Deceptions of the Dunderdale Government - an Example

As complicated as the pharmaceutical business is - there are some very simple concepts.

Unlike Doctors who have a billing code a pharmacist does not.

The pharmacy - the business - has the billing code for community pharmacy services.

The government is one of many insurers that offers its clients a card to use at a pharmacy.

A pharmacy can choose to accept or reject any insurance card.

The pharmacist does not decide that administrative and business decision.

CICPO is a duly incorporated not-for-profit trade organization that represents its member companies.

As such the CICPO negotiates on behalf of its businesses with insurance companies.

When a tentative agreement has been reached - the members of the CICPO vote on the agreement.

If a majority of members vote in favour of the tentative deal - then each corporation must separately sign an agreement with the insurer. This is a tariff agreement which outlines the amounts that will be paid to the pharmacy for acceptance of that particular drug card. Amounts include a dispensing fee, any specialty fees, mark-ups etc.

At all times the agreement reached is between the insurer and corporation - not a pharmacist.

In Newfoundland and Labrador you DO NOT have to be a pharmacist to own a pharmacy. Wal-Mart, Lawton's, Shoppers, and independent pharmacies can be owned by shareholders who are not pharmacists.

A pharmacy must employ a pharmacist as part of a staff in order that the pharmacy can conduct business.

A Pharmacy has the following expenditures:

1. salaries; CPP - EI - Workers Compensation - Benefits Package,
2. mortgage, lease payments, building maintenance,
3. light and power, Oil, or other energy,
4. taxation - federal, provincial, municipal,
5. security systems,
6. refrigeration,
7.specialized computers - software,
8. consumables such as pill bottles, special packaging, paper,
9. communications, telephone, facsimile, and other,
10. shipping - delivery costs,
11. inventory - medications - both prescription and over the counter drugs,
12. accounting - legal - professional services,
13. snow clearing, paving, property external maintenance,
14. carrying costs (significant when you accept an insurance card and wait up to two weeks for payment),
15. working capital,
16. operating licences,
17. garbage storage and removal,
18. delivery - vehicle maintenance - gas,
19. banking fees,
20. and other normal expenditures of businesses in the service and retail sector.

Not one of the above is the responsibility of a pharmacist.
The pharmacist is an employee of the pharmacy.
If a pharmacist is not working in a pharmacy, they work for Universities, Governments, Hospitals, insurance companies and pharmaceutical manufacturers.

The pharmacist is an employee.

The government of Newfoundland and Labrador wants pharmacies in the province to administer the provincial drug card. It like all other insurers is asking that their clients have the convenience of simply presenting an insurance card for payment of prescriptions drugs.

The pharmacy has the right to accept that card for payment or to reject it - in preference to immediate payment by the customer. This is the same for all businesses - including other essential goods such as groceries, furnace oil, light and power, or telephone.

The government of Newfoundland and Labrador chooses to negotiate with the Pharmacists Association of Newfoundland and Labrador - an organization that is responsible to represent all pharmacists - regardless of where they are employed. The organization is NOT a trade body and pharmacists not pharmacies are the only entities eligible to vote.

Therefore the government of Newfoundland and Labrador is negotiating with employees not the corporations it wishes to conduct trade with.

The CICPO members - all corporate - are not willing to have employee pharmacists negotiate a corporate contract on behalf of the company. The CEO's of the corporations represent the business interests - not the pharmacists - not the employees.

Making matters worse the vast majority of pharmacists in PANL do not have a shareholder interest in private sector pharmacies be they publicly traded or private.

The vast majority of voting members of PANL are employees and have nothing whatsoever to do with running a business or any responsibility for paying the bills of a corporation.

Pharmacists receive a paycheck and benefits from their employer - the pharmacy.

How can this professional organization (PANL) that has the mandate to represent pharmacists as employees also represent the employer - the corporation? How can this same organization claim to represent business when the business has not given express written permission to negotiate anything on the companys' behalf?

Is PANL going to go to the bank for these corporations and seek an interest rate for borrowing? Are they going to negotiate with wholesalers and manufacturers on their behalf? No they cannot and do not. Why then does this organization continue to claim to represent business? That is ethically wrong. It is materially wrong. PANL can say that government is negotiating with them - but PANL cannot claim to be negotiating for any business without the express written permission from the corporation.

The Government chooses to negotiate with PANL - when they have no authority to make decisions on behalf of the business. PANL does not bind a corporation.

Even under the farcical negotiation process with PANL - a "deal" was reached with government which is not binding on pharmacy - and not one corporation was asked to ratify such a "deal".

The CICPO pharmacies were not satisfied with a process which could bankrupt them - without a say - without any control - so they sent a formal notice to the Minister of Health that they would no longer accept the drug card for payment. This is a normal right of all businesses.

The notice was filed in accordance with the Provider Agreement between each pharmacy and government. All insurance companies and pharmacies operate under a "provider agreement" which outlines the rights and responsibilities of both parties.

The provider agreement between government and pharmacies required a 30 day notice for withdrawal of acceptance of the "card" as payment.

Upon that proper notification which was signed and delivered by over 60 individual corporations - the government decided to change the rules. The Government unilaterally changed the 30 day notice to 120 days and also added a condition that all patients that have been in the pharmacy within the past year were to be notified in writing - individually.

Further our members were threatened with disciplinary action and summary convictions if the "new" "immediate" changes to law were not followed.

We remain in the courts with that issue.

Now let's take the absurdity a step further - PANL which is supposed to represent pharmacists as a profession regardless of where they are employed do not actually negotiate any contracts for pharmacists!

The hospital pharmacists are represented by their union.
The University pharmacists are represented by MUNFA.
The government pharmacists are represented by their union.
Private sector pharmacists negotiate with their employer - the private pharmacy, drug manufacturer, insurance company etc.

All of the above pharmacists are voting members of PANL who are then trying to negotiate on behalf of private sector corporations!

We have a total conflict of interest. We have employees through PANL negotiating on behalf of businesses - most of whom have no risk whatsoever.

If a pharmacist has a problem with their working conditions or scope of practice or workplace health and safety - PANL is their representative. How then does PANL represent the employer?

There are no examples of this in any other sector.

The government is simply trying to force business to administer their social program at whatever they deem fit to pay for that administration. They can in fact put the business out of business without the private corporation having any control of their investment.

The government uses PANL as the path of least resistance knowing full well this is not would not be acceptable to any other corporation the government does business with.

When the government used Danny's old law firm to participate in the lawsuit against tobacco companies - the law society did not determine what the firm had to do the work for. Legal aid lawyers do not decide what hourly rate is charged by the law firm Minister Jerome Kennedy used to be a partner in. Tom Marshall did not allow government or a professional association to set his private legal rates.

Their law firms are not FORCED to do legal work for government at whatever rate of pay the government deems fit.

This is a pure deception - and the larger chain drugstores and mass retailers who have the individual ear of government when they employ lobbyists are happy enough to let their competition be slaughtered by government policy - when they publicly state they will be there to pick up the scripts when the more "vulnerable" independents fail. As for rural areas? They would be happy enough to mail the drugs if the local pharmacy disappears. Who cares about urgency, snowstorms, equal access, and rural communities? Good question.

The bottom line is government chooses it's people to sit at a table and then proceeds to dictate who sits on the other side. This is deception. This is dealing in bad faith with the corporations they want to do business with. Most importantly they are placing in jeopardy the equitable delivery of necessary medications to the most vulnerable in our society.

CICPO and Blue Cross Reach New Agreement

Continuing to build on a good partnership - promoting best health outcomes resulting in controlled costs the Council of Independent Community Pharmacy Owners and Medavie Blue Cross have reached a new agreement.

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.

To read complete release PRESS HERE

This type of industrial cooperation will achieve the best results both from a fiscal and health perspective. Positive negotiations that recognize the needs of and objectives of both sides - prove consultation and collaboration work in an arena of respect.

Marketplace and CARP (CRAP)

CBC's Marketplace has done it again.

This time it is with an episode on Travel Insurance called "tripped up" - regarding difficult insurance questionnaires and the "surprises" one may receive when they actually avail of that insurance.

This time they interview Susan Eng the VP Advocacy for CARP - a 50+ group that offers services and advocacy for membership.

In either case the investigation reveals that Manulife has a very tricky and/or difficult questionnaire to be completed when acquiring travel insurance. It shares some pretty sad stories of people who believed they had insurance - only to find out some time after using it - that their "questionnaire" was not filled out properly.

Marketplace needs to do a story on CARP and the relationships it has/had with drug companies, insurance companies, etc to see who is lobbying them.

Eng from CARP states that because Manulife did not agree to an interview with Marketplace - then they must have "something to hide".

Although this story was first shown just a couple of months ago - there was no problem finding a lovely "Manulife" advertisement on the CARP site.

Further the following is offered to CARP members:

The Travel Insurance Program for CARP Members is underwritten by The Manufacturers Life Insurance Company (Manulife Financial), and by First North American Insurance Company, a wholly owned subsidiary of Manulife Financial. Life and health plans offered by The McLennan Group Life Insurance Inc.

Please explain Marketplace why you did not ask Susan Eng why they expose their membership to such a company.

Rural Communities to have Mail-Order Pharmacy? Ask Premier Dunderdale!

Last week - Express Scripts Canada announced it had received a licence to operate a Pharmacy in Ontario. 

ESI for short - is a pharmacy benefits manages and negotiates agreements and provides management services to insurance companies. In other words a middle man.

The Council of Independent Community Pharmacy Owners (CICPO) was in fact in negotiations with the company last year to reach a deal for Desjardins card holders in Newfoundland and Labrador (provincial government employees insurance card).

So the fellow who was sitting at the table across from the independent pharmacies was in fact involved with establishing a pharmacy for the the company he represented. This fellow Mark Murphy was actually gathering further information about pharmacies, costs, and services - reportedly in an effort to reach an agreement with independent pharmacies in Newfoundland and Labrador.

Express Scripts Canada is located in Missisauga Ontario with its Parent company Express Scripts Inc. is located in Missouri, USA. 

As a pharmacy benefit manager - they negotiate contracts for Insurers like Desjardins and in the case of these negotiations - in direct contact with the employer - the Government of Newfoundland and Labrador.

As Express Scripts Canada have now announced they will be looking at setting up pharmacies in other provinces - we might expect that rural areas of the province may now be served by mail order - thereby eliminating the local pharmacy, business, personal service, and professional face to face contact with an essential member of your health-care team.

Is this what the Dunderdale government wanted? Is this why they passed a regulation contrary to the agreement they were under with pharmacies? Is this why they wanted extra time? Will they be seeking to eliminate direct services in rural areas and have all the money leave those communities and even our province?

There is no doubt that a conflict exists here and it is time for the Premier to speak on this matter.