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Saskatoon doctor says pharmacy dispensing fees ‘a rip off’

A Saskatoon surgeon says he recently asked his pharmacist for a three-month supply of his hypertension medication and was shocked by the reply.

The pharmacist told Morales he could receive only one month's supply at a time.

Morales, who just moved back to Saskatchewan, explained to the pharmacist that in New Brunswick he was always given three months of his prescription at a time.

“It made me laugh,” Morales said. But he recalled it also concerned him. “I just started to say, ‘Come on guys, be fair.’"

The pharmacist eventually agreed to provide a three-month supply, but he charged Morales three dispensing fees, one for each month's supply.

“This guy, I am thinking, is taking my money for nothing. That's what I thought,” Morales said.

“I don’t want to say it, but it’s a rip off,” Morales said.

At $11.25 per prescription, the dispensing fees came to $33.75; far more than the $11 he was charged for the same thing in New Brunswick.

“Then I [said] ‘that's unfair for me and if it is unfair for me it is also unfair for all of Saskatchewan,’ because first you have to pay three fees for one shot.”

He said the alternative is to return to the pharmacy every month to refill the prescription.

“[You] spend more time out from working or being home taking care of your children or doing the things that you do every day. And this is inconvenient.”

Morales has worked in British Columbia and New Brunswick and said those provinces don’t charge extra dispensing fees for a greater number of pills.

He said as a surgeon he could never get away with triple charging.

“We cannot charge three fees for doing a pandectomy for example. We charge one fee and the pharmacist charges three fees for one thing,” Morales said. “It's unfair, you know.”

Pharmacists’ association explains fees

The Pharmacists’ Association of Saskatchewan confirms that pharmacists are allowed, and in fact encouraged to charge $11.25 for each month (34 days) of drugs they dispense.

Dawn Martin, the executive director of the organization, said the fee was negotiated years ago as part of the total compensation package for Saskatchewan pharmacists.

“So when we put together the portfolio of things that are in the pharmacy contract we actually certainly encourage pharmacies to be compliant with those things.”

Martin said she understands why people might see the fee as unfair “if they don’t understand some of the complexities and what goes on as part of the process for actually dispensing drugs.”

She explained that the fees take into account the people it takes to fill the prescription, the expertise to ensure it’s safe and the time it takes to consult with the patient.

Martin said some research shows that the $11.25 fee may actually be too low to cover all of the costs.

She acknowledged that Saskatchewan’s approach to dispensing fees is “probably different than many other provinces.”

But Martin argued it’s essential for pharmacies in small communities because “smaller pharmacies in rural areas may not have the same volume that larger pharmacies have.”

And she said having patients come in monthly to pick up their prescriptions can help cut down on the waste of medication.

Government wants to change dispensing fees

Despite Martin’s defense of the fee structure, she said pharmacists are willing to consider changing it.

Their contract expires at the end of March and Martin said the province is pushing for a new approach.

“I don't know that we jumped on this as a priority. This was identified as the ministry needing for us to look at this,” Martin said. “And they obviously wanted to do it collaboratively with us and we have agreed to do it.”

Kevin Wilson, the executive director of the drug plan for the Ministry of Health, confirmed that the government would like changes. But he said at this point it’s not clear what exactly might change.

“We’re doing some work to look at policies in other jurisdictions and then to see what the impact of those policies are,” Wilson said. “Generally to consider what's good for patients and balance for access to pharmacies, particularly in rural saskatchewan.”

Wilson said the government will be sensitive to the needs of pharmacies in small communities because there have been a number of changes to their income.

Plenty of changes for pharmacists

The Saskatchewan government has been working with other provinces to reduce the price of generic drugs which Wilson said would also reduce the rebates paid by the drug companies to pharmacies.

“They are being significantly reduced because of the difference in the pricing that's available now to the benefit of both patients and to payers,” Wilson said.

Martin said that’s not the only change pharmacists are facing.

The province is set to pass new legislation empowering pharmacists to provide vaccinations and order lab tests, providing them a new stream of revenue.

It would also empower pharmacy technicians, who have far less education than pharmacists, to play a more active role in dispensing medication.

She said with so many moving parts the negotiations with the province for a new contract are complicated.

“There's been a huge amount of change both on the business and the practice side of pharmacy and we are just trying to navigate through all of these elements and do the best we can on behalf of our members, but also as part of a larger system.”

She said because of the complexities any changes to the fees won’t be seen for at least a year; maybe a year and a half.

Morales is pleased the fees may change, but he said there’s no need to wait, especially if the public demands it.

“When I see something like this it pushes me to be engaged because I’m convinced that the community has the leverage to change.”