In her 2019 report tabled on Monday, Saskatchewan Ombudsman Mary McFayden described her investigation into pricey medications for care home patients.
The review began when a pair of siblings noticed their father’s cost of prescription drugs rose significantly after moving into a care home run by the former Saskatoon Regional Health Authority.
The man’s medication jumped from $45.40 to an average of $113.31 per month.
For safety reasons, describes the report, staff at care homes won’t give patients their medication unless it’s bought from the pharmacy contracted under the facility. Families can purchase from other pharmacies, although they must privately arrange for someone to administer the medication.
“Since this would be impractical or prohibitively expensive for most residents, it means that all residents of a special-care home have no reasonable option,” said the report. “So, the authority’s pharmacies have a ‘captive’ market.”
Before resorting to the ombudsman, the man’s children brought up their concerns to the Saskatchewan Health Authority (SHA), which must ensure care home patients are charged competitive prices for both prescription and over-the-counter drugs.
The report said the SHA did a thorough review and made changes to its Contract to Provide Pharmacy Services template. But the shift didn’t address the underlying issue, read the report—the changes instead worked towards making sure residents were charged consistently across all facilities.
The SHA said it couldn’t dictate or negotiate dispensing fees because it’s governed under agreements between the Ministry of Health and pharmacy proprietors.
However, McFayden found the health authority was able to ensure the proprietors were charging competitive prices and that those prices were evaluated.
“(Because) the Ministry’s proprietor agreement only provides for the maximum amount a pharmacy can charge, it clearly contemplates a pharmacy charging its customers less than the maximum, and does not deal with over-the-counter medications.”
She pointed to the former Prince Albert Parkland Regional Health Authority. It conducted a Request for Proposals where each pharmacy had to submit what it would charge for dispensing prescriptions, as well as packaging and dispensing over-the-counter medications.
The process ensured residents weren’t paying a markup price because pharmacies charged their cost plus a fee.
McFayden made two recommendations to the SHA, which accepted both.
The first was that the SHA implement a standard Request for Proposals that includes the evaluation of proposals based on the total, prices, fees and charges of competing pharmacies. The second recommendation is that it develop and implement a standard pharmacy services agreement.