Shoppers Drug Mart billed almost $62 million to the provincial government for medication reviews over a 14-month period, data obtained by the Star shows, raising concerns the pharmacy chain is abusing the Ontario Drug Benefit program and providing little benefit to patients.
The reviews, performed through the MedsCheck program, are provincially funded consultations between pharmacists and patients intended to make sure doses are being followed and patient concerns are being addressed.
Three former Shoppers franchise owners, all pharmacists, told the Star they faced corporate pressure to meet quotas for MedsCheck reviews, compromising their ability to use professional judgment as to whether patients needed the service.
One of the pharmacists said they were “expected” to perform between 80 and 100 MedsCheck reviews per week during COVID-19, whereas prior to the pandemic they were “applauded” if they performed 25 a week.
They also said they were told to hire additional pharmacists to “cold call” patients for the reviews.
“I really felt disgusting as a health-care professional because it was no longer a health-care service, and I’m now a salesperson trying to convince someone that they need this medication review and I don’t feel that it was necessarily beneficial,” the pharmacist said.
Another said the company was telling pharmacists “you still have to do these things, even if in your professional judgment you don’t want to.” This pharmacist said they gave up their Shoppers franchise “out of disgust.”
(The Star granted the pharmacists anonymity because their comments could result in retribution from Shoppers and harm future employment opportunities.)
Doctors add that the millions of dollars in Ontario Drug Benefit funds spent on the program could be better used in other areas where patient need is higher. Ontario’s MedsCheck program pays pharmacists up to $75 for each annual review.
Internal government figures obtained through a freedom-of-information request by the Star show that between Jan. 1, 2023, and March 13, 2024, Shoppers Drug Mart pharmacies billed the Ontario health ministry $61.9 million for just over 1.2 million MedsCheck reviews.
That means Shoppers, which is owned by Loblaw, was responsible for performing, and billing for, roughly 60 per cent of the medication reviews done in Ontario during that period, despite Shoppers pharmacies only making up about 13 per cent of the pharmacies in the province. (The company initially objected to the province’s decision to provide the data to the Star, forcing the request to mediation at the Information and Privacy Commissioner of Ontario.)
“The numbers raise some serious questions regarding how meds checks are initiated and being conducted,” said Aly Haji, a health regulatory lawyer at the Toronto firm RxLaw. “Given that the intention of the MedsCheck program is to conduct a thorough medication review that takes 20 to 30 minutes, if meds checks are being conducted at this rate, this data brings into serious question whether the intention of the program is being achieved.”
Asked about the high number of reviews, Loblaw’s public relations department told the Star MedsChecks “are more necessary than ever for Canadians,” citing a rise in chronic and pre-chronic conditions, particularly among patients without primary care providers. The company noted that the data obtained by the Star “represent fewer than five medication reviews per day per location across the province” over the 14-month period.
“Compared to other pharmacies, we provide more medication reviews because of our established infrastructure, which includes larger stores, central prescription-filling capabilities that allow pharmacists more time for professional services, more pharmacists per location and higher weekly operating hours,” Loblaw said, noting that 78 per cent of its Ontario stores operate for more than 84 hours per week. “Simply put, there is an important need for this service, and we are delivering.”
Optimum rewards misused
Controversy around the MedsCheck program began to grow early last year following media reports that Shoppers Drug Mart pressured pharmacists to meet quotas for the reviews, as well as targets for vaccinations and diagnoses of minor ailments.
A photo posted to social media platform Reddit at the time showed a memo titled “Bonus Optimum Points Chart,” which was posted at one franchise where pharmacists were offered 20,000 Optimum points (the equivalent of $20) if they conducted more than 16 MedsCheck reviews in an eight-hour shift, while students were offered the same if they conducted more than eight checks in a four-hour shift.
The company told the Star that this was “absolutely unacceptable,” and said it took “immediate action” when it was made aware of the issue.
However, one patient who spoke to the Star said that even as controversy swirled around the MedsCheck program, she was pressured by staff at one Shoppers Drug Mart pharmacy to have a review she neither wanted nor needed.
Toronto resident Alanna Kong, 24, said she was picking up her medications from a Shoppers location near the intersection of Bay and Bloor streets in early 2024 when she was asked by a pharmacist if she wanted a medication check.
“I just said no because my doctor had never said anything about me needing this sort of thing and they had never said anything about potential harmful interactions,” said Kong, who was taking three medications at the time. “It felt a little bit pushy and it just felt like it was some sort of sales pitch to be honest.”
She also got a phone call at home from someone she presumed was a staff member at the pharmacy “and they just kind of gave me the same song and dance, essentially.”
“It just didn’t feel completely necessary and the way it was presented to me it didn’t feel right,” Kong recalled.
Poonam Prajapati, owner of the Bay and Bloor Shoppers, said she was sorry that Kong had a negative experience at the store and that the review was offered as a “value-added service.”
“I’ve seen firsthand the benefits to our patients and many times patients do not realize the impact until after having the consultation with the pharmacist,” Prajapati said.
Loblaw said it regrets “any negative interactions with patients,” but said it has heard from “countless” patients and health-care providers who “value and appreciate not only this service, but the end-to-end care their local Shoppers pharmacy provides.”
Kerry Bowman, a bioethicist at the University of Toronto, said he has worked with seniors who felt they had meds checks “pushed on them.”
“These types of things can be very confusing, especially when they’re not initiated by patients,” he said. “Under laws of Ontario, consent has to be three things: it has to be capable, it has to be informed, and it has to be voluntary. So any element of coercion is not acceptable. No is no.”
Pharmacists ‘pressured’
One of the former Shoppers franchisees who spoke to the Star said they were told by district managers that any patient on three or more medications was to automatically receive a medication review, and any diabetic patient, even if they were on just one diabetic medication, was also to receive a review and a minimum of four followups a year.
The pharmacist said Shoppers “abused” the MedsCheck program, and that it was “disgusting because at the end of the day, it’s taxpayers’ money.”
Another former Shoppers franchisee said they didn’t think it was acceptable for anyone other than a pharmacist to be talking to a pharmacist about the appropriate delivery of a professional service. This pharmacist added that they were pressured to minimize support staff hours, which means pharmacists could become rushed in their work and “may miss the critical piece of information that’s required to protect the patient from harm.”
When asked about the allegations from the former Shoppers franchisees, Loblaw told the Star that the decision to deliver a professional service “must always be made by the pharmacist and we adhere to that principle.”
“Pharmacy as a profession has evolved rapidly in recent years and some have embraced the change more than others. We have worked hard to ensure the teams have the support they need to continue to deliver quality, professional care, and as part of these efforts we are doubling down on quality and patient safety,” the company said, adding that it has established a “quality services framework” for pharmacists and a “patient care and quality committee” that includes “renowned” health-care leaders, “reaffirming our commitment to excellence in health care.”
Jennifer Lake, an assistant professor at the University of Toronto’s Leslie Dan Faculty of Pharmacy, points out that fee-for-service procedures can incentivize health-care providers to focus on simpler cases as the reviews can be performed more quickly.
“It means more complex patients who may need the service may not receive it,” she said. “The same problem likely exists with MedsCheck. The program could be improved by changing the patient criteria to those at higher risk of medication harms, such as those with more medications.”
Ontario ‘improving’ program
When asked what it was doing to ensure the MedsCheck program rules are being followed, the Ontario health ministry said it was “improving” the program “to support health outcomes” and “reduce unnecessary service duplication and administrative red tape, while continuing to protect patient choice.” It added that it has consulted with sector partners on how to improve the program and has posted regulations for public feedback.
“We will have more to share about changes to the MedsCheck program in the coming months,” the ministry said.
Pharmacists the Star spoke to say there is nothing inherently wrong with performing medication checks. If they are done properly the reviews can be a valuable service and can catch patients taking their medications incorrectly, they said, preventing unintended side effects and hospital visits.
However, there is little research in Ontario about whether the MedsCheck program as currently implemented results in better patient outcomes.
The Star asked the health ministry if it had any data showing that MedsCheck reviews keep patients out of hospital or prevent harmful drug interactions. The ministry provided none, saying the Star would have to make a freedom-of-information request to obtain any information it had.
One study published five years ago found that older adults who were discharged from hospital and received medication reviews when they had their prescriptions filled had a lower risk of returning to hospital or dying within 30 days.
In 2023, the World Health Organization deemed medication safety as fundamental to reducing patient harm and pointed to medication reviews as a key area of action.
“It helps build relationships, it helps build trust, and it also allows us to try to educate the patient in more depth about the medication they’re taking,” said Kathleen Leach, a pharmacist and owner of independent Sutherland Pharmacy in Hamilton, Ont.
Leach said she has performed about 30 MedsCheck reviews a year since the provincial program began in 2007 and has found “hundreds” of cases where patients had problems with their medications. This, she said, helped prevent visits to the hospital or family doctor and improved patients’ quality of life.
But, she said, in any kind of quota system “you’re going to choose the low-hanging fruit.”
“If you figure that three meds is going to take 20 minutes, how much do you think a proper review of 15 meds is going to take?”
Meds checks not useful, doctors say
Several family doctors interviewed for this story said that while MedsCheck reviews may benefit some patients, particularly those recently discharged from hospital and who are on several medications, on the whole they are not particularly useful.
Dr. Allan Grill, a family doctor and lead physician at the Markham Family Health Team, said he doesn’t find the checks helpful for his practice because most of the MedsCheck reports he receives — which can be as long as seven pages — indicate no concerns.
“Sometimes I’ll have days where I get 10 of these in my inbox and I’ve got to open each one and take a look,” he said. “Even though it might only take 10 seconds to sign off, I’m spending time on things that haven’t benefited the patient really at all in my opinion, at a time where family physicians are already spending an average of 19 hours a week on administrative duties.”
Grill added he believes there are other places where the tens of millions of dollars spent on the MedsCheck program could be put to better use in Ontario’s publicly funded health-care system, where resources are limited. These include investing in more access to team-based primary care, increasing staff at emergency departments to prevent closures and funding expensive new cancer drugs, he said.
Markham family physician Shivani Sritharan said she received 52 meds checks in February 2024 alone.
“I also had a patient who declined a med check but yet I still got a fax a day later that a med check was done,” Sritharan said.
“In theory, the med checks are a good program with good intentions,” she said, “but I think private corporations are finding loopholes for it to be taken advantage of.”
