Thank you, thank you, thank you, Mrs. Grammond for calling this out. The abuses of pharmacist-owners (not all, but a very large number) have long been known to stakeholders in the field, insurers, brokers, consultants and even the government, but little to the general public. The reimbursement agreement concluded between the insurers and the Association québécoise des pharmacists proprietors (AQPP) gives too much power to the latter and the insurers have (or say they have) their hands tied and are afraid of being accused of collusion. After more than 40 years in group insurance, during which I have participated in countless conferences and committees, including the Monmarquette committee, I have come to the conclusion, like some other independent observers, that the only solution is imposition by the government of the same fees on pharmacists, whether the patient is covered by the Régie de l’assurance maladie du Québec or by a private plan. In “Association québécoise des pharmacists proprietors”, the word “pharmaciens”, which refers to health professionals, could be removed: only the word “owners”, which rhymes with profits, is legitimate.

I’m glad you’re talking about this topic. Recently, my private insurance, which acts as second payer, refused to pay part of the pharmacist’s fees, considering them abusive. These were vitamin D tablets (D-Tabs) and the cost of the fee was higher than the tablets. I went to another pharmacy to compare prices and was told that their fees were even higher for this vitamin. I also asked this person why they were charging three months’ worth of fees for 90 pills (one a day), when it was actually just one manipulation. Is counting 90 pills rather than 30 so much longer and tedious that the fee has to be tripled? I was told that it was a RAMQ requirement. Find the mistake !

The real debate is not that private insurance pays too much, it’s that the RAMQ does not pay enough. Are you also forgetting the services that RAMQ pays for and insurance doesn’t? Profile transmissions to emergencies, pharmaceutical opinions, refusals to fill a prescription, putting in pill boxes, etc. In the PUC, all these costs are pooled in the famous fees. Of course, we could cap fees in exchange for a markup on the cost of the drug like in Ontario: 10% of $25,000 is how much? We can even add a fee of only $10 if you want.

I am a human resources professional, specializing in the management of employee benefits, therefore group insurance and, indeed, everything you say in this editorial is very well documented. Pharmacists in Quebec are a very powerful lobby. They make the rain and the sun, and it is inadmissible. However, when you say insurers don’t do much to lower the bill, that’s not entirely true. The Canadian Life and Health Insurance Association (CLHIA) puts a lot of pressure on the government and some gains have nevertheless been made in recent years. But we must continue the pressure, because it is not normal that it is so much the Wild West in Quebec.

Excellent editorial! An issue that is of great concern to us in the group insurance industry. Another important issue that is often overlooked: Employers who wish to end drug coverage must end all accident and sickness coverage under the plan! Send employees to the public plan for the expensive portion of drugs and continue to offer them dental insurance, salary insurance and travel insurance with the private plan? Impossible ! The Act respecting prescription drug insurance provides that a group insurance plan that offers accident-sickness coverage must offer prescription drug insurance coverage equivalent to that of the General Prescription Drug Insurance Plan (RGAM) offered by the RAMQ. So yes, private plan members are held hostage by the staggering costs of drug insurance to benefit from disability insurance coverage that is oh so important and difficult to buy on the individual market…

Comparing the professional fees of the public system with those of the private system is completely unrealistic. For your information, the fees that pharmacists receive from the RAMQ are long gone. And right now, pharmacists and the government are in negotiations to completely overhaul the method of remunerating owner pharmacists. If you need medical advice on an evening or weekend, the pharmacist will be there for you and it will cost you a hefty $0 even if you took 15 minutes of his time. Can the same be said of doctors, dentists, lawyers, etc.? who charge a fee as soon as you ask them for advice?

Being a pharmacist-owner myself, I am very surprised, and disappointed, by the way in which the last editorial dealing with pharmacies is written. It falsely gives the impression that pharmacists are “thieves” for whom only profit matters.

The “fees” referred to are not just to pay the pharmacist, but also to cover all related costs, from storage to electricity costs to employee salaries. These costs are in fact different whether the patient is insured by the RAMQ or by the private sector. On the other hand, the fees paid by the RAMQ are quite insufficient to cover the operating costs of a pharmacy. Comparing private costs with those of the public without mentioning the fact that the latter are derisory fails to put things into perspective. If a single realistic tariff were to apply, it would be much closer to that charged to the private sector. Unfortunately, the examples presented in the editorial are isolated and infrequent cases of expensive drugs for which high fees have been applied, drugs that are mostly served by a minority of pharmacies in Quebec given their complexity (so-called specialty pharmacies) . This is very, very far from being the case for the majority of pharmacies, and far from reflecting the average fees charged.

The editorial also omits an important aspect, namely that in the end, the big winners are the private insurers. They pass the bill on to the consumer as soon as possible. No question of reducing their profit margin. What have been the net profits of these companies over the past few years? Just look at the generous bonuses to their leaders to get an idea. This is rather where we should aim to cap…

On the other hand, the financial situation of pharmacies in Quebec is far from enviable, believe me. We have to deal with an increasingly slim margin of maneuver since the costs of supplies, services and operations are increasing dizzily while the remuneration from the insurer of the majority of our patients, the RAMQ, is stagnating. The demand for service from patients who are left to fend for themselves in our dysfunctional healthcare system, and therefore the workload of our teams, in return, is increasing very rapidly. We are overworked on a daily basis and we have to do more and more, without additional resources. Several pharmacies are reducing their services and opening hours to limit losses despite the increase in demand. It is clear that this is not a financially viable model.

We have been negotiating for several years for this archaic compensation model, based on the distribution of drugs, to be completely reviewed. But we are still waiting.

The editorial takes advantage of this ignorance of the business model of pharmacies to undermine the image of dedicated health professionals that we are.

How much is the advice of a pharmacist who will very often save you a five-hour wait in the emergency room? $0.

How much is the delivery service of the medication sometimes even over long distances? $0.

You will therefore understand that the image of “thief” is very badly received.