MSP May June 05 Mag 128747

CommunicationA Publication of the Manitoba Society of Pharmacists Inc.

Continuing Education: Therapeutic Options Focus on Gonorrhea Treatment

The Last Word: The Curious Economics of Prescription Drugs

May/June 2005 Vol. 30, No. 5

The Voice of Pharmacists in Manitoba

Publication Mail Agreement No. 40013710 Return Undeliverable Canadian Addresses To: The Manitoba Society of Pharmacists 202–90 Garry St., Winnipeg, MB R3C 4H1 �� THIS ISSUE M AY /J UNE 2005

Manitoba Society of Pharmacists Up Front Board of Directors Changes at the Top 4 Having Health Minister Tim Sale attend this year’s Manitoba Pharmacy Brent Havelange, President Conference was a noteworthy event for a least a couple of reasons. Nancy Remillard, Honourary Secretary Treasurer, Finance Chair, Professional Relations Chair Sounding Board Mel Baxter John Hill 5 You may or may not be aware that for the last 25 years I have been Bonnie Coombs claiming—in 3 books and hundreds of articles—pharmacist’s worth as Michelle Glass society’s drug experts. Wayne Hogaboam Joe Piotrowski Feature Article Lisa Zaretzky Dauphin’s Myles Haverluck wins Bowl of Hygeia Award 6 Liaisons The 2005 Bowl of Hygeia has gone to Dauphin pharmacist Myles Chuck Narvey, Insurance Liaison Haverluck. Ron Guse, MPhA Liaison Manitoba Pharmacy Conference 2005 Elmer Kuber, CPhA Liaison April 15th to 17th, 2005 7 Beatrice Reyes, Student Liaison Feature Article

Scott Ransome, Executive Director & Editor MSP Student Night 11 The Manitoba Society of Pharmacists hosted their annual Student Night Jill Ell, Assistant to the Executive Director & Editorial Assistant on Mar. 31st, 2005. Feature Article Editor/Publisher Manitoba Society of Pharmacists The MILE Line: An Update 12 90 Garry Street, Suite 202, Winnipeg, MB R3C 4H1 The Medication Information Line for the Elderly (MILE) was relocated to Telephone: (204) 956-6680 or 1-800-677-7170 the University Centre Pharmacy by Vice-President (Administration) Mrs. Deborah McCallum in July of 2004. [email protected] www.msp.mb.ca Feature Article COMMUNICATION is published six times a year. The subscription NIHB Pharmacy Audits 14 rate is $12.00 per issue, $77.04 per annum (including GST). The inclusion of proprietary names in this publication is for reference only. The inclusion of brand names does not imply that the brands Pharmacy Focus listed are in any way preferable to those not listed. The sources of Morden Pharmacist Lisa Zaretzky Turns to information are published articles in pharmaceutical and medical journals, private communications, etc. Incorrect quotations the Past 15 or interpretations are possible but not intentional. The views In Morden, Lisa Zaretzky is turning the page of pharmacy practice back a expressed in COMMUNICATION do not necessarily reflect the views of the Manitoba Society of Pharmacists Inc. The Society assumes hundred years. no responsibility for the statements and opinions advanced by contributors in COMMUNICATION. Material from COMMUNICATION Feature Article may be copied provided that the source is acknowledged. The deadline for submission of material for inclusion in COMMUNICATION NIHB Pharmacy Provider Audit 16 is the 15th of February, April, June, August, October and December. Q&A: Getting to Know your Manitoba Pharmacists ISSN 0829-6197 Claire Gillis 19 Printed in Canada by: Leech Printing (204) 728-3037 Classifieds Pharmacists Wanted 20 Publication Mail Agreement No. 40013710 Return Undeliverable Canadian Addresses to: The Last Word Manitoba Society of Pharmacists 202–90 Garry Street The Curious Economics Winnipeg, MB R3C 4H1 of Prescription Drugs 22 Email: [email protected] Pharmaceutical manufacturers would like the world to know that prescription drugs are good for you.

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 3 UP FRONT Changes at the Top

Having Health Minister Tim Sale attend this year’s Manitoba Pharmacy Conference this same period. There is even a newly was a noteworthy event for a least a couple of reasons. It suggests he is willing appointed Acting Executive Director of Drug Programs, but we are hopeful that to make an effort to establish a relationship with pharmacists. While it is clearly situation is only temporary. too early to know how issues related to the practice will be addressed during Few would dispute that some of Mr.Sale’s tenure in the Minister’s office, he has satisfied the basic requirement of today’s most important challenges addressing the profession at the largest annual gathering of pharmacists. are related to the health care system. Patients and advocates are demanding changes and improvements. Changes The last Minister of Health who The changes in Health Ministers with key personnel in the health care agreed to participate in the annual con- represent something that has become system are easy to identify, but perhaps ference was Darren Prazink, who was very common amongst senior officials those constant changes prevent making later replaced by Ernest Stephanson who in government health departments; the needed improvements to the Health later made way for David Chomiak who change is the only real constant. You need Care System. then was replaced by the current Health to look no further than the Manitoba Most would agree the challenges Minister, Tim Sale. Mr. Stephanson’s Health Department to prove this theory. are vast and complex. It takes signifi- time as health minister was less than a Over the past 12 months there has been cant time and effort to find thought- year so perhaps he shouldn’t be judged a new Minister of Health appointed, ful solutions. It is unfortunate that the too harshly, but Mr. Chomiak had 5 years as well as a new Deputy Minister of same people who are chosen to find to make himself accessible to Manitoba Health; in addition, there has been three the answers, often aren’t around long pharmacists and it never happened. Mr. separate individuals who have served as enough to really understand the prob- Sale’s participation should be viewed as Assistant Deputy Minister responsible lems. a positive development. for Provincial Drug Programs during MSP Excellent Plans, Exclusive to You The CPBA is dedicated exclusively to providing quality insurance and benefits programs to meet the needs of pharmacists. All CPBA plans are designed for you, your store and staff, and your personal and business properties. Your provincial CPBA Insurance Advisor will ensure you receive quality products and personal service to meet your specific needs.

• Malpractice Insurance • Internet Malpractice Insurance • Store Insurance • Homeowner Insurance • Life & AD&D Insurance www.cpba.ca

• Disability Insurance Your Manitoba CPBA Insurance Advisors • Health & Dental Insurance Property & Casualty Insurance Individual & Group Benefits Bill Benham Ed Bodnarchuk • Critical Illness Insurance Phone: (204) 988-5002 Phone: (204) 988-1517 Email: [email protected] Email: [email protected]

4 C OMMUNICATION M AY /J UNE 2005 SOUNDING BOARD The Sounding Board is here for members to speak up and speak out on issues that are of interest to pharmacy. The Sounding Board is not intended to be an expression of the opinions of the Manitoba Society of Pharmacists, but rather is meant to be a forum for opinions and thoughts. We encourage you, our members, to write in with your opinions on the topical issues of the day.

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 5 FEATURE ARTICLE Dauphin’s Myles Haverluck wins Bowl of Hygeia Award

The 2005 Bowl of Hygeia has gone to Dauphin pharmacist Myles Haverluck. “If we are going to have a pharma- The award has been given since 1958 for community service by pharmacists. care system, we are going to have to tol- erate some reference based pricing,” he Dauphin, a town that’s about 170 explains. “Perhaps patients should have km. north of Brandon and 300 km. west the privilege of paying the difference of Winnipeg, would probably not be the in cost between the drug the physician same without Myles’ efforts. He has raised wants and the drug the insurer is will- money for a new hockey rink that will be ANDREW ALLENTUCK ing to buy for the patient.” Similar to attached to an existing curling rink, taken the idea that two tier medicine can take part in the work of the Kinsmen, helped pressure off the public purse, co-pay- to build swimming pools, and sponsored “I find it a challenge to establish the ment for certain drugs is already a part the Dauphin Festival of Arts. correct dosage for patients,” he says. He of many insurance plans that provide “Myles has always been ready to recalls preparing transdermal creams for drug coverage, he notes. lend a hand or to contribute to com- for cats’ ears and, recently, in finding Myles says that he and his wife munity projects. He gives the most ways to make drugs for erectile dys- Bonnie plan to stay in Dauphin past and helps as much as he can,” says Dr. function work faster when prepared as retirement. Jim Compton, 52, retired physician in sublingual tablets. “I have no reason to leave,” he Dauphin who has worked with Myles. Myles opened the Dauphin Clinic explains. Though his three daughters “He was a major contributor to the rec- Pharmacy in 1979. “We don’t have mops have moved away and established reation complex and swimming pool, or plastic toys or even diapers,” he careers in health professions – one as a raising $50,000 to $60,000 for the com- explains. “We are a professional dispen- rep for a major pharmaceutical manu- plex through a golf tournament,” Dr. sary.” In his work, Myles has taken an facturer, one as a pharmacist and one Compton recalls.” interest in the problems of addiction, as a dietician - his roots in Dauphin are A 1974 graduate of the Faculty of speaking to various groups about the deep. Pharmacy at the University of Manitoba, misuse of prescription drugs. “Myles enjoys his life and being able Myles has pushed his professional prac- He sees a challenge to the pro- to be a leader in his town,” states Mark tice into compounding of medications in fession in the co-existence of public McMunn, President of McMunn and human and animal health. He is a mem- finance of prescription drugs and the Yates Building Supplies Ltd. in Dauphin. ber of the Professional Compounding prescribers’ preference for the most “He has the ability to take a situation Centers of America. appropriate drugs for patients. and to fix it. He is a guy who makes things happen.” Myles sees Dauphin as what he calls “a community of friends.” He notes that in the close-knit town of 8,000 there is almost always a friend to ready for a round of golf which he loves. “I am never short of something to do,” he explains. The future of independent pharmacies should not be in doubt, Myles says. He adds that there are five pharmacies in Dauphin, one of which, at Wal-Mart, tends to have lower dispensing fees than he has at the Dauphin Clinic Pharmacy. He feels, nonetheless, that his fees are competitive in most cases. As well, not everyone wants the Wal-Mart experience, he notes. Independence, profes- sionalism, and being part of the texture of the town mean a lot, he says. Myles Haverluck accepts the Bowl of Hygeia award from Chris Walby.

6 C OMMUNICATION M AY /J UNE 2005 MAC AR Y C PH O MANITOBA PHARMACY CONFERENCE 2005 N A F B E O R

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The Winning Combination M Friday, April 15, 2005 Exhibitors Wine & Cheese Reception

The Conference Exhibitors had their first chance to show off their displays while pharmacists, faculty members, and friends enjoyed the evening. Presentations included The Dean, Dr. David Collins, who gave an update on the new Faculty of Pharmacy building, as well as Tracey Maconachie who presented 8 of the brightest young pharmacists and pharmacy students with the Merck Frosst Young Leaders Award.

This evening was sponsored by

Faculty of Pharmacy Dean, Dr. David Collins GlaxoSmithKline Exhibitors

Tracey Maconachie (second from the left) pictured with the Merck Frosst Young Leader Award Winners

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 7 MAC AR Y C PH O N MANITOBA PHARMACY CONFERENCE 2005 A F B E O R

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M The Winning Combination Saturday, April 16, 2005 Conference Chair Reception and Silent Auction

The Conference Planning Committee would like to thank our corporate sponsors for their support of the auction through the donation of such great items. A big thank you also goes out to all of those who supported the auction by placing bids. This year’s auction was the most successful ever and raised $3580.00 for the Pharmacists-At-Risk program.

8 C OMMUNICATION M AY /J UNE 2005 MAC AR Y C PH O MANITOBA PHARMACY CONFERENCE 2005 N A F B E O R

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The Winning Combination M Saturday, April 16, 2005 Annual Awards Banquet

The Conference Planning Committee was fortunate to have arranged for Bob Irving, voice of the Winnipeg Blue Bombers, to be the guest speaker. Mr. Irving was both entertaining and informative, and we would like to thank him for taking this opportunity to address Manitoba Pharmacists.

Congratulations to all the award winners on their achievements in the field of pharmacy. Many of the award winners had family members in attendance which helped contribute to the success of the evening. There was also a 40 year class reunion held in conjunction with the banquet. Ron Eros being presented with the Pharmacist of the Year Award

Honourary Conference Chair, Morna Cook thanking Bowl of Hygeia winner, Myles Haverluck and family Guest Speaker, Bob Irving

Ralph Whitfield, Winner of the Manitoba Society of Pharmacists Award of Dinah Santos being presented with the Bonnie Merit, and family Schultz Memorial Award

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 9 MAC AR Y C PH O N MANITOBA PHARMACY CONFERENCE 2005 A F B E O R

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M The Winning Combination Sunday, April 17, 2005 The Manitoba Pharmaceutical Association Awards Luncheon

The year’s luncheon saw the first ever awarding of the William G. Eamer Post-Graduate Scholarship, as well as the 50 Year Gold Pins, 25 Year Silver Pins, and the M.Ph.A. Honourary Membership.

Mutasem Rawas-Qalaji, Winner of the William G. Eamer Post-Graduate Scholarship, pictured with Bill Eamer

Barbara Wells, Winner of the M.Ph.A. Honourary Membership

25 Year Pin Recipients 50 Year Pin Recipients

10 C OMMUNICATION M AY /J UNE 2005 FEATURE ARTICLE MSP Student Night The Manitoba Society of Pharmacists hosted their annual Student Night on March 31st, 2005.

This year’s event saw some changes and the trophy were fourth year stu- from previous years and the evening dents Allan Presto, Kevin Klippenstein, was an overwhelming success. The Kevin Le, and Victoria Loewen. Prizes annual pool tournament was replaced were donated by MSP and included gift with the “Boss-Q Challenge” which saw certificates for Famous Players Theatres, the students and a number of board as well as T-shirts that were donated by members compete in a variety of games the Quality Inn. including 3 ball pool, darts, and ping- The Society would like to thank all pong. It took some time to get the teams the students who attended the event set up, but once that was accomplished, and wish them success with their stud- the competition was underway! ies. We know they will be fine if they The event coincided with the third have the same enthusiasm at school year students’ final exam and the turn- as they do at Student Night. We look out was the best ever. There were a forward to seeing them out for next total of 14 teams competing for the tro- year’s competition. We would also like phy and there were several very intense to thank our student liaison Beatrice displays of ping-pong, pool and darts. Reyes for her assistance with scheduling Many of the students participated in and promoting student night, assisting an informal competition of foosball as with the first year student membership MSP Student Liaison, Beatrice Reyes well. drive and all the work she has done with and fellow third year student Cameron The big winners of the competition the MSP Board. Murphy prepare to play a little foosball.

Ping Pong was a welcome addition to the competition this year. First year student Hayley Enns, prepares to serve while her teammate MSP Board Member, Jason Pankratz and opposing The winning team consists of fourth year students, Kevin team member, Carey Lai watch. Klippenstein, Victoria Loewen, Kevin Le, and Allan Presto.

MSP Executive Director, Scott Ransome and MSP Board Second Place finishers pictures with MSP Board Member, Member, Jason Pankratz prepare to announce the winners of Marian Kremers, MSP Executive Director, Scott Ransome, and the competition. MSP Board Member, Jason Pankratz.

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 11 FEATURE ARTICLE The MILE Line: An Update (Medication Information Line for the Elderly)

The Medication Information Line for the Elderly (MILE) The nature of the questions handled by MILE varies widely. was relocated to the University Centre Pharmacy by Vice- Patients seek information for prescription and non-prescrip- President (Administration) Mrs. Deborah McCallum in July tion medications, including new products and investigational drugs. Many queries focus on herbal products, nutrition and of 2004. interactions between drugs and natural products. Mrs. Debra Giesbrecht, manager of the University Centre To date, mile has fielded 539 calls, an average of 4.3 ± 2.1 Pharmacy, ensured that the move progressed smoothly and calls per day that range from 1 to 10 calls per day (Figure 2). in a timely manner. A room was specially designed within the The majority of the calls (516 or 95%) are made by the patient pharmacy to accommodate a comfortable office that could and the remainder (23 or 5%) by pharmacists, physicians and also serve as a private counseling area for patients wishing to nurses. Calls from females outnumber males by a ratio of 4:1. discuss their medications. The average age of females is 67.5 years and males 64.5 years. The strength of the MILE Line is in the people and tech- Of the 516 patient calls 58.91% are made by the patient nology being utilized to provide current drug information. who is aware of the service. Another 30.03% are made by the The service employs an electronic province-wide data base patient who has been referred to MILE by a physician, phar- for patient files, and an online reference library for medical macist, nurse or Health Links indicating that MILE is a valu- information that allows the pharmacist on the phone to call able service to both patient and practitioners (Table 1). up a patient profile and assess their medication issues with up to date information. Number of calls (%) The staff includes pharmacist consultant Sunita Persaud, B.Sc.(Pharm.) who fields questions on the phone and meets Patient 304 (58.91%) with patients who can either drop into the office or make an Friend 18 (3.48%) appointment to see the pharmacist. The Outreach Program for Relative 11(2.13%) MILE is handled by Meera Thadani, M.Sc.(Pharm.) who meets MILE advertisement 28 (5.43%) with community groups, hospital staff, students in other Nurse 58 (11.24%) faculties and provides continuing education to other health Pharmacist 70 (13.56%) professionals. The first few weeks in the new location were spent becom- Physician 14 (2.71%) ing familiar with the technology and database (Figure 1). MILE Health Links 13 (2.52%) now handles calls for patients as young as three months to (Total calls = 516; patient 58.91%, health older adults in their nineties. The current location is more professionals 30.03%, other 11.04%) accessible to the University population as well as the public and patients are encouraged to come to the office to discuss Table 1 Calls Referred their medications in person. MILE has received a total of 898 queries, an average of 7.2 queries per day that range from 1 to 21 queries per day (Figure 3). The majority of queries are from females. The ratio of queries female to male is (3.42:1). On quieter days, the pharmacist has the opportunity to address questions and health issues that are less urgent and provide the patient or practitioner with information that is mailed or faxed as requested. Of interest is the average number of medications being used by patients. Table 2 shows the summary indicating that females on average use more medications than males.

Female 5.8 ± 4.3 (1 to 24) drugs 888 Male 4.7 ± 3.4 (1 to 16) drugs 230 … 4 Total 5.5 ± 4.1 (1 to 24) drugs 1,122 Figure 1 MILE Database designed by Dr. David M. Collins, Table 2 Patient self-reported medications Dean, Faculty of Pharmacy.

12 C OMMUNICATION M AY /J UNE 2005 22 21 20 25 19 QUERY statistics CALL statistics 18 17 Total queries 898 y 16

20 a

D 15 Average 7.2 3.9 queries / day

/ ±

Total calls 539 s 14

r Range 1 to 21 queries / day c 15 13

n e 12

e Average 4.3 2.1 calls / day ± u

Q 11

r Range 1 to 10 calls / day 10 10 o

r 9

b 8

5 m 7 u 6

N 5 0 4 0 1 2 3 4 5 6 7 8 9 10 11 3 Number of Calls/Day 2 1 0 Figure 2 Call statistics 0 5 10 15 20 Frequency Figure 3 Query statistics

10 MILE is unique as a community based pharmacy consult

s service. It serves as a model for the profession in that medication

l l 8

f information can be handled as part of day to day practice by any

r 6 e Call history, by DAY b pharmacist. The University Centre Pharmacy benefits from the

m u 4 N new location because MILE provides an additional resource to

2 the services currently provided. Current plans are to expand the

25 scope and potential for MILE as a service, outreach, teaching and research opportunity for the benefit of all Manitobans. 20

s The staff acknowledges the support MILE has received

u 15 from the office of the Vice-President (Administration) Mrs.

o Deborah McCallum. A very special thank you is extended to

r Queries, by DAY

b 10

m Dr. David M. Collins, Dean, Faculty of Pharmacy, for writing

N 5 the MILE program and managing the data base. Please visit us at the University Centre Pharmacy. 0 0 26 52 78 104 130 University Centre Pharmacy Day Room 111 University Centre Figure 4 Call history by Day and Queries by Day for MILE 66 Chancellor Circle University of Manitoba Figure 4 shows the call history from 7 July 2004 to 9 March Winnipeg, R3T 2N2 2005 indicating that MILE has been receiving an increasing 9.30am to 2.30pm Monday to Thursday number of calls and queries per day. Tel: (204) 474-6493 Figures 5 and 6 show the MILE Program outreach for Fax: (204) 474-7572 Winnipeg and Manitoba South respectively. e-mail: [email protected]

MILE Program OUTREACH MILE Program OUTREACH Winnipeg Manitoba South

Maps prepared by the Maps prepared by the MANITOBA CENTRE FOR HEALTH POLICY MANITOBA CENTRE FOR HEALTH POLICY Figure 5 MILE outreach Winnipeg Figure 6 MILE outreach Manitoba South Maps prepared by the Manitoba Centre for Health Policy

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 13 FEATURE ARTICLE NIHB Pharmacy Audits Over the past few years there has been an increased 3. Extrapolation. This occurs when an audit reclaim within number of pharmacy audits conducted in relation to the a given sample size is applied or extended over a larger Non-Insured Health Benefits (NIHB). The Manitoba Society period of time and the reclaim adjusted accordingly. For of Pharmacists and the other Provincial Pharmacy Advocacy example, an audit process samples 100 prescriptions over Organizations who participate on the Community Pharmacy a 2 week period and finds a specific reason to reclaim on Economic Committee (CPEC) have been meeting with senior 4 prescriptions. They then may determine that they will representatives of Health Canada in an effort to achieve some extrapolate this over a 6 month period, which extends the changes (improvements) to the audit process. reclaim amount. While the parties continue to meet, the MSP Board wanted 4. No gradation in the response given to errors. Whether an Pharmacy Providers to be fully informed of the most common infraction is minor or major there is no gradation in the audit findings as identified by NIHB. On the next page you will response given to errors. find a copy of an article which recently appeared in NIHB’s 5. Lack of performance standards for the length of time between newsletter. If you didn’t have a chance to review the article and completion of the audit and issuing the audit letter and lack you have a significant number of patients receiving coverage of a reasonable response time for the pharmacy which through the NIHB program, take a few minutes to familiarize should be balanced with the time lines set for auditors. yourself with the typical audit issues. 6. The limited time auditors are actually on site. They seem Below you will also find a copy of a document developed unable to complete their work in the time allotted resulting by CPEC which outlines a pharmacists’ perspective on the top in pharmacy staff having to look up everything they miss. ten reasons for “bad audits”. This document has been shared 7. Auditors do not look at computer records resulting in phar- with Health Canada and has been a central focus in discus- macy staff having to supply information at a later date. sions between the parties. 8. Lack of formal dispute resolution mechanism. The audit program does not allow for after-the-fact correction of The Top Ten Reasons For Bad Audits clerical errors, (supported, if needed, by information from Pharmacists Perspective physicians) this would reduce the incidents of #2. 9. Ongoing lack of communication between regional NIHB 1. Errors during audit process that result in wasted pharmacy management, including the director and audit personnel. resources and time. 10. Poor auditor training on provincial regulations so they can 2. Reclaim of drug costs. Drug costs are reclaimed as well understand the scope of authority of the pharmacist in dif- as dispensing fee despite that fact that the patient has ferent jurisdictions. They also need to understand that they received the drug. are not employed to audit for the regulatory authority.

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In Morden, Lisa Zaretzky is turning the page of pharmacy practice back a hundred years. Her dispensary, the BeeWell Apothecary, was built to have the look and feel of an old-fashioned drug store complete with soda fountain.

‘We opened on March 1st with the concept that folks could linger and have time to chat with me,” Lisa says. “That builds confidence and integrity. It helps to build a reputation with our patients. I had to do that, since I am a new face in the community. There are two other dispensaries in town and five more in Winkler, which is just seven miles down the road.” Lisa recalls that in leaving Winkler, where and businesses such as a dance studio and fitness club. Our she worked for almost six years, she was making a statement. location has brought in new customers who snack after “I did not want to compete with other retailers to sell front their routines,” she notes. Some of those customers also buy of store merchandise. I wanted to be a pharmacist and help Watkins ointments and other liniments, she adds. “What we people with their health. The soda shop helps people feel sell has a scientific basis or a long history of use,” she explains. good. We also serve buns made with organic products, whole “We are not competing with health stores or herbalists, aroma grain breads and desserts that are also made with wholesome therapists or oriental medicine. The core of my practice is still ingredients.” professional pharmacy and evidence-based medicine.” Lisa’s fair trade (i.e., not exploitative to growers) coffee is Lisa decided to build her practice around an antique organic and custom roasted in Ontario. She blends it in the theme. “I like the old fashioned theme. We have a wooden store. She has expresso, French roast and Colombian. There’s floor in the dispensary ceramic tiles in the coffee bar and the no decaf, she says. “If you don’t want caffeine, you can have tea customer areas in front of the dispensary,” she says. She chose or a milkshake,” she adds. the name of the store because her husband, Abe, has been a Lisa took a large risk in opening BeeWell. “We did not buy beekeeper for more than a quarter century. “I thought of other any patient files, so we are starting from zero. We are building names, including Drugs R Us and Lisa’s Apothecary. But they up from that. The town has ten physicians and three dentists, did not convey the idea of comfort that I think is implied in the an orthodontist, and a vet clinic too.” reference to being well.” Running a pharmacy with a coffee bar/soda shop changes Reaction in Morden has been enthusiastic, Lisa says. the customer mix of the pharmacy, Lisa says. “We are in an old “People say ‘Wow! This place looks great. We can wait for a hospital that was converted into a mall with several offices doctor and have a snack. It takes some of the annoyance of waiting for one’s turn in a doctor’s office.” “I go once or twice a week to BeeWell,” says Colleen Doerksen, a psychologist in Morden. “I like the personal relationship with Lisa. The atmosphere with wood has a homey feel. The conventional style of pharmacy is too impersonal.” Adds Heidi Grieser, homemaker in Morden, “Lisa really likes her patients and is genuinely concerned with their health. The store is a fun place. My kids can have a milkshake while I get a prescription filled. This is a world away from a megastore with a dispensary. In Lisa’s store, I get the feeling that I matter.”

Pharmacy Focus will be a new feature article in “Communication”. If you know of a pharmacy that is doing something innovative or of interest and would like to see them featured in Pharmacy Focus contact Jill Ell, Editorial Assistant at 1-204-965-6680 or by email at [email protected].

15M ANITOBA C OMMUNICATION S OCIETY OF P HARMACISTS C OMMUNICATIONM AY /J UNE 2005 15 FEATURE ARTICLE NIHB Pharmacy Provider Audit The Non-Insured Health Benefits b) That the requirements of the identify potential drug-related problems (NIHB) Audit Program conducted 71 NIHB Program be met as outlined in or interactions. The results of the analy- pharmacy provider audits during 2003. the NIHB Pharmacy/MS&E Provider sis are returned to the provider, in the The majority (94%) of the audit find- Information Kit, Pharmacy/MS&E form of CPhA standard response codes. ings relate to the five categories outlined Provider Agreement and other NIHB A DUR message will be received by below. All audit findings were reviewed Program documents issued to pharma- the pharmacist if the patient has used by an Audit Process Working Group, cies, such as the First Canadian Health/ less than two-thirds of the medication, which includes representatives from the NIHB Program Newsletters and NIHB based on the days supply from the pre- Canadian Pharmacist Association (CPhA), Program Drug Bulletins. vious dispense. Although many provid- the Canadian Association of Chain Drug c) That faxed prescriptions contain ers are now documenting interventions, Stores (CACDS), and the NIHB Program. the fax transmission details, such as the documentation of overrides remains We are sharing these findings with you the date and the sender’s information, a concern to the NIHB Program. As reaf- and clarifying the requirements for bill- to adequately verify the prescription firmed in the Fall 2001 and Spring 2002 ing the NIHB Program. during an on-site audit. (See the article First Canadian Health/NIHB Faxed Prescriptions in this newsletter). Program Newsletters, the reason for 1. Incorrect Billing or Pricing (54% Example: The pharmacist refills the intervention is to be documented of findings) the Rx for Metformin 500 mg once either on the patient’s electronic profile As stated in Section 5.12.2 of the beyond the timeframe of prescribed or on the hard copy of the prescription. NIHB Pharmacy/MS&E Provider repeats. Examples of unacceptable support- Information Kit : “The total amount The refill must be documented on ing documentation used in the case of billed for the identical prescription, the Rx hard copy or electronic patient overrides include: including cost of drugs, mark-up (if profile as follows: • Pharmacist is going on vacation applicable) and professional fee must be • Patient requires medication, MD • Patient requested blister pack consistent with the costs and fees estab- cannot be reached • Use of override code only lished pursuant to the NIHB Program.” • Rx refilled one additional time to • Documentation of overrides pro- Examples of incorrect billing or ensure continuity of treatment vided after the on-site audit (docu- pricing include: • Signed, Mary Jones, Pharmacist, mentation was not written at the • Extemporaneous mixtures: May 22/04 time of the dispense to support the Kaopectate claimed, however it is override) Rx: March 22, 2003 not a listed benefit. Mr. Joe Smith • Extemporaneous mixtures: claims Example 4A: The patient lost the tab- 123 Any street submitted for methadone used for lets of Metformin 500 mg. The pharma- Any town, Any province the treatment of addiction with cist refills the Rx on April 8/04. Metformin 500 mg an improper “pseudoDIN”, result- The refill must be documented on 1 tab t.i.d ing in overpayment (the difference the Rx hard copy or electronic patient 90 tabs Rep x12 between the actual acquisition cost profile as follows: Dr. Scott Bennett, 1 River Road and ingredient cost billed). • Patient lost Rx, requires an early • Methadone for Opioid Dependency: refill 3. Prescription Not Found on Site (7% dispensing fees should be submit- • Signed, Mary Jones, pharmacist, of findings) ted weekly, but a number of provid- April 8/04 As per provincial regulations and ers are billing the NIHB Program NIHB Program requirements, providers Rx: March 23, 2004 daily, with the full seven day dis- are expected to retain original or faxed Mr. Joe Smith pensing fee. In those situations, prescriptions for review during an on- 123 Any street the weekly dispensing fee must be site audit. If the original or faxed pre- Any town, Any province divided by seven to reflect the daily scription is not found while the auditors Metformin 500 mg dispensing fee. are on-site, providers can submit the 1 tab t.i.d 90 tabs Rep x3 (See NIHB Drug Bulletin, September 2003 and the article Methadone For Opioid Dependency, prescriptions to FCH within a fixed peri- Dr. Scott Bennett, 1 River Road Pseudo-DIN 00908835 in this newsletter for details on the reimbursement policy for metha- od of time following the on-site audit. done used to treat opioid dependency) Providers can also submit the prescrip- Example 4B: The physician increases tions with their response to the letter the dose of Novasen 325 mg tabs from 2. Unauthorized Prescription or of audit findings sent to them by FCH 1 o.d to 1 t.i.d. Following consultation Refill (28% of findings) following the on-site audit. with the physician, the pharmacist This category applies to instances refills the Rx according to the modi- where the dispense is not according to 4. Fill Too Soon (3% of findings) fied dose. the prescription and there is insufficient A concurrent Drug Utilization The modified dose must be docu- documentation to support the dispense. Review (DUR) program is part of the mented on the Rx hard copy or elec- The NIHB Program requires: NIHB on-line claims adjudication sys- tronic patient profile as follows: a) That all federal and provincial tem. When claims are submitted to the • Called MD on April 8/04; MD legislation be applied to each dispense. NIHB Program, they undergo DUR to increased dose from 1 o.d to 1 t.i.d

16 C OMMUNICATION M AY /J UNE 2005 • Signed, John White, pharmacist, approved 12 tabs with 8 repeats Example 5C: The package size is not April 8/04 • Signed, Mary Jones, pharmacist, available in the prescribed 50 g size. March 25/04 The pharmacist dispenses 60 g follow- Rx: March 23, 2004 ing consultation with the physician. Mr. Joe Smith Rx: March 23, 2004 The Rx modification to 60 g must 123 Any street Mr. Joe Smith be documented on the Rx hard copy or Any town, Any province 123 Any street electronic patient profile as follows: Novasen 325 mg Any town, Any province • Called MD on March 25/04; MD tabs 50 tabs Amerge 2.5 mg tab approved 60 g 1 o.d 8 tabs • Signed, Mary Jones, pharmacist, Dr. Scott Bennett, 1 River Road X 12 repeats March 25/04 Ud max. 2 tabs in 24 hours 5. Discrepancies between quantities Dr. Scott Bennett, 1 River Road Rx: March 23, 2004 prescribed and packaging size (2% Mr. Joe Smith of findings) Example 5B: A quantity is not written 123 Any street Audit findings will identify situ- on the Rx. The pharmacist dispenses Any town, Any province ations where the quantity prescribed 18 tablets following consultation with Lamisil cream 50 g does not match the packaging format the physician. Apply o.d available on the market, therefore the The quantity must be documented Dr. Scott Bennett, 1 River Road pharmacist will have to intervene and on the Rx hard copy or electronic patient ensure that the changes are document- The NIHB Program’s billing profile as follows: ed properly. requirements are detailed in the NIHB • Called MD on March 25/04; MD Pharmacy/MS&E Provider Information approved 18 tabs Example 5A: Although the prescribed Kit, First Canadian Health/NIHB • Signed, Mary Jones, Pharmacist, quantity is 8, the package size is only Program Newsletters, and NIHB Program March 25/04 available in 12’s. The quantity pre- Drug Bulletins. These documents are scribed can be modified to 12 following Rx: March 23, 2004 accessible through the Health Canada consultation with the physician. Mr. Joe Smith website at: The Rx modification to 12 tabs must 123 Any street www.hc-sc.gc.ca/fnihb-dgspni/fnihb/ be documented on the Rx hard copy or Any town, Any province index.htm electronic patient profile as follows: tabs 1 o.d • Called MD on March 25/04; MD Dr. Scott Bennett, 1 River Road Reprinted with permission of Health Canada.

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M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 17 CELEBRATING SUCCESS – PAW 2005 What an exciting Pharmacist Awareness PAW celebrations across Manitoba ranged from Week we had this year! The Professional providing healthy snacks and health promotion to Relations Committee (PR) would like to thank all clients, to submitting supplemental advertising to local pharmacists (current and future) who promoted this newspapers and radio stations. Some pharmacists year’s campaign, “You and Your Pharmacist: A Healthy provided medication reviews, health clinic days and Partnership” and who participated in the Medicine talks to interest groups such as seniors’ homes and Cabinet Clean-Up. local schools. Coloring contests and in-store draws were also popular among the PAW activities. Overall On your behalf, the PR Committee sent public service 68 pharmacies requested PAW Medicine Cabinet announcements to radio stations across the province Clean-up bags and 20 pharmacies reported feedback and submitted a series of news releases to both daily on their PAW activities. and weekly provincial newspapers. The PR Committee also distributed more than 40,000 Clean-Up bags We would also like to acknowledge the great work across the province. The main distribution occurred in by the Canadian Association of Pharmacy Students Winnipeg through the weekly community newspapers, and Interns (at the Faculty of Pharmacy, University of however many pharmacies ordered bags to distribute Manitoba) for promoting this year’s PAW campaign “You directly to their pharmacy clients. and Your Pharmacist: A Healthy Partnership”. In addition to various local and campus media promotions, the At the end of our PAW campaign, the PR Committee pharmacy students organized health promotion booths once again requested all pharmacists/cies to submit at University Centre on the following topics: Did You their PAW celebration/accomplishments to the Know, Sun and Skin Care, Smoking Cessation, and Know committee for our annual draw. The First prize went to Your Blood Type. To end PAW, pharmacy students joined Susan Thompson at the Flin Flon Pharmasave (palm together to take part in World Vision’s 30-Hour Famine, pilot) and second and third prize went to Sharon Smith raising more than $1,000 for those less fortunate. at the Gladstone Pharmacy and to Gwen Lawson at the Pharmasave #454 in Winkler. Both received $50 Way to go Manitoba Pharmacists and thank you for gift certiﬁ cates to Polo Park. making PAW 2005 a continuing success!

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18 C OMMUNICATION M AY /J UNE 2005 Q&A: GETTING TO KNOW YOUR MANITOBA PHARMACISTS

Name: Claire Gillis Place/Year of Graduation: Dalhousie University 1983 Are you looking to work in a patient focused care setting? Years in Practice: 6 years Do you want to work for a company which provides a strong team environment? Currently Working: Are you looking for a company that can provide you Pharmasave Gimli and Teulon room to expand your skills and future opportunities? Pharmacy Do you want to feel secure and work for a company Accomplishments in phar- that will provide you an outstanding benefits package as well as bonus potential for your skills? macy: Spent 15 years working in the Publications Department of the Canadian Pharmacists Association, Our Benefits Package allows you to earn over $100 000 in compensation and benefits. the last 3 years as Editor-in-Chief. Then I moved to Our Bonus Plan allows you to receive potential yearly Manitoba and became a “real” pharmacist!!! Bonuses as a Staff Pharmacist. Family: Husband, Ernest Stefanson and “the furry Our Prescription Sharing Plan allows you to enjoy one”, Jag potential yearly Profits as a Staff Pharmacist. In addition, we believe in reimbursement for cognitive Hobbies: Walking, reading and fishing at Paint Point services and as such have developed positions in Lake many practicing specialties including: Community activities: Special events like TSN Skins • Long Term Care Clinical Pharmacists • Asthma Certified Pharmacists Favorite thing about Manitoba: The surf of Lake • Certified Diabetes Educating Pharmacists Winnipeg, it reminds me of the Atlantic Ocean. • Men’s and Women’s Health Specialty Pharmacists Most relaxing vacation choice: Winter storm watch If you are a pharmacist who is licensed to practice in the province of Manitoba, and looking to provide patient on the beaches in Tofino, BC focused care within a strong team environment, then Pet peeves: Squirrels in my bird feeders this opportunity may be for you.

Favorite fictional character and why: Anne of Green Together, the Safeway family is one of the largest Gables – spunky, full of life; showing that everyone employers of retail pharmacists in North America, and should have hopes and dreams because truly any- in Canada operates pharmacies in British Columbia, Alberta, Saskatchewan, Manitoba, and Ontario. thing is possible. We currently have full time employment opportunities What could you do without forever: Mosquitoes and for both staff and manager positions in various rural Manitoba locations. people who tailgate If this is an opportunity of interest to you, please What couldn’t you do without for even a day: my Tim send a cover letter and resume by e-mail or fax to the Hortons coffee address below. New grads are welcome to apply.

What you love about pharmacy: The people, always Farzin Rawji, B.Sc. Pharm the people, and hopefully being able to make a dif- Pharmacy Recruiting Coordinator ference in their lives. Canada Safeway Ltd. 14360 Yellowhead Trail, Edmonton, AB T5L 3C5 Voice Pager: (800) 749-4974 Fax: (780) 439-4227 Do you know someone who is making a difference in the pharmacy Email: [email protected] community? We would like to highlight them in this article! Please contact the MSP office at (204) 956-6681 or [email protected].

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 19 CLASSIFIEDS LOOKING TO RETIRE? Great pharmacist available with 3 years managing a rural community pharmacy, looking to purchase an Looking for Locums in Winnipeg. independent pharmacy in Winnipeg or surrounding areas. Call Please contact Manny Morry at 896-4577. Peter at 996-7383.

PHARMACIST WANTED: Part-time pharmacist required for a busy and well organized pharmacy. Some traveling involved but will pay for mileage and meal allowance. Wage will be open for negotiation. www.drugstorepharmacy.ca Call Christian or Raj at 204-656-4113. Opportunities available for licensed pharmacists… • Full-time Pharmacists in Brandon, The Pas, Winnipeg, FEBRUARY 2005 WINNIPEG: Part-time pharmacist wanted for Swan River, Winkler, Flin Flon, Selkirk 2 days a week (Mon, Tues - 9-5) plus covering other pharmacist • Full-time area relief positions based in Winnipeg vacation time. Join a team of 7 pharmacists. Competitive wages. Please contact: We are not an internet pharmacy. If interested call Grand Medicine Maureen Neary – Western Canada Health Services - 885-0768 The Real Canadian Superstore #1577 5858 Signal Centre SW PHARMACIST OPPORTUNITY: Looking for a change? Generous Calgary, AB T3H 3P8 Phone: 403-249-5290 Cell: 403-249-4758 salary, no evenings, no Sundays or holidays, friendly staff. Call Keith Fax: 403-461-7121 e-mail: [email protected] at (204) 367-2517; evenings (204) 367-8635, fax (204) 367-2984.

FULL TIME PHARMACIST REQUIRED for Rock Lake Pharmacy, The MILE Line: An Update Crystal City, MB. No evenings or holidays, closed for lunch. Close (Medication Information Line for the Elderly) to a wide range of recreational activities. Housing available The Medication Information Line for the Elderly (MILE) was relocated to for successful applicant. Competitive salary offered with the the University Centre Pharmacy by Vice-President (Administration) Debbie McCallum in July of 2004. A room was specially designed to accommodate opportunity for partnership into business if desired. For more a comfortable office that could also serve as a private counseling area for information contact: Wayne Currah at work (204) 867-2071 or patients wishing to discuss their medications. home (204) 867-3978. The strength of the MILE Line has been in the people and technology being utilized to provide current drug information. The service uses an electronic FULL TIME PHARMACISTS WANTED: Super Thrifty requires full province-wide data base for patient files, and an online reference library for medical information that allows the pharmacist on the phone to call up a time pharmacists at the following Manitoba Locations: Virden patient profile and assess their medication issues. and The Pas. Career opportunity for experienced pharmacist or The staff includes pharmacist consultant Sunita Persaud, B.Sc.(Pharm.) who new grads. Good communication and human relations skills are fields questions on the phone and meets with patients who can either drop an asset. Quality rural lifestyle, no evenings, Sundays, or holidays, into the office or make an appointment to see the pharmacist. The Outreach technician Support, salary negotiable, profit sharing available, Program for MILE is handled by Meera Thadani, M.Sc.(Pharm.) who health benefit package, future ownership opportunity. Contact meets with community groups, hospital staff, students in other faculties and provides continuing education to other health professionals. Tom Busch at: Phone (204) 727-8451, fax (204) 727-3471 or While the first few months were spent becoming familiar with the technology [email protected] All replies kept confidential. and database, MILE now handles calls for patients as young as three months to older adults in their nineties. The current location is more accessible to the FULL-TIME PHARMACIST needed for busy but well-organized University population as well as the public and patients are encouraged to community pharmacy in Northern Manitoba. We’re looking for come to the office to discuss their medications in person. someone who works well as part of a team and genuinely cares The nature of the questions handled by MILE varies widely. Patients seek information for prescription and non-prescription medications, herbal about people. Call Mike (204) 778-8391 Shoppers Drug Mart, products, and nutrition, interactions between drugs and natural products as Thompson, MB well as investigational drugs. The University Centre Pharmacy also benefits from MILE because it provides an added resource to the services currently being provided. MILE is unique as a community based pharmacy consult service. It serves as a model for the profession in that medication information can be handled as part of day to day practice by any pharmacist. Current plans are to expand the scope and potential for MILE as a service, outreach, teaching and research Pharmacy is the most important part of our business at Shoppers Drug Mart®/ opportunity for the benefit of all Manitobans. Pharmaprix®, and we want you to be a part of it. As Canada’s leading pharmacy, The staff acknowledges the support MILE has received from the office of we have tremendous career opportunities. We offer competitive salaries and the Vice-President (Administration). A special thank you is extended to Dr. benefits and, if you have an entrepreneurial spirit, the chance to become a Pharmacist Owner. You will also have access to rewarding professional practice David M. Collins, Dean, Faculty of Pharmacy, for writing and managing the opportunities, career development and leading-edge technology. Achieve your program for the data base. full potential while providing top patient care. For a more detailed report please attend the presentation at the Annual General Conference or visit us at: We are currently looking for Licensed Pharmacists for: • Thompson, Manitoba • Prince Rupert, BC University Centre Pharmacy • Thunder Bay, Ontario • Dawson Creek, BC • Calgary, Alberta • Kitimat, BC Room 111 University Centre • Edmonton, Alberta • Kelowna, BC 66 Chancellor Circle University of Manitoba Shoppers Drug Mart has opportunities available across Canada! Winnipeg, R3T 2N2 E-mail to receive a current listing of opportunities in other provinces! 9.30am to 2.30pm Monday to Thursday For the experience of a lifetime, please contact in strict confidence: Tel: (204) 474-6493 Samantha Beaudry, Recruitment Coordinator Fax: (204) 474-7572 Phone: (306) 586-8582 e-mail: [email protected] E-mail: [email protected]

20 C OMMUNICATION M AY /J UNE 2005 PHARMACIST WANTED: Full/Part-time with flexible hours Retired? or Bored? at a newly opened pharmacy in the north end of Winnipeg. No weekends and no evenings. Please forward resume to Pharmacist required Saturdays Only! [email protected] or by Fax 204-339-8023. 10am til 5pm

PHARMACIST WANTED: Pharmacy has immediate opening for Will pay for yearly license fee plus licensed pharmacist. We require excellent pharmaceutical care and competitive hourly rate of pay! communication skills. We offer competitive rates and a very flexible schedule, unique arrangement. For more information contact Tony at All you do is work Saturday and (204) 582-3287. relieve my Pharmacists Vacation Call Jim @ 837-7882 Ext # 7

LOOKING FOR A PHARMACIST TO FOR SALE RELOCATE TO THE TOWN OF ROBLIN, MANITOBA PHARMACY MANITOBA. • Established Southeast Mb location (since 1950) A town considered to be the jewel of the Parkland. • Significant amount of assets including land Roblin is located on the Manitoba-Saskatchewan border & building and brags about the great fishing at Lake of the Prairie; • Solid history of sales and profitability water skiing; golfing and other amenities for a good life. Vendor may assist a qualified purchaser with financing Pharmasave has a staff of 12 young personable employees who work hard and play hard. Gary Ostir, M.B.A. MARLTON BUSINESS BROKERS Competitive salary with a signing bonus a division of Marlton Realty Ltd. and moving allowance. For more information, please call Telephone (204) 943 7722 1-204-937-6505 and ask for Darren or Vera. [email protected]

Problems – or more appropriately – personal problems. We all experience them, and work them out most of the time. Some problems might involve • Marital issues • Financial issues • Family issues • Chemical use (including alcohol) • Emotional/psychological/physical issues PART-TIME • Gambling Because we are all unique as individuals, we respond differently to problem situations. At times, however, these PHARMACIST POSITION problems may seem next to impossible to resolve on our We are a family-owned and operated pharmacy own. We may need HELP! The Pharmacists-At-Risk committee is dedicated to that serves both the Winnipeg community and the care and assistance of pharmacists in need of Physical, distance-based patients. We are looking for energetic Psychological, Social and Spiritual Support. pharmacists to join our IPS team. If you or a colleague are experiencing personal problems, no matter what the issue may be, the Pharmacists-At-Risk • 4, 6 and 8 hour shifts available Committee can HELP. • Day-time hours Monday-Friday All calls and inquiries are CONFIDENTIAL. To access the At-Risk Program please call 992-2704 and leave • Starting at $55/hour a message. Your call will be returned within 24 hours. • Experienced pharmacy technicians ManitobaManitoba Please forward resumes by fax to (204) 261-6390 with a cover page titled “Part-Time Pharmacist Position”, Pharmacist-At-RiskPharmacist-At-Risk and provide a preferred call-back time and contact ProgramProgram number. All correspondence will be kept in the strictest “let us help … you … keep it together” of conﬁdence.

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 21 THE LAST WORD The Curious Economics of Prescription Drugs Pharmaceutical manufacturers would like the world to Access to medical care could be what differentiates cen- know that prescription drugs are good for you. As it hap- tral Canada from Newfoundland and PEI. Newfoundland had a wait time between referral by a GP and appointment with pens, recent research shows that’s even more true than a specialist, an average of 19.3 weeks and PEI of 27.4 weeks, drug makers would dare to claim. And it opens a Pandora’s according to the 2004 Fraser Institute report, Waiting Your Turn: Hospital Waiting Lists in Canada. In comparison, Quebec box of policy questions. patients had to wait only 18.7 weeks and Ontario patients had In a study published in Health to wait only 15.5 weeks. Perhaps access to Economics this year, Pierre-Yves Crémieux specialist treatment is also a predictor of and his colleagues demonstrated a strong outcomes. statistical relationship between spending Finding causation in a system in which correlations are abundant is on prescription drugs and overall health ANDREW ALLENTUCK outcomes. The study also distinguished no easy task “Covariance is a problem outcomes for drugs funded by public with all health policy research that is plans and drugs funded in whole or in part done with aggregate statistics,” explains by patients or private insurance plans. Brett Skinner, Director of the Centre for The study, “Public and private pharmaceutical spending Pharmaceutical and Health Policies in the Toronto office of the as determinants of health comes in Canada,” showed that Vancouver-based think tank, the Fraser Institute. public benefits flow from the growth in pharmaceutical spend- “If you try to separate variables, and there can be thou- ing in Canada from 8.8% of overall health costs in 1975 to sands, and there are unexplained variables, you wind up find- 15.0% of such costs in 2000. In that 25-year period, male infant ing correlations,” he adds. “They are not necessarily cause and mortality declined by 2.7% per year and female infant mortal- effect. But the Crémieux study provides reason to believe not ity by 2.6% annually. From 1986 to 1998, life expectancies in only that prescribed drugs help patients, which is a given, but Canada at birth grew by 3.2 months per year for male infants that health outcomes for patients who have their drugs paid and by 2.2 months per year for female infants. Moreover, said privately, where there is a broader choice of drugs tailor–made the authors, “private drug spending has a greater estimated for their conditions, are better than outcomes for patients who impact on health than publicly-funded drug spending does.” lack the same range of choice of appropriate drugs. The bot- While it is true that there have been great advances in tom line is that choice of drugs is vital. After all, patients vary treatment of ulcers, heart disease, cancer, HIV and AIDS in the in their responses even to similar drugs.” 25-year survey period, the remarkable association between The finding that private drug spending is more beneficial drug taking and decreased mortality is worth further discus- for health outcomes than public drug spending begs further sion. The problem, of course, is that much more has changed explanation. Employed persons and their families often have than the ratio of drugs to total health care spending in the drug insurance plans. The poor and the hospitalized tend to quarter century reviewed in the study. receive drugs through public health care and hospital pro- Health outcomes provide a clue to the problems with the vided pharmacies funded by provincial budgets. Who pays is analysis. The authors sought associations of health outcomes thus covariant with employment, age, family status, and the with other factors including the official poverty rate (which is good fortune to have a parent or a pension plan that pays for really only a relationship of variance of family income to mean some or all drug cost. family income, not a test of cost of living), population density, The Crémieux study confirms not only that prescription spending on smokes and booze and spending on food. All of drugs help patients – something that does not really require those non-drug factors turned out to be weak predictors of proof - but that it is good to have supplemental private drug health outcomes. insurance which provides more choice than generic substitu- So do prescribed drugs make people healthy? Or could it tion regimes provide and far more choice than reference based be other factors covariant with use of drugs? pricing allows. It is also a good thing to have access to physi- The authors suggest that wealth is correlated with health cians who do the prescribing. Access rises with income, so spending, which is true, though too general a statement. income remains a predictor covariant with having drugs and Wealth is positively correlated with education and education having private drug insurance. Thus those who are relatively with reduced smoking, increased exercise, longer work hours well off and well positioned in urbanized, central Canada tend and newer vehicles with better safety devices. There are many to have better medical and pharmaceutical care than those who more influences on health, including environmental factors. are less well off. The political issue embedded in this state of Which matter the most? the art but unsurprising finding is whether better off Canadian Drilling down into the data in the study, it turns out that patients should be made less well off by transfers of resources to the highest rates of growth in life expectancy at age 65 were in remote, small places. The doctrinal issue merges into the medi- Ontario and Quebec for men and for women. The lowest rates cal/pharmaceutical dilemma: Can tax and transfer policy heal of growth in life expectancy were in Newfoundland and PEI better than doctors, pharmacists and drugs? Fans of govern- for men and in PEI for women where, surprisingly, there was ment will answer in the affirmative. Those who doubt it might an average annual decrease in life expectancy for women of suggest that, next time you are sick, call an economist. 0.1% per year. Reference: What is it about living in Ontario and Quebec that increas- Pierre-Yves Crémieux, Marie-Claude Meilleur, Pierre Ouellette, Patrick Petit, Martin Zelder and Ken Potvin, “Public and private pharmaceuti- es life expectancy and about living in Newfoundland and PEI cal spending as determinants of health outcomes in Canada,” Health that decreases it? Economics, 14: 107-116 (2005)

22 C OMMUNICATION M AY /J UNE 2005 Because we believe in good chemistry too.

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