Shoppers Drug Mart billed the Ontario government’s MedsCheck program $81.2 million for medication reviews over a two-year period when some of its current and former pharmacists said they were facing “unethical” corporate pressure to meet targets for the professional service.
That total for the 2022-23 and 2023-24 fiscal years is $8 million more than the corporate pharmacy chain billed for the same services over the previous six years combined, according to data obtained by CBC News through a freedom of information request.
“Correlation is not causation, but the upswing in MedsChecks is remarkable given the downswing in revenues from things like COVID shots or other services that were allowed during COVID,” said Aly Háji, a regulatory lawyer who specializes in pharmacy health-care law.
“It speaks to a larger problem around corporatization of healthcare, where the healthcare professional has dual loyalties, the loyalty to the corporation and their business, and the loyalty to the patient, which should always be paramount.”
Medication reviews are meetings between a pharmacist and a patient to go over their prescriptions and ensure they’re taking the right combination of medicines. Anyone who takes at least three medications for a chronic condition, is living in a licenced long-term care home, or is receiving treatment for diabetes is eligible for a medication review in Ontario.
Pharmacies can bill the government $60 for an annual medication review, $75 for a person with diabetes and $25 for follow-ups.
Last year, a CBC News investigation revealed that Shoppers Drug Mart had targets for professional services like medication reviews — and corporate management pressured pharmacy owners to meet those numbers. At the time, several current and former Shoppers pharmacists said that pressure ramped up after the pandemic when demand for COVID-19 testing and vaccinations waned.
After that reporting, CBC News requested nearly a dozen years worth of billing data for the MedsCheck program from pharmacy chains operating in Ontario from the Ministry of Health.
Data obtained by CBC News shows Shoppers Drug Mart billed the Ontario government’s MedsCheck program more than $81 million in a two-year period when Shoppers pharmacists revealed they were facing increased corporate pressure to bill for medication reviews.
Recently, the ministry provided the data for eight of the 10 corporations in the province: Shoppers Drug Mart, Loblaw Pharmacy, Walmart Pharmacy, Pharmasave, Costco Pharmacy, Sobeys Pharmacy, Metro Pharmacy and Pharmachoice.
The other two, Rexall, and McKesson (which owns chains like Guardian and I.D.A.), appealed the ministry’s decision to share their billing data and their numbers so they are not included in the data for this story.
In emailed statements, most of the pharmacy chains emphasized that patient care is their priority.
Shoppers billing lion’s share of $225M
Overall, the eight pharmacy chains collectively billed the province $293.2 million for medication reviews from the 2013-14 fiscal year through the end of October 2024 in the 2024-25 fiscal year.
Shoppers’ billing accounts for 77 per cent of that total at $225.3 million across an average of 682 pharmacy locations a year. Those locations make up just over half of the average total number of pharmacies across the eight chains combined.
In March 2020, the MedsCheck program was amended to allow pharmacists to conduct medication reviews over the phone in addition to in person because of the pandemic.
Since that fiscal year, Shoppers has billed more for medication reviews than it did in the previous seven years combined and has an average revenue per pharmacy of $183,800, which is more than double that same figure for the other seven chains, and as much as 16 times the average revenue per pharmacy.
In a statement, Shoppers Drug Mart told CBC News the data shows the pharmacy chain is a leader in providing health-care services like MedsChecks, and said the need for them is “growing exponentially amid the primary care crisis and skyrocketing rates of chronic disease.”
“Shoppers Drug Mart pharmacies deliver more MedsChecks because our scale and the nature of our operations … are specifically designed to give pharmacists more time for the one-on-one clinical care that patients require,” read the statement.
The company also said medication reviews account for less than 20 per cent of the professional services provided by Shoppers’ pharmacists in Ontario, and referenced a patient care and quality committee it created more than a year ago to support store owners and to ensure patient care “remains our absolute priority.”
However, it appears that, generally, corporate pressure remains a problem.
Pharmacists still facing pressure: new survey
The regulator for Ontario pharmacists told CBC News in a statement that preliminary results from its most recent survey conducted in June of this year, show “respondents continue to report business pressures that get in the way of their professional obligations, including pressure to perform MedsCheck reviews.”
The Ontario College of Pharmacists (OCP) has been tracking MedsCheck complaints related to pressure to meet corporate targets since CBC News’ reporting last year.
As of mid-September the regulator said it had opened 111 investigation files related to business pressures, nearly half of which specifically mentioned MedsCheck, but the college would not provide a detailed breakdown “to ensure the integrity and fairness of ongoing investigations.”
“The majority of investigations related to business pressures in pharmacy that have been initiated to date remain open,” said spokesperson Dave Bourne.
“We can acknowledge generally … the decisions from completed investigations to date have ranged from taking no action through to referral to OCP’s discipline committee.”
In a June 2024 report on the issue titled “Under Stress and Duress,” the college reported that pharmacists told them “corporate influence on pharmacy professional autonomy is compromising the delivery of ethical, quality patient care and their wellbeing.”
That initial report also included the results of a 2024 survey which found 70 per cent of respondents were experiencing pressure to “complete an activity in a limited timeframe, or to a certain target number, or dollar amount.”
The vast majority of respondents were from Shoppers Drug Mart, according to the report.
Program needs to be overhauled: lawyer
There’s technically nothing problematic about the profits Shoppers and other pharmacy chains can make from medication reviews under the current rules of the MedsCheck program, according to Háji. That’s one of the reasons he thinks it needs to change.
“The program really needs to be overhauled and corrected to prevent … the way it’s being used,” Háji said.
Háji’s recommended changes include increasing the number of medications a patient has to be on to qualify for a medication review, requiring the reviews to be documented to ensure pharmacists were taking enough time to do them and more active communication between the pharmacist and prescriber.
The Ontario Pharmacy Association (OPA) included at least one of those recommendations in a proposal on reforms to the MedsCheck program it submitted to the province back in July 2024. The advocacy organization for pharmacists wants to see the number of medications a patient has to be on to quality for a medication review raised to five from the current three.
“We’re very much committed to maintaining medication reviews, we think there is value,” said Justin Bates, CEO of the association.
“But we also recognize that the current program needs to be improved.”
The association met with the province last week to discuss the proposal and Bates says the government is committed to a process to improve and modernize the MedsChecks program.
CBC News asked the Ministry of Health what, if any, changes it intends to make to the program given the OPA’s proposal, and a public consultation the province held on the pharmacy sector last year.
“We are improving the MedsCheck program to support health outcomes and reduce unnecessary service duplication and administrative red tape, while continuing to protect patient choice,” said a response from the ministry.
The statement didn’t elaborate on how the government is improving the program, except to say that the ministry is currently conducting a comprehensive review of all the feedback it received through the public consultation to determine next steps.
