http://www.canada.com/cityguides/toronto/story.html?id=d9e04fa0-c4f1-4d53-aa0c-58de537fbfbe&k=98830
<http://www.canada.com/cityguides/toronto/story.html?id=d9e04fa0-c4f1-4d53-aa0c-58de537fbfbe&k=98830>
Pharmacists, patients squabble over Ont. drug changes
Angela Pacienza
Canadian Press
Sunday, May 28, 2006
TORONTO -- Pharmacists, patients and drug companies are set to turn up
the heat Monday as public hearings begin to examine Ontario's
contentious effort to change how drugs are bought and sold in the province.
The hearings come at a time when the government is under fire about
limited access to life-saving drugs such as the breast cancer medication
Herceptin, and for failing to pay for expensive drugs that treat rare
diseases such as Fabry's, an enzyme disorder.
Pharmacists, too, have long complained that they're not being
compensated for the work they do outside the basic job of filling
prescriptions.
The sweeping changes are aimed at controlling escalating drug costs
while improving access to medications in the province's $3.5-billion
drug program, which includes coverage for welfare and disability
recipients, seniors and hospitals.
The thinking is that by using Ontario's massive buying power, the
government can pressure pharmaceutical companies into giving it
discounted drugs.
Other proposed changes include allowing pharmacists to replace brand
name drugs with generics when filling prescriptions.
One of the more contentious changes would halt a scheme that sees
generic drug companies give product or financial rebates to pharmacies.
"Most people who use the program say it doesn't work. It needed
restructuring. That's what we've done," said Helen Stevenson, the
executive lead for the Drug System Secretariat who crafted many of the
recommendations that ended up in the legislation, known as Bill 102.
The province estimates it can save about $289 million a year if the
legislation is approved.
But ever since announcing the changes last month, the government has
come under fire from critics who say the plan will create a host of new
problems.
Among them is a coalition of pharmacists who calculate that the pharmacy
industry stands to lose $500 million from the changes, largely a result
of the end of the rebate system. The group also believes the changes
would force an estimated 300 pharmacies to close shop while forcing
others to reduce services.
"We won't be sustainable the way we are today," said Rita Winn, general
manager of Lovell Drugs, a 10-store chain in central and eastern
Ontario, and a member of the Coalition of Ontario Pharmacy.
"Rebates, marketing allowances are paid in every industry in this
country. That's just free enterprise. There's nothing wrong or illegal
about that."
The government, however, says it has done its homework and doesn't agree
with the pharmacists' doomsday scenario.
"We've done a very, very detailed analysis of the impacts. We certainly
do not believe that as a result of the recommendations that pharmacies
will go out of business," said Stevenson.
"We were very thorough in our numbers."
On the patient end, there's some concern over granting pharmacists the
ability to interchange medication.
Durhane Wong-Rieger, of the Institute for Optimizing Health Outcomes,
said drugs are only similar to a degree and don't work the same in some
cases.
"A patient may be well stabilized on one brand of the drug and not be
well stabilized on the other," said Wong-Rieger, who represents anemics
and people with rare disorders, among others.
"Under the way the bill is written now, when they talk about a similar
active ingredient, it would allow the pharmacist to switch you to
something that is different from what the doctor actually prescribed."
Other changes in the legislation include creating a drug program chief
executive who would decide which drugs the province would cover, taking
the role away from Ontario's cabinet.
The legislation also recognizes the role pharmacists play in the
health-care system by allowing them to charge OHIP for counselling
patients. The government said it will set aside $50 million to pay the
new fees.
Karen Philp, executive director of public policy with the Canadian
Diabetes Association, said she welcomes the move.
"There's a huge shortage of diabetes educators in the province," Philp
said. "This could help fill that gap."
Philp said her organization supports the legislation because it improves
the drug approval process by including patients on the committee which
evaluates which drugs are funded.
"The status quo doesn't work. Ontario has the worst record in the
country for access to drugs," she said.
"(The legislation) could significantly improve access to medications and
therapeutic treatments for people with diabetes."
The hearings, scheduled for Monday, Tuesday and June 5, are sure to be
spirited.
Some 99 separate presentations are scheduled from all sides of the
debate, including brand name pharmaceutical companies, asthma patients
and pharma research firms.
A group of pharmacists has scheduled a protest Wednesday on the front
lawn of the legislature.
But while many in the health-care sector can't agree on the best course
of action, few disagree that the system needs an overhaul.
"Things have been broken for a long time . . . It's not a simple
system," said pharmacist Winn, who practices in Oshawa, Ont.
Added Wong-Rieger: "The drug plan that we have currently in Ontario does
not work for lots of patients, for lots of reasons."
© Canadian Press 2006
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