Pharmacy companies should be covering the costs of added dispensing fees being imposed on low income Nova Scotians during the COVID-19 pandemic, says a Dalhousie University law professor.
“The claim that these fees are absolutely needed is just that, it’s a claim," said Matthew Herder, director of the university’s Health Law Institute and a professor in the pharmacology department. “We don’t have any facts behind how many added costs pharmacies have incurred as a consequence of the pandemic."
Pharmacies in Nova Scotia and across Canada are now filling prescriptions monthly, instead of once every three months, but they're still charging the same dispensing fees per refill.
The Canadian Pharmacists Association recommended the 30-day prescription limit to safeguard against drug hoarding and shortages of supply. The Nova Scotia College of Pharmacists responded by putting the advice into policy on March 20.
That means people who were previously prescribed a 90-day supply of medication are seeing their dispensing fees triple. Those fees range roughly from $8 to $12 in Nova Scotia.
Herder said he believes the 30-day limit is warranted to protect prescription drug supply but he fears that the added cost could result in some low-income Nova Scotians forgoing essential medication. For that reason -- and the potential havoc the scenario could create on an already overtaxed health-care system -- pharmacies should seriously consider reducing or waiving the additional dispensing fees, said Herder.
“Pharmacies should be taking a hard look at their costs given the pandemic and the health problems that would be introduced if a bunch of folks who could previously afford their medicine suddenly can’t," said Herder.
“What happens if they wind up in hospitals or needing additional forms of care when the system is already stressed so thin?”
The added costs are also putting a strain on some seniors covered under the province’s pharmacare program. Seniors who normally faced one co-payment with a 90-day prescription for high blood pressure or high cholesterol now have to pay three fees. While one extra refill amounts to a few dollars, the amount can quickly add up for low-income seniors on multiple medications. According to the province, 111,000 seniors in the program filled at least one prescription beyond a 30-day supply during the last fiscal year.
Antigonish senior Jean MacIntyre and her 72-year-old husband, who has chronic obstructive pulmonary disease, are covered by the province’s pharmacare program. They live on government pensions and take 13 medications between them, all of which are normally prescribed for 90 days. After their monthly bills are covered, including their mini-home mortgage and car payment, they’re left with between $300 and $400, said MacIntyre. They both pay about $3.50 out of pocket per refill, amounting to an added expense of $45 a month, or $540 a year. That’s money they can’t afford to part with.
“For us, there’s no such thing as a savings account,” said MacIntyre.
“We’ll survive but it will mean even less to get by on.”
MacIntyre said the added refills mean more trips to pharmacies, putting her and other seniors at added risk during the pandemic. Most pharmacies in the province are set up for home deliveries, including her husband’s, but her pharmacy doesn’t offer delivery.
"I will be fighting this whole change. But it’s not just me. This affects a lot of people, a lot of seniors."
Nova Scotia is so far the only Atlantic province not covering the added dispensing fees for seniors enrolled in a government drug plan. While Herder believes it’s ultimately the province’s responsibility to ensure people have access to essential medicine, he also thinks pharmacy companies should lead the charge.
“Pharmacies have the discretion to not charge those fees or really reduce them as they see fit," said Herder.
“There are added costs with this pandemic forcing pharmacies to put into place new protocols, including screening and social distancing measures, but whether that justifies in some cases essentially tripling the dispensing fees, it needs to be questioned."
The Chronicle Herald made several attempts to have parent companies of four pharmacies in the province explain why the added dispensing fees are necessary and whether they would consider waiving them. None of the companies responded to those questions, including Sobeys (parent company of Lawtons Drugs) and Loblaws (Shoppers Drug Mart and President's Choice pharmacy) and Walmart.
Allison Bodnar, Pharmacy Association of Nova Scotia CEO, said dispensing fees should remain in place for all prescription refills regardless of the amount. She said pharmacists require to be paid for their work, and dispensing fees are part of their income.
"Whether there are seven, 14, 30 or 90 days worth of medication provided during a single dispense, the work for each dispense is exactly the same," said Bodnar.
"That is why our dispensing fee is independent of the supply or cost of the drug."
The process of filling prescriptions requires careful work to ensure patients get the correct medication, dosage and regimen, said Bodnar. She said pharmacies have had to take on added significant costs as a result of the pandemic, including purchasing personal protective gear, extra security tape and expensive disinfectant cleaner.
She said pharmacists still have the discretion in some cases to prescribe larger supplies than 30 days.
“If a patient is in a situation where they can’t pick up a drug and there’s no delivery available or they have no health plan because they lost their job, a pharmacist can say, ‘You know what, I’m going to give you the 90 days.'
“They retain that authority because they always act in the best interest of the patient but they also have to balance that with acting in the best interest of public health."
Since supply restrictions were put in place, the association has been pressuring the province to cover the added dispensing costs for pharmacare members, she said, and the group is also hoping the government will also assist people who have no drug plan.
"We’re hopeful they’ll come to the table with something because they’ve done so in the other three Atlantic provinces.”
The province hasn’t committed to covering additional dispensing fees for pharmacare participants. Marla MacInnis, a spokeswoman for the Nova Scotia government, said in an email that the province "continues to monitor the impacts of COVID-19 to determine the most effective ways government can support Nova Scotians."
She said the changes wouldn't have any impact on many in the program because the majority of claims submitted to pharmacare are for 30-day supplies or less.
It's the minority that had been relying on 90-day prescriptions that the government and pharmacies should be worried about, argues Herder.
"While it might be heartening to hear that there are many folks who this isn’t a problem for, the fact that it is, I would wonder about those folks being the most vulnerable," said Herder
"Those are the people that we may be needing to prioritize."
