Abuses well known to stakeholders in the field
Thank you, thank you, thank you, Madam Grammond to denounce this situation. The abuses of pharmacist-owners (not all, but a very large number) have long been known to stakeholders in the field, insurers, brokers, consultants and even the government, but little to the general public. The reimbursement agreement concluded between the insurers and the Association québécoise des pharmacists proprietors (AQPP) gives too much power to the latter and the insurers have (or say they have) their hands tied and are afraid of being accused of collusion. After more than 40 years in group insurance, during which I have participated in countless conferences and committees, including the Monmarquette committee, I have come to the conclusion, like some other independent observers, that the only solution is imposition by the government of the same fees on pharmacists, whether the patient is covered by the Régie de l’assurance maladie du Québec or by a private plan. In “Association québécoise des pharmacists proprietors”, the word “pharmacists”, which refers to health professionals, could be removed: only the word “owners”, which rhymes with profits, is legitimate.
Jacques L’Esperance, actuary
Find the mistake
I’m glad you’re talking about this topic. Recently, my private insurance, which acts as second payer, refused to pay part of the pharmacist’s fees, considering them abusive. These were vitamin D tablets (D-Tabs) and the cost of the fee was higher than the tablets. I went to another pharmacy to compare prices and was told their fees were even higher for this vitamin. I also asked this person why the equivalent of three months’ fees were required for 90 tablets (one per day), when in fact it was only one and the same manipulation. Is counting 90 pills rather than 30 so long and tedious that the fee has to be tripled? I was told that it was a RAMQ requirement. Find the mistake !
Linda Craig, Montreal
Shared costs
The real debate is not that private insurance pays too much, it’s that the RAMQ does not pay enough. Are you also forgetting the services for which the RAMQ pays and the insurance does not pay? Profile transmissions to emergencies, pharmaceutical opinions, refusals to fill a prescription, putting in pill boxes, etc. In the PUC, all these costs are pooled in the famous fees. Obviously, we could cap the fees in exchange for a markup on the cost of the drug as in Ontario: 10% of $25,000, that’s how much already? We can even add a fee of only $10 if you want.
Maxime Laflamme, owner pharmacist
A powerful lobby
I am a human resources professional, specializing in the management of employee benefits, and therefore group insurance, and indeed, everything you say in this editorial is very well documented. Pharmacists in Quebec are a very powerful lobby. They make the rain and the sun, and it is inadmissible. However, when you say that insurers do little to lower the bill, that’s not entirely true. The Canadian Life and Health Insurance Association (CLHIA) is putting a lot of pressure on the government and some gains have nevertheless been made in recent years. But we have to keep up the pressure, because it’s not normal that it’s so much the Wild West in Quebec.
Isabelle Arrivault
Taken hostage
Excellent editorial! An issue that greatly concerns us in the group insurance industry. Another important issue that is often overlooked: employers who wish to end drug coverage must end all of the plan’s accident-illness guarantees! Send employees to the public plan for the expensive portion of drugs and continue to offer them dental insurance, salary insurance and travel insurance with the private plan? Impossible ! There Prescription Drug Insurance Act provides that a group insurance plan that offers accident and health benefits must offer drug insurance coverage equivalent to that of the general drug insurance plan (RGAM) offered by the RAMQ. So yes, those insured under private plans are held hostage by the staggering costs of drug insurance to benefit from disability insurance coverage that is oh so important and difficult to buy on the individual market…
Catherine Vézina, Director of Operations at ARC Group Benefits
Precious advices
Comparing the professional fees of the public system with those of the private system is completely unrealistic. For your information, the fees that pharmacists receive from the RAMQ are long gone. And right now, pharmacists and the government are in negotiations to completely overhaul the method of remunerating owner pharmacists. If you need medical advice on an evening or weekend, the pharmacist will be there for you and it will cost you a hefty $0 even if you took 15 minutes of his time. Can the same be said of doctors, dentists, lawyers, etc.? who charge a fee as soon as you ask them for advice?
Guylaine Vachon, pharmacist
Insufficient fees at the RAMQ
Being a pharmacist-owner myself, I am very surprised, and disappointed, by the way in which the last editorial dealing with pharmacies is written. It gives the false impression that pharmacists are “thieves” for whom only profit matters.
The “fees” in question are not only used to remunerate the pharmacist, but also to cover all related costs, ranging from storage to electricity costs and employee salaries. These costs are in fact different whether the patient is insured by the RAMQ or by the private sector. On the other hand, the fees paid by the RAMQ are quite insufficient to cover the operating costs of a pharmacy. Comparing private costs with those of the public without mentioning the fact that the latter are derisory fails to put things into perspective. If only one realistic tariff were to apply, it would be much closer to that charged to the private sector. Unfortunately, the examples presented in the editorial are isolated and infrequent cases of expensive drugs for which high fees have been applied, drugs that are mostly served by a minority of pharmacies in Quebec given their complexity (so-called specialty pharmacies) . This is very, very far from being the case for the majority of pharmacies, and far from reflecting the average fees charged.
The editorial also omits an important aspect, namely that in the end, the big winners are the private insurers. They pass the bill on to the consumer as soon as possible. No question of reducing their profit margin. What have been the net profits of these companies in recent years? Just look at the generous bonuses to their leaders to get an idea. This is rather where we should aim to cap…
On the other hand, the financial situation of Quebec pharmacies is far from enviable, believe me. We have to deal with an increasingly slim margin for maneuver since the costs of supplies, services and operations are increasing dizzily while the remuneration from the insurer of the majority of our patients, the RAMQ, is stagnating. The demand for service from patients who are left to fend for themselves in our dysfunctional healthcare system, and therefore the workload of our teams, in return, is increasing very rapidly. We are overworked on a daily basis and we have to do more and more, without additional resources. Several pharmacies are reducing their services and opening hours to limit losses despite the increase in demand. We can clearly see that this is not a financially viable model.
We have been negotiating for several years for this archaic compensation model, based on the distribution of drugs, to be completely reviewed. But we are still waiting.
The editorial takes advantage of this misunderstanding of the pharmacy business model to undermine the image of dedicated health professionals that we are.
How much is the advice of a pharmacist who will very often know how to save you a five-hour wait in the emergency room? $0.
How much does the medication delivery service cost, sometimes even over long distances? $0.
You will therefore understand that the image of “thief” is very badly received.
Camille Dupuis-Brousseau, owner pharmacist