Magnifying MedsCheck Misuse: Pharmacists Take Note
Recent news stories have highlighted concerns that pharmacists are misusing the MedsCheck program which reimburses pharmacies for conducting medication reviews . On February 28, 2024 a CBC news report was published where pharmacists expressed feeling pressured by management to conduct unnecessary reviews with low-risk patients and to bill the government.
The Ontario MedsCheck Program
MedsCheck is a government program that reimburses an Ontario pharmacy when a pharmacist meets with a patient to review their medications. Under MedsCheck, the pharmacist can schedule a 20- to 30-minute annual review with patients who are:
taking at least three prescription medications for a chronic condition,
taking at least one prescription medication for type 1 or type 2 diabetes, or
living in a licensed long-term care home.
The review can be done virtually, provided that the pharmacist calls from the pharmacy’s location. The pharmacist is expected to discuss the dosages, usage instructions, and potential side effects of the patient’s medications. The review is intended to (a) help the patient take their medications as prescribed and (b) recognize common issues that can occur when taking multiple medications. Once the review is signed by the patient’s family doctor, the pharmacist can submit a claim for payment, where the government reimburses the pharmacy up to $75 per review.
The Misuse of MedsCheck by Pharmacists
Physicians and others have raised concerns that pharmacists are misusing MedsCheck by conducting unnecessary reviews (e.g., reviews with low-risk patients who have been taking the same medications for years), and Ontario College of Pharmacists (OCP) has commented that it is aware of pharmacists being pressured to schedule MedsCheck reviews. And on March 25, 2024, the Ontario College of Pharmacists (OCP) expressed a position expressing “zero tolerance for business practices that compromise the ability of pharmacists and registered pharmacy technicians to deliver safe and effective care to their patients.”
Pharmacists, for their part, have expressed that they are being pressured to conduct unnecessary reviews because pharmacy management expects them to achieve daily billing targets. In an open letter, a group of pharmacists stated that “the pressures are so unsustainable and unrelenting that they are seriously affecting the mental health of many associates.”
In addition to raising the ire of their medical colleagues and wasting resources, pharmacists who misuse of MedsCheck can face allegations of professional misconduct and regulatory action. In a recent case, the OCP's Discipline Committee made a finding of professional misconduct where a member was found to have "submitted accounts or charges for services that she knew or reasonably ought to have known were false or misleading to the Ontario Drug Benefit program for MedsCheck review." The member received a lengthy suspension and was prohibited from serving as designated manager for a pharmacy, in addition to other sanctions.
Furthermore, a pharmacist who conducts unnecessary reviews could adversely affect patient quality of care. These reviews are burdensome as pharmacists must prepare medication lists, and often conclude with insignificant changes for the patient.
Takeaway
MedsCheck has the potential to be a valuable program that promotes safe medication use and access to health care. However, MedsCheck can’t be used for unnecessary reviews to meet corporate profit pressures. Pharmacists are encouraged to reassess their practices as they risk facing allegations of professional misconduct and harming the public good.
Pharmacists ought to ensure that their reviews are scheduled with eligible patients who need the service, and that their reviews are conducted in compliance with the program’s requirements. To determine whether your MedsCheck reviews satisfy the program’s requirements, or to assess any potential risks with your MedsCheck reviews, please contact us.