The Proud Pharmacists of Ontario “PPO”

As I doubt CBC/Radio-Canada will respond to the inaccuracies in their recent article, I have decided to post this letter here for anyone who would like to share. Please spread it around so more people can become well-informed instead of misled by the media!

I also want to commend all the other health care workers out there right now on the front lines. You are all heros and I am honoured to be your team member

April 3, 2020

Dear Editor,

I am currently a young Doctor of Pharmacy, a pharmacist working in Ontario.

I have just read Rosa Marchitelli’s recent article entitled “Prescription change meant to safeguard supply in COVID-19 crisis triples fees for some patients”, published April 3, 2020.

Not only is it lacking background research but it does not address any of the issues pharmacies and pharmacists are currently facing in this crisis. What was provided was a completely biased misconception regarding what is actually happening in the pharmacy environment to the public, once again targeting pharmacies and their staff, when they are doing nothing but protecting the public and providing front line care in the current state of emergency.

Pharmacies are currently operating ONLY for the benefit of their patients. Insinuating that we are out to make money is disgusting and shows a blatant lack of understanding of what is actually going on.

Let us review: walk-in clinics have closed in our area. Most doctor offices have closed. They have opted to work from home in order to protect themselves. Yet we remain open to care for patients, without any personal protective equipment, without any support from the government, and without any reason to stay open other than we care about our patients.

No one understands what goes on daily in a busy pharmacy unless you work in one. I urge you to spend 10 hours behind the counter, to see what occurs and how chaotic it currently is during this pandemic. We are two days behind filling prescriptions because demand exploded as soon as the social distancing measures came into effect. Not only are people calling to fill their prescriptions but to talk to staff about their concerns and ask about masks, disinfectants, hand sanitizer etc., that we do not even have for ourselves. Pharmacists are renewing chronic medications left right and centre because doctors are hard to contact. We are THE LITERAL FRONT LINE for the general public during this pandemic that no one seems to care about.

Then to go and read your article about this “price gouging” opportunity for pharmacies is not only insulting, but completely disheartening. It is so far from the truth that Ms. Marchitelli should be scolded for her lack of professionalism as a reporter resulting in her inaccurate portrayal of the facts.

If she had done her research, she would have learned that suppliers like McKesson have been LIMITING the amount of stock we can order every day. That means one bottle of 90 pills delivered to the pharmacy could either be used to fill ONE person’s prescription for three months (taking one tablet daily), or used for THREE patients, each getting a 30 days supply. If this past week alone we had continued to fill 3 month supplies for everyone, there is no way we would meet supply demands for all our patients.

I would like to point out there are currently around 2000 drugs on the drug shortage list for Canada. There are already drug shortages, and it has already been a lingering problem before COVID-19 started. The pandemic situation has only made this worse, especially as both patients and doctors were starting to ask for larger quantities (eg 6 month supplies at a time), which was beginning to endanger the regular drug supply already affected by deflated generic drug costs due to government restrictions (too much to go into detail about this here). The MOH and CPhA mandating 30 day supplies for all patients is proactive; pharmacies are the ones currently trying to PREVENT drug shortages during this pandemic. If anyone saw the volume of prescriptions we are filling daily they would understand. But no one does, because they do not ask the pharmacy owners, pharmacists, technicians, assistants, and other staff who are working tirelessly to remain open and provide essential medication for our patients.

The article states that “critics say it’s increasing the cost of medication for those who can least afford it.” Let me explain a bit about medication coverage for those over 65 years of age. In this pandemic situation, it is true that seniors covered by Ontario Drug Benefit (ODB) may have to pay $8.22 more by getting their prescription filled every month for three months, instead of $4.11 once. What was not made clear to the public or discussed at all is that only patients who have been classified as HIGH INCOME SENIORS by the government of Ontario are paying for their prescriptions. For high income seniors, the cost for each prescription under ODB is $6.11. In our pharmacy, as a courtesy, we waive $2.00 for every senior. This brings the prescription cost down to $4.11 per medication. For low income seniors, the cost is $2.00 per prescription, which we waive to $0. So the seniors that “can least afford it”, the low income seniors, DO NOT PAY ANYTHING FOR THEIR PRESCRIPTIONS. This was left out entirely from the article written by Ms. Marchitelli and shows she needs to check her facts. In addition, Kathleen Finlay’s remark concerning extra trips to the pharmacy for seniors is invalid, as most pharmacies are currently doing deliveries for free (and an abnormal amount at that) for patients who wish to social distance. Kym Harris’s remark that the reduced frequency for filling prescriptions is a “green light to gouge” is a testament to her ignorance on the issue, even stating herself that “it doesn’t make sense to me”. I hope she can read this so that it now makes sense.

The section entitled “waiving fee not an option” is clearly trying to imply that it should be an option. Pharmacist and staff are not paid by the government, as are all other health care workers that are currently on the front line. To suggest that pharmacists and other staff should not be paid for their work continues to side line the profession. Essentially, it seems those who are not informed would prefer we continue to serve the public without any protection for ourselves, putting ourselves at risk every day we go to work, and do it all for free.

The dispensing fee for each pharmacy has stayed unbelievably low for DECADES, when comparing dispensing fees to inflation. In case people are not aware, the $10.89 dispensing fee (at our pharmacy) is meant to cover the following: salary for the technician inputting the prescription, the software the pharmacy uses, the salary of the assistant counting the prescription, the bottle the pills are put into, ink and printers, the label, the salary for the pharmacist technically and clinically verifying the prescription, as well as the time they take to deal with any issues/faxes to the doctor regarding the dose or indication, as well as any counselling time for the patient, the receipt paper for the prescription, and the bag the prescription goes into. People seem to have the idea that pharmacies make a lot of profit, but all markups on drug costs are small and extremely regulated — the dispensing fee is what keeps pharmacies running.

Many pharmacies are independently owned and currently draining money trying to stay open during the pandemic. Not only that, but they are incurring additional fees to keep staff at work and protect them any way they can, such as installing plexiglass barriers, spending money on disinfectant supplies where available, and increasing deliveries at no cost to patients. None of this is subsidized or provided by the government, just like we were all left out of any PPE supply to all other health care workers.

I am a newer graduate and have been appalled at the lack of respect and support that we as a medical community have received from the media, particularly CBC reporters, not only in recent years but during this pandemic. This is just a glimpse behind the counter during the COVID-19 pandemic, and I implore you to publish this letter so that your readers are given the correct facts behind the current 30 day supply limit. On a positive note, many of our patients are truly grateful, thanking us for what we are doing in this time of crisis, recognizing that we are risking our own health and safety every day we go to work. If only the media and rest of the public could recognize this too.

Sincerely,
Your Friendly Frontline Pharmacist,

Chelsea
PharmD, RPh
BScH, MES

COVID-19 has shown the real face of Canadian Ontarian Pharmacists and Staff. Health care providers who has proven by deeds -not by words- that they are the real genuine front line of defence.
Pharmacists work long shifts to make sure that their patients get their needs under some of the unprecedented difficult conditions, and I am not talking about Covid-19 only, but the extreme shortage of drugs, physicians unreachable -physically-except via a pre-booked phone call only, hospitals and emergency departments overwhelmed with the Virus victims, vulnerable patients cannot leave home to pick up their meds, others are doing their best not to leave home and again do not go out to get their meds, according the mounting need for home delivery and all its consequential complications and overload . The few patients visiting the pharmacy could be carriers of the virus and no PPE available to pharmacists and staff whether to purchase or supplied by the authorities to help protect the working personnel! Pharmacists and their staff are humans too! They are scared of the killer virus, they are trying to take every measure to protect themselves and their patients under Very unusual conditions and no support from the government to protect them, BUT because they put Patient First, they go through these difficult times, taking all kinds of life threatening risks, finding solutions and ways to help supply their patients with their needs to stay healthy.
Thank You is the least pharmacists deserve and appreciation is the most they expect.