“I think you have to take away any financial reward to have a prescription,” said Dr. Chris Ozere, in family practice for more than 25 years in North Dartmouth. Ozere said his thinking on the matter has changed after hearing a story in his practice about prescription abuse. It led him to worry about a blind spot in the system.
“as a favor”
Through his daily medical practice at Albro Lake Medical Clinic, Ozere heard a story about the intentional transmission of the blood-borne hepatitis C virus. Hep C is not transmitted through sex, or hugging or coughing, Ozere said. “That’s how they know that blood is where you get this infection, because hepatitis C is not a sexually transmitted disease, it’s a blood-borne disease,” he said. He said he heard people were “sharing blood.” He wasn’t sure if that meant they were sharing needles with blood in them or something else. “Well, during my internship, I heard a story about intravenous drug users passing hepatitis C to each other or to someone as a favor… the favor is that you get hepatitis C.” Albro Lake Medical Clinic is located on the corner of Primrose Drive and Windmill Road in Dartmouth. (Mark Crosby/CBC) It is considered a grace because seeking healing can reap rewards. Once infected, people can turn to the government to pay for treatment, he said. Prescriptions for treatment are taken to a pharmacy where reward points can be earned. Points can be converted into things that can be “traded and used”. It’s just a story, but Ozere believes it’s credible. “If you’re an intravenous drug user and, you know, they’re desperate for money at times, that’s, I think, what they came up with, that idea,” he said.
Deep disadvantage
From a public health perspective, Ozere believes this is a significant risk. “Hepatitis C is a very serious disease,” he said. His hepatitis C patients were always diagnosed using the blood test you would get from an outreach team on the street or in the emergency department. Once reported, the person is in the hands of Public Health. The next step is a visit with the blood-borne infectious disease specialists at the QEII Health Sciences Center in Halifax. A three-month C virus treatment in Nova Scotia can cost $60,000. Doctors need to monitor the virus in your blood until it is gone. “And it doesn’t work for everyone,” Ozere said. If left untreated, hepatitis C can lead to liver cancer or liver failure. Ozere has been a family physician at Dartmouth since the mid-1990s. (Mark Crosby/CBC)
Taking a stab at prescription rewards
Ozere said there is no way to prove the story one way or the other. But even the possibility of it happening has changed his thinking about allowing patients to benefit from prescriptions. A Loblaws spokesperson said PC Optimum points are credited on all pharmacy purchases made with a Shoppers Drug Mart rewards card. A $60,000 prescription would translate into $900 in reward credits. Nova Scotia is one of the last Canadian provinces to allow it. The issue has been fought through the courts on a province-by-province basis, with the various provincial colleges of pharmacy fending off corporate challenges to their bans. Courts backed pharmacists in Ontario in 2004. Sobeys West fought a ban on sales incentives for prescription drugs in British Columbia. Their arguments, based on the best interests of consumers and the protection of competition, were rejected when the Supreme Court of Canada said they had no interest in hearing their appeal. Last month, New Brunswick pharmacists also voted to get rid of reward points, on the principle that the money had no place in a practice that now includes pharmacists who fill prescriptions themselves. But Nova Scotia walks a finer line.
Balancing interests
The Nova Scotia College of Pharmacists looked at this issue nine years ago and decided that prescription rewards should remain. “There are competing public interests at play,” Beverly Zwicker, the college’s secretary, told CBC News in late June, “tangible benefits that people perceive from rewards, and the value of those rewards programs in encouraging patients to remain in a pharmacy. .” For this reason, the college has ended vouchers or reward points for pharmacy switching bonuses, where the policy is currently in effect. After hearing Ozere’s concerns, Zwicker doesn’t want to reopen the issue. “The College is committed to evidence-based decisions,” he wrote in an emailed statement, “We are careful not to over-regulate and proceed cautiously when there is little evidence to support a regulatory intervention.” The Nova Scotia Department of Health and Wellness defers to pharmacists. “We rely on frontline professionals such as doctors and pharmacists to inform the DHW of issues like this and ensure all prescriptions are filled appropriately,” spokeswoman Khalehla Perreault said. “At this time, we do not have sufficient information to support the idea that our programs are negatively impacted by loyalty points,” he said.
Unwanted doubts
In the days since he started thinking about prescription rewards, Ozere has had unwanted thoughts about other possible systemic problems, such as patients pushing for drugs as a way to increase their point balance. He makes it clear, he doesn’t blame anyone. “People will do what they have to do when they’re desperate,” Ozere said, “They’re not the problem. The problem is that … the financial incentive is there to get expensive prescription drugs.” MORE TOP STORIES
