PHARMACISTS VS. BILL 16: The proposed funding formulas in omnibus provincial Bill 16 have pharmacies across Ontario, including those in Orangeville, concerned that a reduction in funding and a subsequent loss of services pharmacists can provide to their customers. Thus, pharmacists like Sanjay Gandhi, right, and his staffers Jane Riseborough, left, and Erica Beck are protesting the bill through their Stop the Cuts website, www.stopcuts. ca Photo/DAN PELTON Local pharmacies are joining with others across the province to express their concerns regarding Bill 16, an omnibus provincial health care bill which aims, among other things, to make the operation of Ontario’s health care system more transparent and to lower the price of prescription medicine.

Meanwhile, the pharmacists contend that, while the goals of the bill are noble, it jeopardizes a key source of funding and exposes how under-appreciated pharmacists are when it comes to their role in the overall health care scheme.

Proposals in Bill 16 include an amendment to the Ontario Drug Benefit Act (ODBA) that would prohibit generic drug manufacturers from paying pharmacies and other specified entities a “professional allowance” of up to 20 per cent of the value of the drugs sold.

For example, if a generic manufacturer sells a pharmacy a particular drug for $100, the manufacturer could add an additional amount, up to $20, on top of that. It has been estimated that the elimination of the allowance could cut as much as $500 million annually off the cost of generic drugs in the province.

It should be noted, however, that the ODBA currently permits private companies to shoulder the costs of an apparent disparity between what a pharmacy receives as a professional fee for Ontario Drug Benefit (ODB) dispensing fee, ($7), and what the pharmacies say is the true cost, (closer to $14).

If so, the current system is saving the provincial government money, insofar as it need not make up the difference through rebates to the pharmacies; something not permitted in the ODBA.

The pharmacists say they support measures that would reduce drug costs, but warn the lack of funds could force them to cut staff and roll back services they now offer the public.

Sanjay Gandhi, proprietor of Rolling Hills Pharmacy in Orangeville, says the current version of the Act is not what pharmacists prefer. Nevertheless, he points out that “we have been able to manage this funding gap through the use of professional allowances provided by generic manufacturers. (This is) a strategy that has been approved, implemented and managed by the Ontario government, itself.”

Mr. Gandhi, speaking on behalf of other pharmacists, said in an interview that he and his colleagues have no problem with the Ontario government wanting to find formulas that will reduce the price of prescription drugs.

“Pharmacists have agreed to the elimination of professional allowances and have advocated a more direct funding model. We have endeavoured to negotiate with the government in good faith for nine months and brought forth three proposals that (would) save the government hundreds of millions of dollars without compromising our frontline health care obligations to our patients.”

Mr. Gandhi said the amount of money the government puts toward dispensing fees has gone up just 56 cents in the last 20 years.

In a press release, the Canadian Generic P h a r m a c e u t i c aAssociation (CGPA) said: “Reductions to prices of generic prescription medicines must also be coupled with reinvestments in community pharmacies to ensure the ongoing availability of the important services they provide to Ontario patients.

“More than 70 cents of every dollar spent by the Ontario government on prescription drugs is spent on brand-name drugs. Clearly, reducing generic drug prices and support for community pharmacies does not address the primary cost driver for the government’s drug plan.”

Mr. Gandhi added that the proposed amendments mean generic drug companies have less money to fund pharmacies. He also said that the large pharmacy chains, and pharmacies attached to big box stores such as Wal-Mart, would be in a better financial position to cope with the proposed changes to the ODBA.

This brings up the fact that, in this day and age, independent and smaller retail businesses have been impacted by chain stores and big box stores and have had little recourse but to bite the bullet and deal with it.

Why should an independent and smaller pharmacy be any different?

“It’s not a matter of funding a product,” said Mr. Gandhi. “It’s a matter of funding advice and health care. We are health care professionals.”

He explained how pharmacists are not only responsible for dispensing prescriptions; they also have the task of packaging them in such a way that ensures the patient is taking the right dosage at the right time.

Perhaps more poignant to the point is that pharmacists are as legally liable for the advice they give across the counter as a doctor is during a medical appointment. In addition to the everyday costs of operating their businesses, they also have to subscribe to malpractice insurance.

Meanwhile, the Registered Nursing Association of Ontario (RNAO) has voiced its support for this ODBA amendment, as well as the Ontario government’s pledge to increase pharmaceutical presence in rural and under-serviced areas.

It has also, however, suggested in a press release that moves be made to regulate the brand-name pharmaceutical manufacturers as much as the generic manufacturers.

“Although pharmaceutical companies claim that research costs are high,” said the RNAO, “as a percentage of U.S. domestic sales of $235.4 billion, advertising and promotion consumed 24.4 per cent of the sales dollar compared with 13.4 per cent for research and development in 2004.

“It is estimated that the pharmaceutical industry spends between $2.4 and $4.8 billion annually in Canada promoting their products to physicians.”