The stage is set for a battle between the Ontario government and pharmacists over drug reforms introduced Wednesday by Health Minster Deb Matthews.

The government says Ontarians could see their pharmacists fulfill services that doctors and nurses have mostly performed until now.

But pharmacists warn they can’t afford to do that and some may have to reduce hours or close, increasing wait times for prescriptions, because looming drug price cuts will cripple their bottom line.

“Pharmacists will fight hard to stop this cut, on behalf of the thousands of patients we treat every day,” said Ben Shenouda, a community pharmacist in Brampton and president of the Independent Pharmacists Association of Ontario.

In a luncheon speech to the Canadian Club, Matthews detailed a new vision of health care designed to stretch scarce health care dollars across more patients by forcing down the price of generic drugs.

Matthews noted that Ontario pays 50 times as much as the U.S. Veteran's Administration for a popular blood pressure medication called amlodipine.

“That is simply not fair,” she told a crowd of 500 people at the Royal York. “It's not getting the best value for Ontario's dollars.”

While pharmacists would earn less for the medicines they dispense, the government—which spends billions annually on drugs for seniors and welfare recipients—plans to compensate for the lost income by paying druggists a fee for doing more one-on-one work with patients, such as counselling on chronic diseases like diabetes, or giving injections like flu shots, as is done in other jurisdictions.

“We’re paying too much for our drugs,” Premier Dalton McGuinty said Tuesday while touring a family health clinic in Peterborough.

Under the reforms—which have some pharmacists warning they will lose money and perhaps close—the government is looking to eliminate much of the $750 million annually in “professional allowances” generic drug companies pay pharmacies to secure shelf space for their products, saying those fees make the medicines more expensive than they would otherwise be.

Sources said those allowances will be eliminated for taxpayer-funded prescriptions to social assistance recipients and seniors, while adjustments will be made to the allowances for drugs paid out for prescriptions to private customers or company drug plans.

“We have an important conversation ongoing with our pharmacies and our pharmacists,” McGuinty acknowledged.

“We think our pharmacists can do more for us. We’d like to pay them for their professional services in a way they’ve never been paid in the past. Some of the savings that we want to generate from paying less for drugs we intend to put into professional duties for pharmacists.”

But pharmacists maintain losing the “professional allowances” will be damaging.

“The massive funding cuts, estimated to be in the hundreds of millions of dollars per year, will put community health care services at risk, and directly contradict the government’s promises to make new health services more convenient and accessible through pharmacies,” the Community Pharmacy Coalition said in a statement Wednesday.

“Pharmacists in Ontario fear their ability to be available to their patients will be severely reduced.”

For months, tense talks have taken place with Ontario’s pharmacists in an effort to get them to ban the “professional allowances” voluntarily.

McGuinty’s government paved the way for the reforms with December’s passage of a law enabling pharmacists to widen their scope of practice and also to clear a path for “remote dispensing” of prescription medicines through pharmacy technicians or automated machines with video and audio links to accredited pharmacists.

Health care costs must come down because they threaten to dominate the provincial budget, eating up 32 cents of every dollar 20 years ago, 46 cents now and a forecast 70 cents within 12 years, crowding out spending for education and other priorities, McGuinty said.

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“There’s more demand coming in the system every single day,” he explained. “Baby boomers start to retire next year. They’re a huge complement of the population and we’ve got to be sure we have the capacity to meet their needs.”

Despite the health care cost crunch, Matthews, who has been critical of hospitals paying their CEOs too much, held a briefing and news conference on the drug reforms at a posh downtown hotel, despite plentiful space and media facilities at Queen’s Park.

It’s the second time the McGuinty government has taken aim at generic drug prices. Several years ago, former health minister George Smitherman shepherded a law that capped the “professional allowances” at 20 per cent of the value of generic drugs sold.

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