In January, a Shoppers Drug Mart district manager in Ontario wrote to store owners in his area to express “deep disappointment” in their performance during the first week of 2024.
“Despite clear plans and expectations, it is evident that we fell significantly short of our targets,” reads the email obtained by CBC News.
The email is one of dozens of internal records frustrated pharmacists from across the country provided to CBC News to show that the pharmacy chain has targets for professional services like medication reviews — and corporate management pressured pharmacy owners to meet those numbers.
This despite president Jeff Leger’s denial last month, when he told CBC News: “We don’t have targets or any other kind of element like that.”
Leger’s statement struck a chord with more than a dozen of the chain’s current and former associate owners and pharmacists, who confirmed the existence of targets for professional services, and pressure to meet them.
“It was really disturbing to us as associate owners to hear that from the president,” said Philip, a pharmacist and associate store owner with Shoppers Drug Mart. “Philip” is a pseudonym. CBC News is not identifying him and other pharmacists interviewed for this story because they fear reprisal for speaking out.
Dozens of current and former Shoppers Drug Mart owners and pharmacists say corporate management pressured them to meet ‘unethical’ targets for unnecessary medical services. Emails and internal records from Shoppers provided to CBC News back up this claim.
“We have brought this up many times starting last year that there shouldn’t be any targets or quotas when it comes to professional services — and in particular for medication reviews.”
Medication reviews are meetings between a pharmacist and a patient to go over their prescriptions and ensure they’re taking the right combination of medicines. Anyone who takes at least three medications for a chronic condition, is living in a licensed long-term care home, or is receiving treatment for diabetes is eligible for a medication review in Ontario under the province’s MedsCheck program.
“The pressure was extremely intense,” said Curtis, a pharmacist and former associate store owner whose franchise agreement was terminated in the last six months.
“They were essentially monitoring performance records weekly and if you were not hitting your weekly billing numbers, you were requested to come up with business plans and somehow come through with those billing dollars at the end of the day.”
CBC News requested an interview with Leger about his claim the company doesn’t have targets for medication reviews, but was told he was not available.
In an email statement, a Shoppers Drug Mart spokesperson said “we stand by our previous remarks.”
“The decision to deliver a professional service, such as a medication review, must be made by the pharmacist using their judgement,” wrote spokesperson Catherine Thomas.
“Our role is to assist associate owners and their pharmacy teams to deliver these services. That includes working with the associates on a yearly plan that is specific to the pharmacy’s unique situation and patient needs in the community.”
Some associate owners dispute that, and say they had zero say in the targets and plans set for their stores by management.
The statement also says Shoppers Drug Mart has heard from “countless” pharmacists who “feel passionately about the care they provide” and encouraged CBC News to speak to some of them — although they were not named in the statement — for balance in this story.
Post-pandemic pressure
Several current and former Shoppers pharmacists said corporate pressure to perform medication reviews, along with other professional services that are billed to the government, ramped up after the pandemic when demand for COVID-19 testing and vaccinations waned.
“I don’t think they wanted to see any of that money disappear,” said Curtis.
During the pandemic the MedsCheck program was amended to allow pharmacists to conduct medication reviews over the phone (in addition to in person). Pharmacies can bill the government up to $75 per virtual review.
Internal numbers show one pharmacy location saw a more than 300 per cent increase in the number of medication reviews it billed between 2022 and 2023.
CBC News reviewed nearly a dozen performance emails corporate management sent to associate owners that included the count of professional services completed — or revenue billed from those services — for a given week at their pharmacies. Those numbers were included alongside Shoppers’s target for those services and the percentage of the weekly plan achieved to date.
In a December 2023 email to associate owners in Ontario — where Shoppers has most of its stores — a vice president reiterated the company’s ongoing plan to “accelerate the care we are providing” through medication reviews before the end of the year. The plan included adopting higher weekly targets (known internally as “run rates”) to prepare owners to meet new targets set out for 2024.
“Over the next 48 hours, I will be reaching out to you directly to speak with you and understand your commitment to meeting this run rate and providing these services to your patient population, and what your plan is to meet the run rate by the end of this week,” the email said.
Associate owners get a cut of the professional services billed by their pharmacies. Records show the company offered an incentive of 10 per cent on top of that cut for a period at the end of 2023 if owners exceeded their target plan.
$1.4M billed in a week
This February, Shoppers Drug Mart pharmacies across Ontario brought in a collective $1,869,300 in revenue for professional services in a single week, according to internal records. Medication reviews accounted for more than 75 per cent of that revenue — $1,423,900.
That same week, 28 Shoppers pharmacies in the Vancouver area billed a total of $27,210 for medication reviews, according to a performance email.
Comparative data for previous years was not available.
In a second statement, Thomas, the spokesperson, outlined steps Shoppers is taking based on recent feedback the company says it received from a few pharmacists.
She appeared to suggest any problem would be corrected.
“We’re reinforcing mandatory training for both our field and store support teams on the appropriate use of pharmacy metrics for patient outcomes, as well as our expectations for how to support and communicate with Associates and their Pharmacy teams,” she said.
Ethical concerns
Philip, Curtis and Scott — another former associate owner — and a handful of other pharmacists all said they support the programs to provide professional services but believe it’s unethical to put targets on them.
“This interferes with our professional judgment as a pharmacist,” said Philip.
“If you are giving me this target I have to achieve no matter what, and you are making weekly follow-ups, bi-weekly follow-ups, from all levels within the corporation this again doesn’t leave me with any kind of discretion or professional judgment.”
Scott says this puts pharmacy managers, and their pharmacists, in a tricky position professionally — pharmacists are a regulated profession and are answerable to provincial regulators.
Shoppers however, is not.
“They are not liable or accountable in front of the college,” said Scott. “The person who’s accountable is actually the person at the front, which is the pharmacist, the pharmacy manager.”
The Ontario College of Pharmacists told CBC it’s currently gathering information on the issue and any pressures pharmacists face. So far, a spokesperson said the province’s regulatory body has received more than 4,000 responses to an anonymous survey and expects more than 500 attendees for a series of virtual town halls.
“MedsCheck reviews can save lives,” said spokesperson Dave Bourne in a statement.
“However, MedsCheck reviews that are performed primarily to meet quotas, rather than to meet patient needs, are a drain on health system resources (both financial and human) and have an impact on other members of the patient’s care team.”
The college says it will look to other jurisdictions for solutions because this problem isn’t unique to Ontario.
“Jurisdictions across North America are struggling to address the tension between profit and patient protection,” said Bourne.
Premier Ford issues warning
A day after publication, Premier Doug Ford was asked about this story at an event in Barrie, Ont. The premier said he hadn’t heard from pharmacists directly, but issued a warning to Shoppers Drug Mart.
“If you’re forcing or putting pressure on your pharmacists, you’re going to be accountable,” said Ford.
“I’ll guarantee you will be held accountable if you’re telling the pharmacists to do MedsChecks, which they don’t have to do. And I don’t have proof of it right now. But if we get proof, then they’re in deep trouble.”
CBC News contacted Shoppers Drug Mart for comment on Ford’s remarks but has yet to receive a response.