The great Canadian prescription scam

Healthcare in Canada has one of the characteristics that supposedly sets Canadians apart from their southerly neighbors, with it being freely dispensed to everyone, compliments of the government.

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But in recent years there have been grumblings about the shortcomings of the Canadian government healthcare monopoly with long waiting lists for treatment and less than stellar outcomes. The excuse most often heard is that there isn’t enough money being spent on healthcare, but given that total Canadian government expenditures on healthcare during 2008 were in excess of $162 billion or nearly $5,000 for every man, woman and child in Canada, one wonders where all the money went. Here’s an example of some of the waste in the Canadian healthcare system that is shortchanging patients, while filling the coffers of corporations. A friend of mine has an aging and ailing family member in a nursing home in a medium sized town in Ontario. The total number of residents in this nursing home is 107. Prescriptions for most but the wealthiest seniors are covered under the province of Ontario’s Drug Benefit Plan (ODB) and most seniors are required to co-pay $2.00 per prescription for the dispensing fee, while the government pays up to an additional $7.00, plus the cost of the medication. The pharmacy that fills the prescriptions on a contract basis for this nursing home sends monthly bills to my friend for the $2.00 per prescription co-pay for her relative’s medication. It struck my friend as odd that the prescriptions were filled on a weekly basis, meaning that each prescription was for a total of seven pills, which amounted to $1.00 per pill in dispensing fees. And since the patient had been prescribed seven different medications the weekly bill for co-pay came in at $14.00, while the weekly bill to the government was for $49.00, plus the cost of the medication. When my friend contacted the pharmacy, in this case Shopper’s Drug Mart to ask why these prescriptions were being filled on a weekly basis, rather than, say monthly, which would cost everyone a whole lot less, the clerk at Shopper’s Drug Mart wondered why she cared since the lion’s share of costs of the weekly prescriptions were “being paid by the government”. My friend had to remind her that “the government” is owned and operated by taxpayers and as such should ensure that monies are spent wisely. The clerk then explained that the reason these prescriptions were filled on a weekly basis was because nursing homes did not have the wherewithal to store and dispense their residents’ medication on a monthly basis and patients’ prescriptions were being filled on a weekly basis in blister packs that contained all of a patient’s medication for a week in one convenient package, which relieved the nursing home of the burden of having to provide storage and management of the patients’ meds. That’s all well and good, but a simple exercise in arithmetic would demonstrate just how wasteful this practice is. Most residents of nursing homes have multiple prescriptions with many taking upward of 10 to 12 different medications per day. Let’s say the average is 7 different prescriptions, meaning that the government will be paying $49 per week in dispensing fees, which comes out to $196 every four weeks, or $2,548 per patient per year. If a nursing home has 107 patients the total in dispensing fees for that one nursing home comes to $272,636 annually. That’s a nice chunk of change for companies like Shopper’s Drug Mart who likely have contracts with hundreds of nursing homes across Ontario. And while a $9.00 per prescription dispensing fee is somewhat less than the going rate, when it comes in on a weekly basis it quickly adds up. What would be wrong with these pharmacies filling prescriptions for seniors on a monthly basis, using the same blister pack methods they currently use to help the nursing homes better manage their residents’ medication? Even if the ODB paid slightly more to have these prescriptions filled on a monthly, rather than weekly basis, the savings would be enormous and could be utilized elsewhere. It seems like the people watching the Ontario government’s healthcare expenses are asleep at the wheel.