Corporate pressure led Shoppers Drug Mart staff to bill for unnecessary medication reviews, pharmacists say
Internal letter describes push for billable work as 'borderline abusive'
Sitting at her home in Ottawa earlier this month, Mary Fernando got an out-of-the-blue call from her pharmacy at Shoppers Drug Mart.
An employee on the other end of the line asked if she was still using two inhalers to control her asthma, as she had been doing consistently for years. She said yes.
The employee then asked whether she was happy with the medication. Again, Fernando said yes, then quickly ended the call — all within five minutes.
"It was just a bizarre conversation," she said.
Fernando later realized Shoppers Drug Mart had billed for the conversation as a virtual medication review under Ontario's MedsCheck program, which reimburses pharmacies in Ontario for meeting with patients to go over their prescriptions.
"I could not imagine a milder patient than me, right? And a more useless MedCheck," Fernando said in an interview.
"You think that money could be used — should be used — more wisely."
CBC News spoke with former Shoppers Drug Mart pharmacy employees who believe the company is taking advantage of the MedsCheck service by pushing staff to bill for consultations patients don't necessarily need. The company can then bill the province up to $75 per call.
WATCH | Former Shoppers Drug Mart pharmacy employees believe company is taking advantage of Ontario program:
Eight former Shoppers Drug Mart employees said intense pressure from management pushed staff to cold-call customers regularly. In an internal letter obtained by CBC News that was emailed to company leadership last July, a group of pharmacy owners said the "borderline abusive" pressure to do more MedsCheck calls was affecting their ability to provide the best patient care.
"It's a shame, it's a disappointment," said pharmacist Jon Nhan, who said he left Shoppers Drug Mart to work for an independent pharmacy last year.
"I worry that something like this could really could set us back as a profession, as a health-care system, and for patients — ultimately because they are the ones who would potentially miss out and suffer."
In an interview on Tuesday, Shoppers Drug Mart president Jeff Leger said the company does not "pressure pharmacists to bill for MedsChecks" in order to turn a profit.
"We obviously monitor this very closely, take these allegations very seriously, but really believe that MedsChecks and med reviews are actually having a positive impact on Canadians," said Leger.
MedsCheck is a government program that reimburses pharmacies in Ontario for reviewing customers' medication to ensure they're informed about their prescriptions and taking the right combination of medicine. People are eligible if they're taking at least three medications for a chronic condition, living in licensed long-term care homes or receiving treatment for diabetes.
At the beginning of the COVID-19 pandemic, the Ontario government allowed for consults to be done over the phone.
The service is free to the public, but the provincial Health Ministry reimburses pharmacies up to $75 per call — nearly double the $38 that family doctors can bill for a patient visit.
Nhan said it has been "generally a valuable program," but he and other pharmacists who spoke with CBC News said they believe Shoppers Drug Mart is exploiting the service in some instances.
Several pharmacists said top-down pressure from "corporate" or "upper management" led them to schedule or make "unnecessary" MedsCheck calls to customers who were technically eligible for the program but not what they would consider to be high risk.
Staff wrapped up some calls in five minutes or less, as in Fernando's case, despite the program saying proper reviews should last 20 to 30 minutes.
Nhan said he never personally felt MedsCheck pressure because his manager at Shoppers Drug Mart shielded staff — but a new owner who "explicitly mentioned" new billing targets was part of the reason he quit last year.
"That was the last straw," Nhan said.
In his interview with CBC, Leger said internal data showed MedsChecks helped patients with their medication or reduced the risk of an "adverse event" roughly 40 per cent of the time. He said the company does not have MedsCheck quotas.
"There's a meaningful service, and this is particularly important in a scenario where there's a lack of access to health care," Leger said.
"We don't have targets or any other kind of element like that."
On Wednesday, Ontario Health Minister Sylvia Jones said the ministry would looking into the issue.
"We'll absolutely do our due diligence to make sure the program is being used appropriately," she said in a brief interview at Queen's Park.
'I definitely felt like I was harassing people'
One former pharmacy assistant at Shoppers Drug Mart in Ottawa said they were tasked with scheduling cold calls with customers from 2022 to 2023. They said their manager brought the issue up daily, asking them to make as many as 20 calls per shift — "96 per cent" of which they said they booked in for reviews.
"I definitely felt like I was harassing people," said the former assistant, whose name is being withheld by CBC News because they now work for a different pharmacy owned by Loblaws.
"When I wouldn't hit the quota that they (higher-ups) would set for me, there would be some annoyance from the higher-ups, which was an annoyance because I didn't exactly sign up to be a telephone telemarketer."
The assistant said pressure to schedule MedsChecks was a "significant" factor in their decision to quit last year.
"When I found out that the MedChecks money was just basically going to Loblaws themselves, it was like, 'OK, I don't want to be part of corporate greed.'"
Often, the former pharmacists who spoke with CBC News said, patients didn't realize the call was an official MedsCheck conversation — or that Shoppers Drug Mart would be reimbursed for the exchange.
In a statement, the Ontario Ministry of Health said, "all virtual professional services, including MedsChecks, must be conducted from the location of the accredited pharmacy."
"Convenience is not a valid reason" for a virtual call.
Last month, a Shoppers Drug Mart location in Milton, Ont., published a job posting on LinkedIn looking to hire a pharmacist whose job would be "particularly" focused on doing "virtual medication reviews in line with the MedsChecks program."
Push 'creating safety concerns' for patients, letter says
The letter the group of pharmacy owners sent to Shoppers Drug Mart leadership said performance expectations — including for MedsChecks — had contributed to a "toxic poison" affecting company culture.
"The pressure ... put on front store and pharmacy metrics and professional services is borderline abusive and is creating safety concerns for the provision of good medical care to patients and customers," reads a portion of the letter emailed to Shoppers Drug Mart management on July 5.
"The pressures are so unsustainable and unrelenting that they are seriously affecting the mental health of many associates and seriously compromising the quality of care to our communities and ultimately the incredible brand of Shoppers Drug Mart."
It added, "These pressures are not in the spirit of the way a real MedCheck is meant to be done."
The group said one senior leader was "being intimidating and threatening the livelihood of associates and pharmacists who are being forced into billing professional services by assigning daily 'targets' which are being policed by the district managers."
Leger confirmed he received the email.
"I did read the letter, and we take these things, these elements really seriously and continue to review the situation," he said Tuesday.
The pharmacy employees who spoke with CBC News said MedsChecks take up time pharmacists could be spending on prescriptions, immunizations and other aspects of patient care.
The calls waste time for family doctors, too, according to two physicians who spoke with CBC. A patient's doctor has to sign off on every record of a MedsCheck call — even if the customer didn't raise any concerns during the call.
"It's not uncommon to get several [MedsCheck call records] in a day … and the vast majority of the time, the 'no issues' box is checked, so there's really nothing to do," said Dr. Michelle Cohen, a family physician in Brighton, Ont.
"It's a big time suck. It literally takes me away from my patients because I have to budget time for paperwork."
Regulator 'aware' of concerns
The Ontario Ministry of Health said it paid out $60 million for MedsChecks in the 2022-2023 fiscal year, but declined to provide a financial breakdown showing how that money was spread between different pharmacies.
The Ontario College of Pharmacists, the province's regulatory body, said it was aware of general concerns pharmacists were being pressured to deliver certain services — including MedsChecks — but had not received any official complaints as of late February.
CBC News contacted Rexall, London Drugs, Costco and McKesson — the parent company for Guardian, I.D.A., Remedy'sRx and The Medicine Shoppe — to request information on their MedsCheck practices.
A representative for Rexall said it would "under no circumstances … encourage the provision of any clinical services that are not in the best interests of the patient." A statement from McKesson said independent owners are responsible for setting and managing their own policies at individual pharmacies.
In an email, a representative from a public relations firm said London Drugs "respectfully declines the opportunity to engage on this topic."
Costco did not respond by deadline.
With files from Ana Komnenic and Christine Birak