By Jen Baker
In today’s challenging economy, we are constantly seeking “value” in our purchases. That is to say, we hope to make the purchase that will deliver the most service, quality and quantity for the money we spend. This has been something I have pondered, researched and tried to embody to my customers and clients throughout the years as I worked in customer service. The patron of the restaurant at the private golf club where I was a waitress wanted his order quickly and with a smile. The lady at the designer cosmetics counter wanted the moisturizer with the most benefits AND an SPF. As a travel agent, the honeymoon couple wanted the nicest resort without having to break the bank. While cost can ultimately the bottom line in some situations, as a society we constantly strive to receive value in our purchases, especially when we are digging into pocketbooks that are stretched uncomfortably thin.
This concept of value, or obtaining the most benefit for the least amount of money, is something that seems to be missing from the government’s plan to cut one billion dollars from Ontario’s community pharmacies. As front-line health care practitioners that provide many of our services for free (without even requiring that someone have purchased a prescription from us in the past), the government’s attempt to slash their bottom line, regardless of the cost to our patients or our livelihoods, is rankling because we feel like our value is being challenged. Comments from members of the public that further denigrate our value, such as we are merely “pill-counters,” do not help in this matter.
Value is also something the people do not generally see in something that they have been given for free. When there is no cost associated with a product or service, the benefit is often not appreciated to its fullest value. If you misplace or break the item, you are not as concerned, as you are not actually out any money. This is something that pharmacists have seen with patients on drug plans, especially government ones, for years. If a prescription is free, or has a very small copay such as $2.00, many people do not appreciate the value of the prescription. It’s actually astounding the number of people who have no concept at all what their prescription would cost without coverage. While many insurance beneficiaries have an appreciation for their drug coverage and treat the system with respect, there are many out there that will abuse the system to the fullest of their abilities. In my somewhat limited experience, I have found patients on ODB to be particularly bad for this, as their insurance isn’t something they see themselves paying for (and hence has no value) as opposed to private plans that are paid for either out of pocket or out of an employee’s wages. I say this, knowing it is a generalization and that this is not true of all ODB recipients, especially seniors who value drug coverage in their retirement.
In addition to drugs themselves being perceived as “free” by many patients, pharmacist help, advice and service is also free to anyone who needs or wants it. This is something that we now see has done a huge disservice to the entire profession, as many of the services provided in community pharmacies are taken for granted. While many patients are deeply appreciative when a pharmacist faxes out a refill request for them, there are many who don’t understand or appreciate the many services that pharmacists provide. If there were a charge for refill requests, delivery, counseling, clinics, OTC recommendation, calls to insurance companies, requests for LU codes, prescription transfers and many of the other benefits pharmacists provide, perhaps people would see more value in them. I am not suggesting there should be a charge for these services, I am merely illustrating the point that as soon as someone needs to pay out for a service, they become more appreciative of what is actually being done for them. Something to think about – the majority of people will tip their waitress more than what the Ontario government pays pharmacists to dispense a medication. To me, having been both a waitress and a pharmacy student, this does not seem right.
One common drug therapy problem (or DTP as pharmacy students in Professional Practice labs no-so-lovingly call them) is that a patient is on too many medications and should be taken off some of them. Many patients worry that they may be taking too many prescriptions and ask their pharmacist to ensure that none of their medications interact or that none of their prescriptions is redundant. However, we also must consider that we live in an age where drugs are often seen as the easiest answers to difficult problems. It is much easier to take a pill or tablet than to make lifestyle changes that take weeks, months or even years to adopt. As a result, prescription medications are over-prescribed, overused and often abused, especially when a patient does not have to pay for these medications. Patients who pay out of pocket are more likely to be cautious in what they take, as many of the “trendy” medications are extremely expensive. This problem of over-prescribing is another huge factor in why the government’s drug bill is ballooning out of control, and could but has not of yet been addressed in attempt to curb drug spending. Pharmacists would be more than happy to help the government audit the drug profiles of ODB patients, as this would help reduce patient side effects, improve health outcomes and reduce government spending. We are not naïve enough to believe this would be the only measure necessary to reduce government drug spending, but it would be a start.
To the pharmacy students, interns, technicians and pharmacists, please know that you are valuable. Through the coming weeks we will surely hear and read many more attacks on our professionalism, integrity and value to society. Through all of this, keep in mind the services you provide, and take comfort in the support of the patients who do value you. Attempt to educate those who don’t understand pharmacy and what pharmacists and technicians do for their patients.
To the general public who stand to lose out from this legislation, please show support for your community pharmacies. Know that your pharmacy staff cares and wants you to have the best possibly health outcomes. If you have questions or don’t understand the issues at hand, please ask us to tell our side of the story. So many media outlets have political agendas and portray only one side or view – please ask us to explain what will happen to pharmacies if these cuts go through as they are proposed now. Visit www.stopcuts.ca, and write or phone you local MPP express your displeasure with the proposed legislation.
To the Ontario government, please consider that the changes you plan to implement take into consideration only cost, and not value. Your plan to reimburse pharmacists for cognitive services is a good one, but ultimately will not sustain the costs of staffing a pharmacy so that they will be able to provide these services. Pharmacists understand and appreciate that there needs to be reform to drug spending – this is why we went to the table to negotiate with you and were ultimately canceled on, ignored and betrayed. Know that we are knowledgeable, caring health care professionals, and we are fighting you because we need to be able to sustain our businesses to keep providing our patients with pharmaceutical care. Please do not attack our integrity by portraying us as criminals and thieves – you designed the professional allowance system and are splitting hairs when it comes to both documentation procedure and categorizing what “helps the patient.” With your recent health care tax and e-Health scandal, it is time you provided Ontario tax-payers value for their money. Arbitrarily cutting funding to community pharmacies, which will ultimately reduce the level of service we are able to provide to patients, will take away from the little value the public is actually receiving for the amount we pay out through taxes for health care. Please work with us to reform this legislation, rather than against us.
