ADVENT OF MAIL-ORDER PHARMACY
`CAUSES CONCERN AMONG SOME PHARMACISTS
`
`David Spurgeon
`
`Ea: W.gm
`MEDITruLst, a major mail-order phar-
`macy, promises low drug prices and
`dispensing fees for people who order
`druLgs via mail. Its arrival has created
`some strong opposition in Quebec.
`The Canadian Pharmaceutical Associ-
`ation says the arrival of mail-order
`companiies may give commuLnity phar-
`macists an opportunity to promote the
`benefits of face-to-face conitact with
`pharmacists. The CMA's Dr. Anne
`Carter says there will always be a need
`for community pharmacists, who can
`provide drugs on short notice and pro-
`vide personal counselling for patients.
`
`I---
`Une importante pharmacie de vente
`par correspondance,
`MIEDITrust,
`promet des prix de medicaments et
`des frais d'ordonnance peu 6lev6s aux
`gens qui commandent des medica-
`ments par correspondance. Son arriv6e
`sur le marche a provoqii6 Line vive op-
`position aLu Quebec. L'Association
`pharmaceutique canadienne affirme
`que lFarrivee des entreprises de vente
`par correspondance pourra permettrc
`aux pharniaciens locaux de promou-
`voir les avantages du contact person-
`nel avec les pharmaciens. Le D)r Anne
`Carter, de 1'AMC, affii-me qu'on aura
`touLjours besoin de pharmaciens com-
`munautaires quli peuvent fournir des
`mndicamnents rapidement et donner
`des conseils personnels aux patients.
`
`A Toronto mail-order pharmacy
`JAcalled MEDITrust, which is pro-
`moting its services within the medical
`profession and to businesses is receiv-
`ing mixed reactions from doctors and
`pharmacists.
`In its promotional literature,
`MEDITrust emphasizes cost savings.
`It claims that both patients and the
`government health system could
`benefit - patients by as much as
`50% on medication costs and the
`Ontario government, for example,
`by up to $100 million annually un-
`der its drug-benefit program.
`
`David Spurgeon is a freelance writer living in Mont-Tremblant,
`Que.
`
`To doctors it offers a telephone
`hot line, customized fax sheets for
`patients' prescriptions, an informa-
`tion and ordering kit for waiting
`rooms, centralized patient profiles,
`consultation with its pharmacists
`and other services.
`To business, it suggests that
`clients can be made happy through
`cost savings. "You become a hero
`increased service!" says one of its
`brochures.
`How does it get business? A
`MEDITrust account manager will
`call a company to promote its
`"cost-containment pharmacy ser-
`vice." The company, in search of
`lower drug costs, advises its em-
`
`ployees or clients to use the ser-
`vice.
`First established in Toronto,
`MEDITrust now also operates in
`New Brunswick. Its two "superphar-
`macies" are accredited under the reg-
`ulations of the Ontario College of
`Pharmacists and the New Brunswick
`Pharmaceutical Society.
`"These facilities are in excess of
`20 000 square feet and are devoted
`exclusively to medication distribu-
`tion," says the company's Physician
`Information Kit. 'Through leading-
`edge technology, MEDITrust is ca-
`pable of delivering over 20 000 pre-
`scriptions per day. Although [we
`provide] patients with predomi-
`nantly chronic or maintenance med-
`ication, MEDITrust carries and de-
`livers all types of medication,
`including acute-care products. To
`order, patients can mail us their pre-
`scriptions or physicians can phone
`or fax in their prescriptions. [The
`company] is owned and operated by
`pharmacists dedicated to improving
`the service and cost of medication."
`Patients are charged a $5 dispens-
`ing fee, compared with the Ontario
`government formulary charge of
`$6.47 and what MEDITrust calls
`"usual and customary fees" of $7 to
`$14. A 90-day supply of medication
`is provided where appropriate for
`the same $5 fee. The mark-up is
`10% on all prescription medications.
`Generic drugs are promoted, but
`doctor and patient may request
`
`CAN MED ASSOC J * MAY 1, 1995; 152 (9)
`
`1485
`
` PAR1010
`IPR of U.S. Patent No. 7,668,730
` Page 1 of 2
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`

`

`brand-name products. Delivery to
`home or workplace is usually made
`within 2 business days.
`"We are not always the suitable
`choice for an emergency drug and
`our pharmacists counsel customers
`accordingly," the company advises.
`Leroy Fevang, executive director
`of the Canadian Pharmaceutical As-
`sociation (CPA), says the association
`"looks upon mail order as another
`type of pharmacy-delivery service."
`However, MEDITrust has had prob-
`lems
`in Quebec, where the
`province's Order of Pharmacists has
`asked at least two Ontario-based
`businesses to stop telling their Que-
`bec employees to use its services.
`Quebec pharmacists obtained a
`temporary injunction against the
`company in 1993, when customers
`in the province were being served
`through the firm's New Brunswick
`centre. They claim that MEDITrust
`is not a pharmacy as defined in the
`Quebec Pharmacy Act and, there-
`fore, not entitled to practise in the
`province.
`The injunction was lifted in Janu-
`ary 1994 by the Quebec Superior
`Court, but subsequently reinstated
`by the Quebec Court of Appeal. Af-
`ter the reinstatement, the Order of
`Pharmacists wrote to the Canadian
`Tire Corporation and Klockner
`Moeller Ltd., asking them to cease
`using MEDITrust. Both companies
`refused.
`Last year, the Toronto-Dominion
`Bank withdrew a recommendation
`that its employees use MEDITrust,
`saying it had underestimated the im-
`pact the recommendation might
`have on local pharmacists who are
`bank customers.
`When a Montreal pharmacist,
`Marcel Dubuc, was licensed by
`MEDITrust to use the company's
`computer system to fill Quebec pre-
`scriptions, officials from the Order
`of Pharmacists made repeated visits,
`seizing prescriptions relating to the
`company. They were later returned.
`MEDITrust's president, Norman
`
`Paul, characterizes actions like that
`as an attempt to limit competition.
`He told the Globe and Mail his com-
`pany plans to seek leave to appeal to
`the Supreme Court of Canada.
`Fevang qualifies the CPAs accep-
`tance of mail-order pharmacies with
`a caveat: "We do believe that phar-
`macists should provide drug-related
`information to their patients on a
`face-to-face consultation basis rather
`than more anonymously or imper-
`sonally over the telephone or
`through written records" - both
`of which are methods used by
`MEDITrust.
`Fevang thinks pharmacists will be
`in a better position to draw conclu-
`sions about customers in a face-to-
`face meeting. 'This can often play a
`very important part in their respon-
`sible and effective use of the medica-
`tions. We do have that concern ...
`and anybody who uses the services
`should be aware of that limitation."
`Dr. Anne Carter, the CMAs asso-
`ciate director of health care and pro-
`motion, says MEDITrust does pro-
`vide "a certain form of counselling"
`and "I don't think it matters terribly
`much to the physician whether
`pharmacists are in the community or
`on the end of a phone line some-
`where as long as they are reachable
`and they can be communicated with
`and as long as they perform their
`functions."
`Speaking from the physician's
`perspective, Carter said "physicians
`need certain functions from the
`pharmacist as another health care
`provider, as a member of the team."
`Those roles are to stock, store and
`dispense medication, provide med-
`ication-related information to pa-
`tients and provide a safety check on
`prescriptions to make sure they pose
`no danger.
`"Doctors are not infallible," she
`said. 'They can make errors and it's
`really nice to know that there's an-
`other pair of eyes going over [the
`prescription] and checking it, and
`also looking at other medication that
`
`the doctor might not even be aware
`of that had been prescribed by an-
`other doctor."
`This drug might be incompatible
`with the new prescription, and a
`pharmacist with a complete record
`of the patient's medication could
`spot that immediately.
`'Those are the roles that doctors
`really need pharmacists for. I think
`MEDITrust could fulfil those roles,
`from what I have seen of how they
`operate, but there are other roles
`nonprescription drugs, patient coun-
`selling - and I'm not sure they can
`fulfil them. Certainly I know they
`can't provide medication on very
`short notice."
`Carter said this means the com-
`munity pharmacist will still be
`needed, for example, for urgent de-
`livery within an hour or so, and for
`short-term, single prescriptions such
`as an antibiotic.
`As for nonprescription drugs,
`Carter said she knows that MEDITrust
`stocks them, but this form of medica-
`tion is sold in tremendous volume and
`requires a lot of counselling.
`"Patients who think they have a
`minor, self-limiting ailment that
`they're not willing to go see their
`doctor about will very often wander
`into a pharmacy and discuss.it with
`the pharmacist. It's a common sce-
`nario, and I don't really know if
`MEDITrust is prepared to fill that
`need. I think they stock nonpre-
`scription medication mostly for peo-
`ple who already know what they
`need - for example, 222s for ten-
`sion headaches about which they've
`already seen a doctor."
`Fevang said mail-order houses
`hold few implications for the phar-
`maceutical industry, but for the
`pharmacist they provide an opportu-
`nity "to market themselves more ag-
`gressively on the advantages that are
`inherent in the local, face-to-face
`environment, and provide that type
`of tangible service that may have
`been taken for granted in the
`past." -
`
`1486
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`CAN MED ASSOC J * ler MAI 1995; 152 (9)
`
` PAR1010
`IPR of U.S. Patent No. 7,668,730
` Page 2 of 2
`
`