Shoppers Drug Mart billed $81 million for MedChecks over 2 years as Covid services diminished
Shoppers Drug Mart billed the Ontario government’s MedCheck program $81.2 million for medication reviews over a two-year period after some of its current and former pharmacists said they faced “unethical” corporate pressure to meet professional service targets.
That total for the 2022-23 and 2023-24 financial years is $8 million more than what corporate pharmacy chains billed for similar services over the past six years, according to data obtained by CBC News through a freedom of information request.
“Correlation is not causation, but the surge in MedCheck is notable given the decline in revenue from things like COVID shots or other services that were allowed during COVID,” said Eli Haji, a regulatory lawyer specializing in pharmacy health care law.
“This speaks to a larger problem associated with the corporatization of health care, where the health care professional has a dual loyalty, loyalty to the corporation and their business, and loyalty to the patient, who should always be paramount.”
Medication reviews are meetings between a pharmacist and a patient to review their prescriptions and make sure they are taking the correct combination of medications. Anyone who takes at least three medications for a chronic condition, is living in a licensed long-term care home, or is receiving treatment for diabetes is eligible for medication review in Ontario.
Pharmacists can bill the government $60 for an annual medication review, $75 for a person with diabetes, and $25 for follow-up.
Last year, a CBC News investigation It turned out that Shoppers Drug Mart had goals for professional services like drug reviews – and corporate management pressured pharmacy owners to meet those numbers. At the time, several current and former Shoppers pharmacists said pressure increased after the pandemic when demand for COVID-19 testing and vaccinations declined.
Following that reporting, CBC News requested from the Ministry of Health nearly a dozen years of billing data for the MedCheck program from pharmacy chains operating in Ontario.
Shoppers Drug Mart billed the Ontario government’s MedCheck program more than $81 million over a two-year period, data obtained by CBC News shows, after Shoppers pharmacists revealed they were facing increasing corporate pressure to bill for drug reviews.
Recently, the ministry provided data for eight of the province’s 10 corporations: Shoppers Drug Mart, Loblaws Pharmacy, Walmart Pharmacy, PharmaSave, Costco Pharmacy, Sobeys Pharmacy, Metro Pharmacy and PharmaChoice,
The other two, Rexall and McKesson (which owns chains like Guardian and IDA), appealed the ministry’s decision to share their billing data and their numbers so they were not included in the data for this story.
In emailed statements, most pharmacy chains emphasized that patient care is their priority.
Buyers are footing the bill for the lion’s share at $225 million
Overall, the eight pharmacy chains collectively billed the province $293.2 million for drug reviews since the 2013-14 fiscal year.cal year by the end of October 2024 in the financial year 2024-25.
Shoppers’ billings at an average of 682 pharmacy locations per year account for 77 percent of the total $225.3 million. These locations account for just over half the average total number of pharmacies across all eight chains.
In March 2020, the MedCheck program was amended to allow pharmacists to conduct medication reviews over the phone as well as in person due to the pandemic.
Since that fiscal year, Shoppers has billed more for drug reviews than in the previous seven years and average revenue per pharmacy is $183,800, more than double the same figure for the other seven chains, and 16 times the average revenue per pharmacy.
In a statement, Shoppers Drug Mart told CBC News that data shows the pharmacy chain is leading the way in providing health-care services like MedCheck, adding that “the need for them is growing rapidly amid the primary care crisis and skyrocketing rates of chronic disease.”
“Shoppers Drug Mart pharmacies offer more MedCheck because of our scale and the nature of our operations … specifically designed to give pharmacists more time for the one-on-one clinical care patients need,” the statement said.
The company also said drug review account That accounts for less than 20 per cent of professional services provided by Shoppers’ pharmacists in Ontario, and referenced the Patient Care and Quality Committee created more than a year ago to support store owners and ensure that patient care “remains our absolute priority.”
However, it appears that, in general, corporate pressure remains a problem.
Pharmacists still face pressure: new survey
The Ontario Pharmacists Regulator told CBC News in a statement that preliminary results from its most recent survey, conducted in June this year, show that “respondents continue to report professional pressures getting in the way of their professional obligations, including pressure to perform MedCheck reviews.”
The Ontario College of Pharmacists (OCP) has been tracking MedCheck complaints related to pressure to meet corporate targets since CBC News reporting last year.
By mid-September the regulator said it had opened 111 investigation files related to commercial pressures, about half of which specifically mentioned Medscheck, but the college would not provide detailed details “to ensure the integrity and impartiality of the ongoing investigation”.
Spokesman Dave Bourne said, “The majority of investigations related to business pressures in pharmacy that have been launched to date remain open.”
“We can generally accept … the decisions taken to date from the completed investigation, ranging from taking no action to referral to the OCP’s Disciplinary Committee.”
In a June 2024 report on the issue titled “Under Stress and Duress”, the college reported that pharmacists told them that “corporate influence on pharmacy professional autonomy is compromising the delivery of ethical, quality patient care and their well-being.”
That initial report also included results from the 2024 survey, which found that 70 percent of respondents were feeling pressure to “complete an activity in a limited time frame, or a certain target number, or dollar amount.”
According to the report, most of the respondents were from Shoppers Drug Mart.
Need for radical change in the program: Lawyer
According to Haji, there is nothing technically problematic about the profits Shoppers and other pharmacy chains can make from drug reviews under the current rules of the MedCheck program. That’s one reason why they feel it needs to change.
“The program really needs reform and improvement to stop the way it is being used,” Haji Said.
Haji’s recommended changes include increasing the number of medications a patient must prescribe to qualify for medication review, requiring pharmacists to document reviews to ensure they are taking enough time to perform them, and requiring more active communication between pharmacists and prescribers.
The Ontario Pharmacy Association (OPA) included at least one of those recommendations in a proposal on reforms to the MedCheck program submitted to the province in July 2024. The advocacy organization for pharmacists wants to see the number of quality medicines a patient must take eligible for drug review increased from the current three to five.
Justin Bates, CEO of the association, said, “We are very committed to maintaining the drug review we think has value.”
“But we also recognize that the current program needs improvement.”
The association met with the province last week to discuss the proposal and Bates says the government is committed to the process of improving and modernizing the MedCheck program.
CBC News asked the Ministry of Health what changes it plans to make to the program, given the OPA’s proposal and a public consultation held by the province last year on the pharmacy sector.
“We are improving the MedCheck program to support health outcomes and reduce unnecessary service duplication and administrative red tape, while continuing to protect patient choice,” a response from the ministry said.
The statement did not go into detail about how the government is improving the program, except to say that the ministry is currently conducting a comprehensive review of all feedback received through public consultation to determine next steps.
