Shoppers Drug Mart accused of unethical billing practices
Shoppers’ billing practices have come under scrutiny, with allegations suggesting a significant shift towards profit-driven healthcare, particularly in the provision of medication review services—aka MedsChecks.
According to insiders and a detailed post on Reddit, Shoppers has been charging the Ontario government upwards of $60–$75 for often unsolicited MedsCheck phone calls, often without clinical basis or need. The compensation figures sharply contrast to what family doctors typically receive for comprehensive, in-person physical exams: $38.
Prior to the pandemic, MedsCheck consultations were mostly conducted in-person as part of a program launched in 2007 for Ontario patients managing chronic conditions and taking three or more medications. A MedsCheck’s intended purpose is to ensure that all prescribed medications are necessary, effective, and not causing adverse side effects. During a consult, a pharmacist evaluates the patient's medication list to identify potential issues, such as unnecessary medications, duplications, or interactions that could be doing more harm than good. After COVID, changes were made that allowed these consultations to be provided virtually or over the phone, with less stringent documentation requirements.
Dr. Michelle Cohen, a family doctor practicing in rural Ontario, expressed concern over the administrative burden that unnecessary MedsChecks place on physicians. "It's not uncommon to get several in a single day...I find the vast majority of the time the 'no follow-up issues' box is ticked, making it a complete waste of my time," she remarked, emphasizing the inefficiency and lack of necessity of the majority of the checks she receives.
Left: A MedsCheck form received by Dr. Michelle Cohen with patient information removed. Cohen and other family physicians say the forms are adding to their administrative burden.
Cohen was particularly taken aback by the financial aspects of the program. "I had no idea how much pharmacies were making off MedsChecks. I find the amount they are making on a single phone call to be insulting given what the typical payment is for a family doctor," she added.
Kara O'Keefe, an independent pharmacist from Newfoundland and Labrador, placed emphasis on the positive impact medication reviews can have when properly conducted. "I have lots of patients (for whom) we have optimized drug use with med reviews," O'Keefe stated, advocating for the benefits of the service when not abused in the manner being alleged. “If there is distrust towards any particular pharmacy or corporation, I would hate for this to rub off onto pharmacists across the country and diminish the great work they do for their patients” she added. O’Keefe also noted that in Newfoundland there are caps on the amount of checks pharmacies are allowed to bill which serve to prevent the abuse being alleged in Ontario.
Kyro Maseh, an independent pharmacist in Toronto, echoed the sentiment that MedsChecks are far from useless. "When done properly, they save lives...They prevent admission to hospital and possibly fatalities," Maseh said, noting the wide discrepancy between the service’s potential when used as intended and its alleged exploitation by pharmacy chains. "This is a huge issue with corporate-owned pharmacies."
Accounts from Maseh and others suggest that the issue is widespread across Ontario, rather than isolated to a few locations. A pharmacist with in-depth knowledge also confirmed the existence of billing targets, quotas and directives in corporate pharmacies designed to maximize billings for MedsChecks and other services. Despite this, there is a notable absence of oversight from the Ontario College of Pharmacists. On this, a former member of the College noted “I believe one of the corporate chains was approached by the College over this, but not disciplined. The College can only discipline individual pharmacists and pharmacies, not corporations. So, if a pharmacist at a corporate chain gets disciplined for doing too many MedsChecks, Shoppers can just replace them with a new pharmacist.”
The allegations and experiences shared by healthcare professionals paint a complex picture of the MedsCheck program's implementation. While there is acknowledgment of the clear utility and benefit of medication reviews on the lives and health of patients, the consensus amongst physicians and pharmacists weighing in on social media appears to center on the need to reform how these services are delivered and billed to the government.
Shoppers Drug Mart was contacted for comment but had not responded by the time of publication.