Ontario's MedsCheck program could see changes amid allegations of improper use

Marg Davies says she was shocked when she learned, through her doctor, she'd supposedly had a recent MedsCheck done.

"I was angry because I knew that I hadn't had one," she said. "There was a charge to the government and that's what bothered me."

MedsCheck, also known as medication reviews, is a government program that re‐ imburses pharmacies in On‐ tario for reviewing a patient's medications to ensure they're being taken correctly. Davies says hers was processed by a Shoppers Drug Mart in Georgetown, Ont., where she gets her pre‐ scriptions filled.

To be eligible, a patient has to be taking three med‐ ications for a chronic condi‐ tion, have diabetes or live in long-term care. An annual re‐ view costs the government $60, or $75 for a person with diabetes, and follow-ups are billed at $25.

"I happened to have gone to my doctor about a month after this had happened," Davies said. "I found out about it. How many other people have had Med‐ sChecks charged to them and they're not aware of it?"

Allegations of improper MedsChecks at Shoppers Drug Mart and corporate pressure to hit billing targets for them, as outlined in a re‐ cent CBC News investigation, has prompted some in the industry to take a closer look at the provincial program.

Since the stories were published, the province's reg‐ ulatory body, the Ontario College of Pharmacists, says it's tracking MedsCheck com‐ plaints that could specifically be related to pressure to meet corporate targets.

"We have also begun to retrospectively analyze cases from previous years in which corporate pressures may have played a role," spokesperson Dave Bourne said.

Some former Shoppers Drug Mart pharmacy employ‐ ees told CBC they believe the company was taking advan‐ tage of the program by push‐ ing staff to bill for consulta‐ tions patients didn't neces‐ sarily need. And dozens of in‐ ternal records showed the chain has billing targets for Medschecks, and that corpo‐ rate management pressured owners to meet them.

Associate owners get a cut of the professional services, including MedsChecks, billed by their pharmacies, while the rest goes to the chain.

Shoppers Drug Mart's president previously told CBC there is no corporate pres‐ sure to bill and denied the use of targets. The statement was at odds with what multi‐ ple current and former Shop‐ pers pharmacists said.

A Shoppers spokesperson did not answer questions re‐ lated to Davies's allegations, but said in a statement that MedsChecks are "a vital health-care service that can save lives."

Pharmacists association wants changes

The Ontario Pharmacists As‐ sociation says it will be sitting down with the provincial gov‐ ernment in the coming weeks to discuss potential changes to the program.

Justin Bates, the organiza‐ tion's CEO, says it's wanted to discuss a redesign for years now, but it's recently come to the forefront given CBC's re‐ porting as well as pharma‐ cists' concerns.

Bates says he hopes to discuss ways to lessen the administrative burden of the program, making changes to its eligibility and considering whether it should be ex‐ panded into a chronic dis‐ ease management program.

WATCH | Industry look‐ ing closely at MedsCheck program:

"What I'd like to see is the proper use of how we go about measuring success and health outcomes being a big part of that rather than necessarily driven by a bot‐ tom line," he said.

"Maybe putting in some more safe guards around the virtual MedsChecks. Virtual care is important, but we also need to make sure it's being done appropriately and not open for abuse."

Bates also says it's vital pharmacists have protection to be professionally au‐ tonomous when it comes to making decisions for patients and delivering care.

"There is benefit to the system and patients when [MedsChecks] are done ap‐ propriately and implemented the right way."

When asked about imple‐ menting changes to the pro‐ gram, Ontario Health Minis‐ ter Sylvia Jones said it's work‐ ing with the association to ensure the program brings value to patients and reaches those who are on multiple medications.

"We'll tweak when it's ap‐ propriate, but to ensure that the programs actually are providing the necessary over‐ sight for patient safety," she said.

Jones also said all health programs, including Med‐ sCheck, are constantly moni‐ tored and assessed.

After CBC's reporting on the issue, Jones said she told the ministry to review the program and that there's been "a number of activities specifically related to assess‐ ing the MedsCheck pro‐ gram."

It's unclear what that en‐ tails, though Jones pointed to steps the Ontario College of Pharmacists is taking.

'Deeply troubling'

That regulatory body says its working on a report based on thousands of responses from pharmacists sharing their "deeply troubling" experi‐ ences with corporate pres‐ sure in town halls and an on‐ line survey, which were launched in light of CBC's in‐ vestigation.

"It's heartbreaking to watch," the college's CEO and registrar Shenda Tanchak said in an interview.

"There isn't any question that this profession is in crisis and if we want them to be able to continue to provide the care that they want to and that they are capable of we need to help clear the way."

While the Ontario govern‐ ment says MedsChecks are supposed to take between 20 and 30 minutes, Tanchak says the college heard from pharmacists who say they're being done in a couple of minutes.

"Maybe something impor‐ tant gets missed in the pa‐ tient's care," she said.

While the college licenses pharmacists, it doesn't have the same authority over the companies they work for, but it's working with a legal team to explore its options given the allegations of corporate pressure.

"We are looking at things like accreditation standards that require business owners to demonstrate or for us to be reassured that the busi‐ ness will be run with in‐ tegrity," Tanchak said.

Shoppers Drug Mart says it's focusing on working with pharmacy owners to ensure they have the supports they need to continue providing services to patients.

Documents obtained by CBC show the chain recently

implemented an updated MedsCheck procedure in On‐ tario that includes a more robust documentation of pa‐ tient consent and acknowl‐ edgement of the scope of services within a review.

MedsChecks valuable, pharmacist says

Sony Poulose, owner of Sher‐ man Speciality Pharmacy in Hamilton, Ont., says his team conducts a MedsCheck near‐ ly every day because his pharmacy specializes in pa‐ tients with chronic conditions who are often on multiple medications with compli‐ cated regimes.

"We find this is a very valuable program and we could avoid a lot of other health issues [using it]," he said.

Polouse says his pharma‐ cy carries out MedsChecks on a case-by-case basis and often sees patients who were recently discharged from the hospital with a new diag‐ nosis.

His team sits with them to avoid drug interactions and duplications and ensure pa‐ tients understand how to properly take their medica‐ tion.

"It's very, very important to use this kind of program appropriately," he said. "The patients' benefit should be the primary focus."