Ontario's MedsCheck program could see changes amid allegations of improper use
Health minister says all programs, including MedsCheck, continually assessed
Marg Davies says she was shocked when she learned, through her doctor, she'd supposedly had a recent MedsCheck done.
"I was angry because I knew that I hadn't had one," she said. "There was a charge to the government and that's what bothered me."
MedsCheck, also known as medication reviews, is a government program that reimburses pharmacies in Ontario for reviewing a patient's medications to ensure they're being taken correctly. Davies says hers was processed by a Shoppers Drug Mart in Georgetown, Ont., where she gets her prescriptions filled.
To be eligible, a patient has to be taking three medications for a chronic condition, have diabetes or live in long-term care. An annual review costs the government $60, or $75 for a person with diabetes, and follow-ups are billed at $25.
"I happened to have gone to my doctor about a month after this had happened," Davies said. "I found out about it. How many other people have had MedsChecks charged to them and they're not aware of it?"
Allegations of improper MedsChecks at Shoppers Drug Mart and corporate pressure to hit billing targets for them, as outlined in a recent CBC News investigation, has prompted some in the industry to take a closer look at the provincial program.
Since the stories were published, the province's regulatory body, the Ontario College of Pharmacists, says it's tracking MedsCheck complaints that could specifically be related to pressure to meet corporate targets.
"We have also begun to retrospectively analyze cases from previous years in which corporate pressures may have played a role," spokesperson Dave Bourne said.
Some former Shoppers Drug Mart pharmacy employees told CBC they believe the company was taking advantage of the program by pushing staff to bill for consultations patients didn't necessarily need. And dozens of internal records showed the chain has billing targets for Medschecks, and that corporate management pressured owners to meet them.
Associate owners get a cut of the professional services, including MedsChecks, billed by their pharmacies, while the rest goes to the chain.
Shoppers Drug Mart's president previously told CBC there is no corporate pressure to bill and denied the use of targets. The statement was at odds with what multiple current and former Shoppers pharmacists said.
A Shoppers spokesperson did not answer questions related to Davies's allegations, but said in a statement that MedsChecks are "a vital health-care service that can save lives."
Pharmacists association wants changes
The Ontario Pharmacists Association says it will be sitting down with the provincial government in the coming weeks to discuss potential changes to the program.
Justin Bates, the organization's CEO, says it's wanted to discuss a redesign for years now, but it's recently come to the forefront given CBC's reporting as well as pharmacists' concerns.
Bates says he hopes to discuss ways to lessen the administrative burden of the program, making changes to its eligibility and considering whether it should be expanded into a chronic disease management program.
"What I'd like to see is the proper use of how we go about measuring success and health outcomes being a big part of that rather than necessarily driven by a bottom line," he said.
"Maybe putting in some more safe guards around the virtual MedsChecks. Virtual care is important, but we also need to make sure it's being done appropriately and not open for abuse."
Bates also says it's vital pharmacists have protection to be professionally autonomous when it comes to making decisions for patients and delivering care.
"There is benefit to the system and patients when [MedsChecks] are done appropriately and implemented the right way."
When asked about implementing changes to the program, Ontario Health Minister Sylvia Jones said it's working with the association to ensure the program brings value to patients and reaches those who are on multiple medications.
"We'll tweak when it's appropriate, but to ensure that the programs actually are providing the necessary oversight for patient safety," she said.
Jones also said all health programs, including MedsCheck, are constantly monitored and assessed.
After CBC's reporting on the issue, Jones said she told the ministry to review the program and that there's been "a number of activities specifically related to assessing the MedsCheck program."
It's unclear what that entails, though Jones pointed to steps the Ontario College of Pharmacists is taking.
'Deeply troubling'
That regulatory body says its working on a report based on thousands of responses from pharmacists sharing their "deeply troubling" experiences with corporate pressure in town halls and an online survey, which were launched in light of CBC's investigation.
"It's heartbreaking to watch," the college's CEO and registrar Shenda Tanchak said in an interview.
"There isn't any question that this profession is in crisis and if we want them to be able to continue to provide the care that they want to and that they are capable of we need to help clear the way."
While the Ontario government says MedsChecks are supposed to take between 20 and 30 minutes, Tanchak says the college heard from pharmacists who say they're being done in a couple of minutes.
"Maybe something important gets missed in the patient's care," she said.
While the college licenses pharmacists, it doesn't have the same authority over the companies they work for, but it's working with a legal team to explore its options given the allegations of corporate pressure.
"We are looking at things like accreditation standards that require business owners to demonstrate or for us to be reassured that the business will be run with integrity," Tanchak said.
Shoppers Drug Mart says it's focusing on working with pharmacy owners to ensure they have the supports they need to continue providing services to patients.
Documents obtained by CBC show the chain recently implemented an updated MedsCheck procedure in Ontario that includes a more robust documentation of patient consent and acknowledgement of the scope of services within a review.
MedsChecks valuable, pharmacist says
Sony Poulose, owner of Sherman Speciality Pharmacy in Hamilton, Ont., says his team conducts a MedsCheck nearly every day because his pharmacy specializes in patients with chronic conditions who are often on multiple medications with complicated regimes.
"We find this is a very valuable program and we could avoid a lot of other health issues [using it]," he said.
Polouse says his pharmacy carries out MedsChecks on a case-by-case basis and often sees patients who were recently discharged from the hospital with a new diagnosis.
His team sits with them to avoid drug interactions and duplications and ensure patients understand how to properly take their medication.
"It's very, very important to use this kind of program appropriately," he said. "The patients' benefit should be the primary focus."
ABOUT THE AUTHOR
With files from Lori Ward, Ana Komnenic and Rhianna Schmunk