CICPO and Medavie Blue Cross Reach New Agreement

NEWS RELEASE

CICPO and Medavie Blue Cross

New Contract seeks to Maximize Health Outcomes while Controlling Costs

2012-07-06 St. John’s NL – For Immediate Release 

The Council of Independent Community Pharmacy Owners NL and Medavie Blue Cross are pleased to advise they have reached a new 3 (three) year agreement.  This is the second successful negotiation of a contract between the two parties and includes financial terms that address the recent generic drug pricing reforms.

This agreement comes at a time when independent pharmacy revenues are being eroded by changes to generic drug pricing at the governmental level. “We are pleased to see Medavie Blue Cross participate in a process of real negotiation and meaningful recognition of independent pharmacy in Newfoundland and Labrador,” says Director of Third Party Relations CICPO, Phil O’Keefe.

“Medavie Blue Cross recognizes the impact of rising drug costs on the industry and our clients”, said Laurier Fecteau, Senior Vice President, Medavie Blue Cross. “We have worked with CICPO’s independent pharmacies to develop unique agreements to ensure all our members have access to the best value at their local pharmacy.”

O’Keefe adds, “Our Council represents local pharmacy service and product delivery in all regions of our province and Medavie Blue Cross recognizes the importance of our role in front-line health care – whether located in rural communities or inner-city neighbourhoods. This continued progressive relationship will achieve best health outcomes at the least possible cost.”

Fecteau continued, “We recognize the important role of Pharmacy in servicing our clients and plan members.  We understand the unique circumstances of independent pharmacies and are pleased we were once again able to negotiate a contract that recognizes the importance of rural and neighbourhood pharmacies in the communities where they do business.”

Both parties continue to develop best practices in their respective responsibilities of health benefits provision and pharmacy collaborative care, and are working jointly on initiatives in the areas of medication and disease management, and collaborative care between pharmacist, physician and patient.

 “Medavie Blue Cross demonstrates an understanding of our unique geography, demographics and pharmacy model – which results in knowledgeable discussions about improving front-line health care delivery. As a result, the people we both serve benefit from a cost perspective and by maximizing best-health outcomes”, concludes O’Keefe.

Both parties also look forward to continued development of pilot projects in the areas of medication and disease management, and the promotion of collaborative care between pharmacist, physician, and patient. 

Medavie Blue Cross, based in Moncton, New Brunswick, offers health, life, and travel products to individuals and employers in Atlantic Canada, Quebec and Ontario.  The Council of Independent Community Pharmacy Owners is a trade body for local pharmacies in Newfoundland and Labrador.

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About the Council of Independent Community Pharmacy Owners

A progressive trade organization representing the majority of independent pharmacies in Newfoundland and Labrador, the Council offers its members business support, third party negotiations, research and development of pilot projects and advanced policy positions. Additionally the Council works with industry partners to ensure the continuity of equitable front-line health care services in all regions of our province.

At a time when Atlantic Canada is experiencing an aging population with escalating occurrences of chronic disease, the Council is dedicated to maximize best health outcomes at the least cost through medication and disease management programs.

About Medavie Blue Cross

With roots dating back to 1943, Medavie Blue Cross provides health, travel, life and income

replacement products to group and individual customers, administers various provincial and federal government-sponsored health programs and, through subsidiary companies, manages ambulance services in New Brunswick, Nova Scotia, Prince Edward Island and the Muskoka and Chatham-Kent

regions of Ontario.

A member of the Canadian Association of Blue Cross Plans, Medavie Blue Cross operates from offices in Moncton, Dartmouth, Montreal and Toronto as well as Quebec City, Halifax, Fredericton, Saint John, Bathurst, Charlottetown and St. John’s.

Notice to Editors

Notice to Editors: 16/04/2012

Please be advised that the Council of Independent Community Pharmacy Owners is preparing information for a News Conference on Thursday or Friday of this week.

This conference will outline the catastrophic losses to independent pharmacy from both the agreement imposed by government and the changes to generic prices forced by legislation. 

Please note that an amending agreement was executed on April 14-2012 and delivered to pharmacies yesterday afternoon. 

There is no tentative agreement and there is no ratification process for pharmacies.

Initially government stated it was making changes to generic drug pricing and would reinvest in pharmacies. The government has since made further changes in an imposed amending agreement that will see negative changes to the reimbursement of dispensing fees. 

Currently there is a “proposal” in place regarding “underserviced” areas regarding an annual reimbursement for qualifying pharmacies. Today there is no agreement on the terms and conditions of such reimbursement.

Further the administration for pharmacies respecting the change in their computer systems to reflect the imposed agreement could not be completed between yesterday afternoon and this morning at opening. This is causing significant confusion as patients fill their prescriptions today. 

The Council will advise editors of the time and place of the conference and the attendees for interview. 

At this point the only comment from the Council is:

Phil O’Keefe Director of Third Party Relations CICPO 

“Our worst fears have materialized; independent pharmacy and the people they serve have been dealt a crippling blow. We are incensed that an agreement was reached without ratification of the businesses it will impact; and in fact was signed by the President of the Pharmacists’ Association of Newfoundland and Labrador, Sandra Carey, who does not own or operate a pharmacy in Newfoundland and Labrador. The government has imposed an agreement which will allow the chain drugstores and mass retailers to survive while inequitably harming independent pharmacy”.  

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CICPO Members Speak Out - Change is Coming

Independent Pharmacy owners raise concerns

Published on April 10, 2012  Gulf News

Corinna Yates  

"So disgusted."


Those are the words from Cindy Goudie, owner operator of The Medicine Cabinet in Port aux Basques.

As a small business owner, Ms. Goudie is concerned that the passing of bill 12 will eventually lead to financial difficulty for her and other independent pharmacy owners.

The bill, titled An Act to Amend The Pharmaceutical Services Act, will provide residents of this province with lower cost generic prescription drugs.

Health Minister Susan Sullivan held a news conference in St. John's on March 26. The new system for generic drugs will be phased in starting April 1.

The new regulations would mandate that all generic drugs be sold at 35 per cent of the cost of their corresponding brand drug.

Currently, generic drugs average about 60 percent of brand prices. The reduction would be phased in over the next year.

The government is saying that seniors are not going to be affected. However the Newfoundland government does not cover dispensing fees for seniors. So if the fees go up seniors will be paying more for their prescriptions, according to Ms. Goudie.

The provincial government is planning on saving more than $30 million on generic drug cost with this new pricing policy.

"There is no way that the government can move in, take the revenue out of your business and expect you to survive," said Ms. Goudie. "When there is revenue lost, we have to find a way to replace it."
The Medicine Cabinet has no storefront like some big pharmacies do. They just have a dispensary. They have nothing to fall back on in order to increase their revenue.

"What happens when the government comes in and starts saying we are going to make adjustments to generic drug pricing," she said. " A lot of the times this is how we keep our business open."
According to Ms. Goudie this will certainly impact her revenue.

"I think over all, you are going to see pharmacies having to increase their dispensing fees," she said. "This in turn will have an effect on seniors, on everyone."

The Council of Independent Pharmacy Owners (CICPO) had a meeting last week on how they are going to approach this.

"Susan Sullivan has shown us nothing," she Ms. Goudie. "Ms. Sullivan is saying there will be money re-invested back into pharmacies but gave no definite answer as to when this would happen."
Members of CICPO are hoping that government will talk to them.

According to Robert Doyle, spokesman for CICPO, independent pharmacies rely on rebate payments from generic drug manufactures in exchange for stocking their shelves.

"The members of CICPO worry that those payments will evaporate as the manufactures are squeezed," he said.

Both the Liberals and the NDP said they have concerns about the independent pharmacies, and they worry about the effect the new system could have on senior citizens.

Yvonne Jones, Liberal house leader, said she will be proposing amendments to the bill.

According to Ms. Jones, many seniors don't pay for drugs because they are covered by the provincial drug plan, but they do have to pay pharmacists' dispensing fees.
"If the government decides to increase regulated dispensing fees to help out independent pharmacist, it could lead to low-income seniors paying more for drugs," she said
.
According to Susan Sullivan seniors will not have to pay more for their drugs.

Craig Walters manages his parents' pharmacies in both Burgeo and the Codroy Valley. He has the same concerns as other independent pharmacy owners.

"I could be looking at 40 per cent loss in revenue from our professional fees," he said. "That money is used to run our business, pay our staff and keep inventory in stock."
According to Mr. Walters, 40 per cent of his sales come from prescriptions.

"The problem is they are changing generic pricing and telling us they are going to take care of the small independent pharmacies, yet they are not telling us how or what they are going to do," he said.
According to Mr. Walters, people in rural communities depend on their pharmacies for not only prescriptions but other things as well.

"In Burgeo we are the only pharmacy and if we were to close down people would have to travel two and a half hours to the nearest pharmacy," he said. "We give out counselling to our customers on different topics such as over the counter prescriptions or how to read their blood sugar meters."
They also provide other free services like faxing doctor's forms.

"Now customers may have to start paying for those services because we may not be able to continue to do that for free," he said.

Bad Prescription for the People

The Government gets its Way and YOU PAY

Outside of the spectacle most PC MHA's displayed in the House of Assembly last week - regarding the change in generic drug pricing - we have a much more serious problem.

That session of comedy revealed an underlying weakness in our political leadership.

I will let the reader decide if stupidity, corruption, indifference, or vindictiveness is the cause.

First let's agree on a few things.

The following are the essentials of life for people in our province:

1. Food
2. Shelter/Housing
3. Energy
4. Transportation
5. Health Care - including Prescription Medications

Today we will deal with number 1.

The price of food is of primary concern to the vulnerable people of our society. Individuals and families living on fixed low incomes are challenged every day to eat - let alone eat healthy.

Every week when one shops at the supermarket one notices the increase in the price of food. 

Food prices rose 4.1% on a year-over-year basis in February, following a 4.2% increase in January.

What is the response of the Government of Newfoundland and Labrador? Nothing! They rely on provincial food banks to hold people over from week to week.

Supermarkets receive rebates for purchases and particular shelf space so there is money in the system to reduce the price of food.

Considering that government (taxpayers) help low to no income people and families through income assistance - in part to buy food - then one would think government would direct food manufacturers to lower the price of generic food. Example - a tin of Carnation milk (brand) compared to a tin of Our Compliments milk (generic). Price of Carnation milk $1.50 and Price of Our Compliments $1.25. Therefore the generic tin milk is priced at 83% of brand. So if the Government of Newfoundland and Labrador lowered the price to 45% of brand then the generic tin of milk would cost 68 cents. Now we're talking.

Then if Dunderdale continued on and lowered the generic milk price to 35% of brand then the price would be 53 cents a tin.

Now if a person or child does not react well to the generic milk and finds that Carnation is the only one they can consume then a special authorization would be needed from government so that they can get enough money to pay for Carnation milk.

While the special authorization is approved - Mr. Sobey could give the customer the milk until the person is approved in 4 weeks. In either case Mr. Sobey would have to wait a week to be paid for the generic milk.

The question is will Tom Marshall, Kathy Dunderdale, and Susan Sullivan ask Mr. Sobey to sharpen his pencil?

For those of you not on any form of income assistance - your price would be lowered too. The Government of Newfoundland and Labrador when regulating prices - apply that price reduction to all citizens.

Do you think the supermarkets can afford to lower their prices?

For many medical conditions - a proper and healthy diet is essential. If the person is a diabetic - incorrect food choices could mean the difference between $1500 dollars worth of drugs a year and $15,000 dollars to keep the disease in check - including otherwise unnecessary stays in the hospital or by a worsening of the disease.

So the biggest problem in Newfoundland and Labrador today is the small independent pharmacy - the same people who day after day ensure people do not go without medications? The pharmacies that have a rotating credit for customers at about $20,000 per pharmacy - the pharmacies that are there whenever they are needed. The pharmacies who have provided free essential services to the people under their care.

Meanwhile the price of generic drugs are going down through competition and are reducing the price of drugs government pays for by replacing brands.

I watched a group of MHA's who were elected to represent people - stand up an speak about something they knew nothing about. The ignorance was incredible. Unfortunately - this means the decisions made are not going to bring the stated desired result.

The government chose this time not to listen to Dr. Wade Locke or the people who are experts in pharmacy services. This time they listened to unknown sources of information but were lobbied by brand companies.

Make no mistake - the money - if any - saved on the generic price changes will be gobbled up by oil and gas giants, mass retail and grocer corporations, and brand drug houses.

Make sure you have the number for your MHA handy as changes occur. It is he or she that has caused the problem.

Changing the face of pharmacy - is not the prescription you need.

Government Ignores Reality - will cost Seniors and Families

News Release

New Pricing Scheme Threatens Rural and Inner-city Services

For immediate release, St. John’s – 26/03/2012

Minister of Health Susan Sullivan is demonstrating a dangerous level of ignorance as she adopts a health policy that will irreparably harm front-line health care delivery in rural communities and inner-city neighbourhoods. 

The changes proposed to the generic pricing model to keep up with other provinces in Canada ignore the social demographics, geography and specific needs of Newfoundland and Labrador.

The Council’s spokesperson, Robert Doyle says, “Do we want Newfoundland and Labrador to spend more - per-capita - on generic drugs? No! But will the Dunderdale government achieve lowering the costs by simply copying the models of other provinces? No!” 

Here's why:

1. Our population is aging more quickly and therefore there is a greater requirement for chronic disease medications. 

2. The prevalence of conditions such as diabetes is higher in our province.

3. The lack of medication and disease management programs involving community pharmacy. 

Doyle adds, “The Government of Newfoundland and Labrador will not lower health care costs they will grow them. The Government of Newfoundland and Labrador will lose any ability to provide medication and disease management programs in rural areas and in the inner-city. The Government of Newfoundland and Labrador will lose informal collaborative medication and disease management currently taking place in independent pharmacies.” 

The Council believes this is not an issue of escalating drug prices – as the prices are going down every year as more generics enter the marketplace and through natural competition among generic manufacturers. This is an issue of poor policy review, research, and planning.

The government tried to buy the silence of pharmacies by signing a non-binding amending agreement with the Pharmacists’ Association of Newfoundland and Labrador. It does nothing for the viability of independent pharmacy and is an insult to local small business. 

“The Minister either does not understand or refuses to see the inherent problems in the government’s plan. The government does not have the information it needs to make this decision and it will result in unintended consequences”, Doyle says. 

Government says it will save tens of millions of dollars from a generic drug price reduction – that is not the case.  While generic drugs are being used in the majority of prescriptions filled they make up less than 40% of costs to the program. 

Doyle states, “If government wants to make a real difference in current costs and sustain costs in the future they must look at increasing generic utilization and developing – with pharmacy – a real medication and disease management program.” 

The Council is holding a meeting of its members within the next week and decisions regarding the next course of action will be discussed and ratified at that time.

The first decision has already been made – the Council will engage Dr. Wade Locke to do a thorough analysis of the situation and to develop a made in Newfoundland and Labrador solution.

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Additional Information

The CICPO represents the majority of independent pharmacies in Newfoundland and Labrador.

The CICPO members are located throughout Newfoundland and Labrador and are the only model of pharmacy available in dozens of regions.

Independent pharmacies average 10% front-store sales (other than prescription medications) and 90% back-store (prescription medications) in its sales mix.

Chain drugstores and mass retailers; Shopper’s Drug Mart, Lawton’s/Sobeys, Walmart, Zellers, Costco, and Loblaws range from a 50/50 sales mix with many averaging over 90% in front store sales.

The changes to the generic pricing policy will severely affect independent pharmacies while the chain drugstores and mass retailers gain opportunities to consolidate the marketplace.

Chain drugstores and mass retailers have buffers from revenue loss such as:

a)      In-house wholesale

b)      Front shop sales

c)       Private label generic drugs

d)      Mass purchasing power

This gives the chains and mass retailers a governmental regulated advantage over Newfoundland and Labrador pharmacies.

Government’s negotiation with PANL does not bind corporations and therefore may result in a rejection of the government drug card.

Private Insurance companies negotiate directly with business which is contrary to the position of the Government of Newfoundland and Labrador – which negotiates with a professional body that has no corporate authority to negotiate.

Generic drug prices have been reduced over the past five years from 70 per cent of brand to 50 per cent of brand through natural competition. Generic drug prices are going down every year. It is the only area of reduced costs in the Health system.

The Government of Newfoundland and Labrador has not completed a review on the potential unintended consequences of this policy and does not have any information that rural and inner-city independent pharmacies can survive this cut to revenues.

Economist Dr. Wade Locke believes that a complete study should be undertaken before this policy is adopted – including developing an optimum model for Newfoundland and Labrador considering – demographics, geography, services, and pricing.

Independent Pharmacy Identifies More Savings for Government

How about $800,000 a month? Next Up Crestor - Where's the Minister?

It is now widely believed that the generic version of Crestor (another cholesterol drug) will be available for the market by April 2012. Great for the health care budget.

Crestor was the the most costly drug in Canada last year coming it at $875,000,000.

Newfoundland and Labrador's portion of this was over $19 million.

When the generic is released it will cost approximately half of this amount or over $800,000 a month savings.

If we continue down the same path used for introducing new generics - we will waste over 3 million dollars.

Just imagine the savings.

Now this is a heads-up to the Minister of Health, the Minister of Finance, and the government.

Will they now deal with this problem?

Will the media or Opposition parties ask the questions?

CICPO sounds Alarm on wasted $$ in Health Care

More $$$$ lost from Health Care - Secret Committee

Another half million dollars down the tube as Newfoundland and Labrador takes 40 days longer to list new generic.

In this case Lipitor - a brand drug to help control cholesterol - came off patent protection in May 2010 - and should have been on our formulary by July 1 of 2010. Atorvastatin the generic version did not make our formulary until August 11 2010. This 41 day delay cost us close to half a million dollars.

More interesting in this case - it may very well have been delayed until December of 2010 - if the Council of Independent Community Pharmacy Owners did not directly advise the Department of Finance of this problem.

That would have cost close to 2 million dollars.

Since that time the situation has not been corrected and we continue to lose millions of dollars.

This is the second example of wastage.

Where are the questions?

Where is the media?

These numbers can be independently verified.

Why are drugs available in our hospitals but not available at the retail pharmacy?

Here is another half million for surgeries to remove excess skin or quicker MRI's. 

Complete Investigation needed on Drug Costs

Will Dunderdale, Ball, or Michael investigate? $$$$ LOST!

We have now entered a time-frame industry people like to call the Patent Cliff.

Over the next 5 years residents of Newfoundland and Labrador as with all other jurisdictions in Canada and the USA should experience an extreme reduction in the price of essential commonly prescribed medications.

As these new generics enter the marketplace - our government should act immediately to replace the brand drugs on our formulary. This will save us tens of millions of dollars.

Unfortunately we still have a secret committee determining when our tax dollars will be used wisely.

If you can buy the drug in New Brunswick, Alberta, or Ontario - why not here in our province?

Why are our hospitals permitted to dispense drugs that our retail pharmacies cannot?

Why does our government pay brand prices when savings of 40 per cent and more are available?

Sue's Blog will layout some of the financial losses our government has allowed of our essential health care dollars.

We also need to discuss and understand if there are any potential conflicts within the secret committee that answers only to the Minister - and NOT the House of Assembly. We need to know if any member of the committee has any dealings with the drug companies - outside of the committee - and whether those dealings are commercial in nature.

Is it possible that any committee members - who have the power of recommendation to the Minister of Health - could use that power in commercial dealings?

Do the Brand Drug Houses lobby any of the committee members - in any way whatsoever?

You see something is not right here. We are losing tens of millions of dollars and nothing is being done about it. Sound Familiar?

Open and Transparent - right? Public Accounts - spending our money wisely right?

Where is the investigative journalism? Where are the NDP members on this - they are the champions of health care right?

Challenges and Recognition - Pharmacists - your Health

NEWS RELEASE

March 4-10 2012 PHARMACISTS’ AWARENESS WEEK – CHALLENGES AND RECOGNITION

For Immediate Release – St. John’s 02/03 2012

The Council of Independent Community Pharmacy Owners is pleased to support Pharmacists’ Awareness Week with our valued employees.

Each of our member corporations recognizes the valued contribution of pharmacists in our society. Through progressive and supportive employee and employer relationships our businesses are proud of the services we provide to people, neighbourhoods and communities.

The pharmacist continues to be one of the most trusted professions and independent pharmacy one of the most trusted businesses. This week celebrates the work a pharmacist does whether as an employee of government, the University, hospitals, Centre for Health Information, or of the private sector. Our corporate members will continue to work toward providing a stable workplace for our professional staff. Our members companies continue to lobby government for medication management programs that allow our communities to avail of preventative and stabilization consults that our employees are fully qualified to do.

 

Executive Director, Sue Kelland-Dyer says, “The scope of practice of Newfoundland and Labrador pharmacists is lagging behind many other provinces in Canada. The CICPO encourages the Newfoundland and Labrador Pharmacy Board (NLPB) and the employee representative – the Pharmacists’ Association of Newfoundland and Labrador (PANL) to work diligently to correct this inequity being experienced by our employees.”

The CICPO also encourages the Government of Newfoundland and Labrador to use this week to reflect on policy choices which may diminish significantly the salaries and benefits for this profession and eliminate the opportunities found in the private sector to deliver additional and advanced medication programs that help to ensure compliance, best use of prescription drugs, and best patient outcomes.

“The demographics of our province show that chronic disease management will become a real budgetary challenge over the coming decade. One of the only real ways to curb the anticipated explosion of prescription drug use is through an expanded scope of practice for pharmacists employed by private sector community pharmacies” adds Kelland-Dyer

The Council is concerned that significant cuts to pharmacy revenues will achieve several undesirable outcomes; a reduction in employment opportunities for these professionals, a reduction in a pharmacist’s wages, a reduction in hours of operation, and the elimination of all non-essential services.

 

Evidence is available in other provinces - where pharmacy revenues have been reduced – that these unanticipated consequences are already occurring. The splintered representation of pharmacists through Allied Health, MUNFA, and PANL may be inadvertently acting to thwart the protection of these essential employees and against finding an equitable solution.

The CICPO is willing to work with other employers such as government, hospital boards, and the university to achieve an equitable benefits and salary package and further willing to work with government to maximize the services our corporations can deliver to the people of Newfoundland and Labrador.

The CICPO also encourages the government to review plans to examine emergency room wait-times. Kelland-Dyer states, “Minister Susan Sullivan missed a very important component in the announced study – the Minister missed pharmacists and pharmacies. It is well established that between 10-20 per cent of emergency room visits are due to drug interactions, medication compliance, and the inability for patients to get the drugs they are prescribed in a timely fashion.” 

Kelland-Dyer concludes, “Our businesses employ a large number of the pharmacists practicing in our province and want to take this opportunity to recognize their service and assure them that as employers we are fighting to protect not only the workplace but also their jobs and the services they deliver to our customers.”

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The Stock Market or Your Health - Pharmacy Models

Below is a pharmacy story from Oregon.

It is interesting to note that the some of the same insurance companies are driving the changes in Canada.

The question remains are we going to follow the crowd (other provinces) who have been heavily lobbied by brand drug companies, insurance companies, and chain drugstores?

This is not the model we need for an aging population - we need more of the services offered by independent stores - not less.

We need to make sure that Newfoundland and Labrador keeps the best network of pharmacies and professionals found anywhere. We need to make sure that all our neighbourhoods and communities have reasonable access to equitable services.

Ontario is the province driving these negative and regressive pharmacy remuneration models and the rest of the provinces are following.

The American system is about 5 years ahead of Ontario - look at the results.

If the stock market is going to be the driver of your health outcomes - then what should you expect?

Workloads, chain stores add to safety risks, Oregon pharmacist survey says

Published: Sunday, February 12, 2012, 10:15 PM     Updated: Monday, February 13, 2012, 12:13 PM

By Nick Budnick, The Oregonian

View full sizeJamie Francis/The OregonianPatrick Bowman opened Tualatin Pharmacy 11 months ago and says his business is building. Pharmacy runs in Bowman's family; his father, sister and he once operated seven stores. Before opening his store in Tualatin, Bowman worked in large chain stores. The experience, he says, was not good.

A retired Paisley minister experiences sudden Parkinson’s disease symptoms, so severe he believes death is imminent — only to learn it’s due to the wrong medication.

A pharmacy technician in Hillsboro sells an Ativan prescription to the wrong man, who gets pulled over for driving erratically.

An Astoria woman suffers a cardiac arrest, and later learns her pharmacy for months had overdosed her with thyroid medication.

These are among the estimated hundreds of pharmacy errors reported in the last few years, either to state agencies or in lawsuits. And some pharmacists say errors are happening more than ever.

A recent survey by the Oregon Board of Pharmacy reported that more than 350 chain pharmacists — more than half of those responding — said their working conditions don’t promote safe and effective patient care.

Many complained it is getting worse. “I feel that we are operating on the edge of disaster,” wrote one. “It is a danger zone for us and our patients.”

Last summer, the state board hosted an online survey for roughly 5,700 licensed pharmacists licensed in Oregon. The results were gratifying and disturbing, says board member Ann Zweber. She hadn’t expected so many to respond — more than 1,300; unfortunately, many responded by reporting safety concerns.

“People had a lot to say,” she says. “It concerns me greatly.”

The survey results describe a profession in transition. Independent pharmacies, which once dominated Oregon, now number just 214 out of about 750 retail pharmacies, according to state records. As independents give way to large chains and mail-order operations, increased competition is inserting a bottom-line mentality into the way people get their pills.

Only 25.9 percent of chain store pharmacists agreed working conditions promoted safe and effective patient care — compared to 76 percent of pharmacists at independent pharmacies.

Not only that, more than 200 hundred chain pharmacists commented about workload and safety.

View full size

The survey data isn’t perfect. It’s anonymous and pharmacists were allowed to self-report their type of workplace. But the board believes the survey is credible, Zweber said.

Many complained of having to fill more prescriptions each day with fewer staff; of 12-hour shifts with scant breaks; and constant distractions, such as administering immunization shots to augment profits.

One reported quitting a chain job because of feeling “like I’m going to jeopardize the patients every time I stepped into that pharmacy.” Another said because of lack of staff, “we have seen a huge increase in errors. We used to have a couple per month, now we have a couple per week and sometimes more than one in a day!”

Blake Rice, a pharmacist who used to sit on the state board, thinks many errors are caught internally by improved safety procedures. But he agrees chain stores don’t protect the public, giving drugs “the same lack of oversight as the sale of bread and milk or canned beans.”

Several chain store representatives disagreed.

Chrissy Kopple, spokeswoman for the National Association of Chain Drug Stores, said the survey does not reflect chains’ commitment to quality. “NACDS and individual chains will continue to work with the Oregon Board of Pharmacy to maximize patient safety and health.”

“We have a strong safety record because of our on-going education and training for pharmacy associates as well as our continued investment in technology for our pharmacies to maximize accuracy and patient safety,” said Rite Aid spokeswoman Ashley Flower.

There is no data to definitively show more pharmacy errors are occurring, or that they happen more often in chains. Pharmacies do not have to report errors to any public agency. The pharmacy board considers roughly 80 cases a year involving reporting errors. The Oregon Patient Safety Commission encourages voluntary reporting, but only 94 pharmacies have signed up.

The Institute for Safe Medication Practices solicits confidential reports of pharmacy errors from consumers and pharmacists. The group is seeing a steady increase in such reports nationwide, said Michael Cohen, a pharmacist who heads the group.

He said the group is sending its own survey. “It’s hard for the pharmacists who work at these chains to complain too loudly to their manager or go public because they work there and they don’t want to undergo any type of job issue,” Cohen said.

Joseph Lassiter, a Pacific University pharmacy professor who sits on the Oregon Patient Safety Commission, said the Oregon survey results are disturbing. “This survey is a signal for us that there’s something going on.”

The board of pharmacy is considering rules to keep an eye on working conditions. The rules do not set strict workload levels, but allows the board to fine or suspend a pharmacy license over safety issues.

Oregon is not the first to take on the issue, said Carmen Catizone of the National Association of Boards of Pharmacy. Iowa and North Carolina adopted stringent standards, with a workload review of every reported error where a customer was harmed. He said state pharmacy boards have to strike a balance between public safety and workplace interference.

Zweber says the Oregon board seeks the same balance. “I don’t think we’re going to be that specific,” she said.

Patrick Bowman, owner of Tualatin Pharmacy, says he’s not surprised at the survey. He founded his business 11 months ago after working in chains.

“I don’t have headaches anymore. I don’t have trouble sleeping anymore,” he said. “People come to me because they’re not a number.”