canadian Association of Chain Drug Stores and the Ontario Chain Drug Association.”