Pharmacists hooked on ‘professional allowances’: Unseemly and unprofessional

Morley Callaghan, the great Toronto-based writer, would have known exactly what to tell Andy Giancamilli and Jürgen Schreiber: “Have the decency to be quiet.”

That was the dialogue Callaghan employed in his 1938 short story, “All the Years of Her Life,” which was forced reading back in the sixth grade English class at Danesbury Public School.

The tale, a spare bit of Depression-era realism, involves a pharmacist who discovers that one of his teenaged employees has been routinely stealing small items from the drugstore — a compact, and a lipstick, and two tubes of toothpaste. The thief confesses his misdeed, and then attempts a fumbling explanation, only to be cut short. Have the decency to be quiet, he is told.

Mr. Giancamilli, who runs the Rexall chain of drugstores, and Mr. Schreiber, president of Shoppers Drug Mart, have been full of fumbling explanations, ever since Ontario health minister Deb Matthews recently put a halt to their organizations’ practice of accepting funds provided by the makers of generic drugs.

Getting the public on side through spreading fear and threats: not healthy

The no-name drug manufacturers have been quietly slipping money to retail pharmacies, terming the practice “professional allowances.” The payments have had the effect of keeping pharmacists complicit in maintaining the steep cost of generic drugs in Canada, which are among the priciest knock-off pharmaceuticals in the world. It’s estimated that pharmacies have received vast sums, reportedly $750 million annually, through this scheme. This hidden cost to patients, and to payers, has been a source of controversy ever since the so-called allowances were introduced. Some have used the term “kickbacks” in describing the plan, although that characterization is bound to sound unseemly and unprofessional, and is certain to be offensive to the executives of the big chain retail-pharmacies. Nonetheless, it is not inaccurate.

Mr. Schreiber says all the revenue syphoned from the generics companies allows his stores to stay open late at night, and to deliver medicines at no charge to patients. Those services may not continue, he says. Mr. Giancamilli claims that without his professional allowance, he just might not be able to “provide the high level of pharmaceutical care that Ontarians have come to trust.”

What utter insulting nonsense. It’s nothing short of stunning that any retailer these days thinks it might be fitting to threaten customers with less convenience and worse service. Rexall and Shoppers might just as well lock their doors and provide directions to the nearest pharmacy prepared to offer value and respect to patients. That would be one of Wal-Mart, Costco, or any grocery store that dispenses drugs.

As much as they will couch their whinging in phrases involving the public health, it’s a mistake to think that the chain pharmacies are in business for any reason other than to make money. The arguments now being used by their spokesmen are reminiscent of when governments told drugstores to stop selling tobacco products, on the basis that pharmacies shouldn’t be killing their clientele by providing them with carcinogens. Many drugstore operators fought that common-sense instruction with obfuscation and twisted arguments, the same way they are currently making a case for continuing to clutch their, ah, allowances.

The pharmacy chain magnates know, as do those within the Ontario government, that a private understanding along the lines of the one enjoyed by the generics companies and their compliant neighborhood pill-counters, would, if perpetrated in the United States, have led to the principals being asked to explain themselves in court, while wearing orange jumpsuits and leg-irons. The Americans have demonstrated a peculiar attitude concerning parties who conspire to set pricing for Uncle Sam on Medicaid, and the state Attornies-General have been known, along with the bunko squads of law enforcement agencies, to take a dim view of such allegations.

Canadians, up to this point, have been inclined to be sanguine and self-congratulatory about our health care system, and are not prone to dwell too much on the operational aspects. This has led to problems. Comparable to the awkward kid in Morley Callaghan’s story, the drugstore CEOs never previously felt obligated to justify their casual acceptance of payments from the generics manufacturers. Now it turns out that, in their view, the payments were essential to providing care. Now they think they can work to reverse the Queen’s Park edict, by frightening the public.

“This is the first time I ever took anything,” Callaghan‘s exposed and shamed kid tells the drugstore owner, who replies as follows:

“So now you think you’ll tell me a lie, eh? What kind of a sap do I look like, huh? I don’t know what goes on in my own store, eh? I tell you you’ve been doing this pretty steady.”

Any government intent on responsibly administering the public purse would right now be considering methods to disgorge all allowances inappropriately paid to pharmacies in past years. This could amount to billions of dollars that could be recovered from the generics industry and their jolly local druggists, and used to fund care in the province. Mssrs. Giancamilli, Schreiber and colleagues need to carefully consider their position before they continue their campaign of yelping, dissembling, and complaining.

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