Dartmouth doctor says awarding loyalty points for prescriptions too risky

A doctor in Dartmouth, N.S., thinks that awarding loyalty points for prescription drugs could lead to misuse of the pharmacare system.

"I think that you have to remove any financial reward for having a prescription," said Dr. Chris Ozere, in family practice for more than 25 years in north Dartmouth.

Ozere said his thinking on the matter has changed after he heard a story at his practice about prescription misuse. 

It's led him to worry about a blind spot in the system. 

'As a favour'

Through his daily medical practice at the Albro Lake Medical Clinic, Ozere heard a story about the deliberate transmission of the blood-borne virus hepatitis C. 

Hep C is not transmitted through sex, or cuddling or coughing, Ozere said.

"So they're aware that it's blood where you get this infection from because hepatitis C is not a sexually transmitted disease, it's blood-borne disease," he said. 

He said he heard that people were "sharing blood." He wasn't sure if that meant sharing needles with blood in them, or something else. 

"So in the course of my practice, I heard a story about IV drug users passing hepatitis C to each other or to somebody as a favour... the favour being that you get hepatitis C."

It's considered a favour because seeking out the cure can reap rewards. Once infected, people can turn to the government to pay for the cure, he said.

Prescriptions for the treatment are taken to a pharmacy where loyalty points can be earned. The points can be converted to things that can be "traded and used."

It's just a story, but Ozere believes it is credible.

"If you're an IV drug user and, you know, they're desperate for money at times, this is, I think, what they came up with, this notion," he said. 

Deep downside

From a public health perspective, Ozere thinks this is a substantial risk. 

"Hepatitis C is a very serious illness," he said.

His hep C patients have always been diagnosed using the kind of blood screening you'd get from a street-based outreach group, or at the emergency department. 

Once reported, the person is in the hands of Public Health. The next step is a visit with the blood-borne infectious disease specialists at the QEII Health Sciences Centre in Halifax. 

A three-month treatment for hep C in Nova Scotia can cost $60,000. Doctors must track the virus in your blood until it's gone. 

"And it doesn't work for everybody," said Ozere.

Left untreated, hep C can lead to liver cancer or liver failure.

Taking a jab at prescription rewards

Ozere said there is no way to prove the story one way or another. 

But even the chance that it might happen has changed his thinking on allowing patients to profit from prescriptions. 

A spokesperson from Loblaws said PC Optimum points are credited on all pharmacy purchases made with a loyalty card at Shoppers Drug Mart. 

A $60,000 prescription would translate into $900 in loyalty credits.

Nova Scotia is one of the last provinces in Canada to allow it.

The issue has been fought through the courts province by province, with the various provincial pharmacy colleges beating back corporate challenges to their bans. 

The courts backed pharmacists in Ontario in 2004. 

Sobeys West fought the ban on commercial inducements for prescription drugs in British Columbia. 

Their arguments, based on the best interests of consumers and protecting competition, were put to bed when the Supreme Court of Canada said they had no interest in hearing their appeal. 

Last month, New Brunswick pharmacists voted to get rid of loyalty points, too, on the principle that money had no place in a medical practice that now includes pharmacists filling prescriptions themselves. 

But Nova Scotia takes a more nuanced line. 

Balancing interests

The Nova Scotia College of Pharmacists looked at this issue nine years ago and decided prescription rewards should stay. 

"There are competing public interests at play," Beverly Zwicker, the college's registrar, told CBC News in late June, "tangible benefits that people realize from rewards, as well as the value of those rewards programs in encouraging patients to remain at one pharmacy."

For that reason, the college put an end to coupons or loyalty points for bonuses for switching pharmacies, which is where the policy sits today. 

After hearing Ozere's concerns, Zwicker is not keen to reopen the issue. 

"The College is committed to evidence-based decisions," she wrote in an email statement, "We are careful not to over-regulate and we proceed cautiously when there is little evidence to support a regulatory intervention."

Nova Scotia's Department of Health and Wellness defers to the pharmacists. 

"We rely on front-line professionals such as physicians and pharmacists to inform DHW about issues like this and to ensure all prescriptions are supplied appropriately," said spokesperson Khalehla Perrault. 

"At this time, we do not have sufficient information to support the notion that our programs are being adversely affected by loyalty points," she said. 

Unwelcome doubts

In the days since he started thinking about prescription rewards, Ozere is having unwelcome thoughts about other possible systemic problems, such as patients lobbying for drugs as a way to bump up their points balance. 

He makes it clear, he's not blaming anyone. 

"People will do what they need to do when they're desperate," Ozere said, "It's not them that's the problem. The problem is that … the financial incentive is there to get expensive prescription drugs."

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