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Toronto physician calls for drug cost transparency, affordability discussion with patients

Dr. Iris Gorfinkel

The CBC’s investigative television program The Fifth Estate has reported, “Canada wasted $15 billion over the last five years on highly priced prescription drugs. Experts say misinformed prescribing practices, influenced by drug company marketing, are at the heart of the wasted spending.”

That report highlighted, “In Canada, doctors often rely on the drug companies to teach them about new drugs and their potential benefits, a situation that inevitably creates a conflict of interest, experts say. A drug company will likely favour its own products, even if they are not the best or cheapest option.”

It adds, “Clinical guidelines from the Diabetes Association of Canada recommend first prescribing generic Metformin — a drug that costs just $65 per year. Only when it fails to work should doctors move on to more expensive alternatives that can cost as much as $3,000 per year. According to the research by Express Scripts Canada, in 2015 more than $100 million was wasted by ignoring those clinical guidelines. In some cases, there may be medical reasons for bypassing the guidelines, but experts say that wouldn’t explain all of it. ‘My guess is that drug promotion is very influential in terms of doctors not following the guidelines’, says Toronto family doctor Sheryl Spithoff.”

The Toronto Star now reports, “[Dr. Iris] Gorfinkel is spearheading an initiative urging the province [of Ontario] to mandate drug cost transparency — having prices pop up in the electronic medical record (EMR), so when doctors and nurse practitioners are writing prescriptions, they can discuss affordability with patients.”

The article explains, “Right now, when doctors write prescriptions, they see the name of the drug, but not the price. This means patients may be prescribed more expensive meds when there are equally effective and cheaper alternatives. As a result, people can experience sticker shock at the pharmacy, leading some to forgo their meds and become sicker, contributing to downstream health-care costs.”

It also notes, “Gorfinkel’s initiative is gaining traction. The Ontario Medical Association, representing 33,000 practising physicians, the Nurse Practitioners’ Association of Ontario, representing 3,300 nurse practitioners, and the Ontario Pharmacists Association, representing more than 10,000 pharmacists, pharmacy students and pharmacy technicians, support the idea. …The Reformulary Group applauds the move and wants it to go even further by updating EMR systems to include the price for comparable drugs as well. …[And] NDP [health critic France Gélinas] says drug cost transparency is ‘crucial’ for physicians and long overdue [and would save money]. …[But] currently, no jurisdiction in Canada has real-time access to drug costs in electronic form.”

The CBC has previously reported, “Dr. Joel Lexchin says this lack of knowledge can result in a doctor prescribing a brand of drug that is more expensive than its generic version, even though both medications do exactly the same thing [while] Dr. Steve Morgan says there is also evidence that some doctors just don’t care. ‘Cost of drugs does not affect their practice’, says Morgan. ‘Sometimes the doctors may even get paid by the drug companies to become an opinion leader.'”

The Globe and Mail has reported, “Pharmaceutical companies pay doctors to deliver speeches, act as consultants, teach continuing medical-education courses, fly to conferences and spearhead clinical trials, among other services. However, in Canada, these specific industry payments to doctors are shrouded in secrecy – unlike in the United States, where the Physician Payments Sunshine Act compels companies to divulge all payments of $10 or more to doctors. The U.S. legislation has generated a rich trove of data, allowing researchers to learn that gifts as small as a free meal can influence physicians’ prescribing behaviour.”

Big Pharma influenced prescribing practices and high drug prices (Canadians pay the second-highest drug prices in the world) are serious problems.

Last month, CBC reported, “Nearly one million Canadians spent less on necessities like food and heat to afford their prescriptions in 2016, according to a new study [by researchers at the University of British Columbia, Simon Fraser University, McMaster University, and The University of Toronto]. The paper found that 730,000 people skimped on food and another 238,000 spent less on heating their home — a total of 968,000 people. …The study also said more than 1.6 million Canadians — 8.2 per cent of people who were prescribed medication in 2016 — didn’t fill those prescriptions, skipped doses, or otherwise didn’t take the medicine because they couldn’t pay for it.”

The National Post has reported, “Those who can’t or won’t fill their prescriptions end up back in hospital [a phenomenon that costs the health care system between $7-and $9-billion annually] and the phenomena leads to ‘higher mortality’… [according to a study by the Toronto-based Mowat Centre for public policy].”

The Council of Canadians supports the call for pharmacare (which could save up to $11 billion a year) and for significant steps to be taken to reduce the influence of Big Pharma and the cost of prescription drugs. We have highlighted that the extended patent provisions for pharmaceutical drugs under that the Canada-European Union Comprehensive Economic and Trade Agreement could cost up to $1.65 billion annually.