At least two managers at pharmacy giant Rexall have pressured pharmacists to drive up revenue by conducting medication reviews at drive-thru windows, insiders have told CBC.

One of the Rexall insiders says a manager made the suggestion after hearing store pharmacists couldn't meet quotas for the publicly funded reviews because some of their customers picked up their prescriptions at drive-thru windows. The pharmacist asked not to be identified, fearing professional repercussions for speaking out.

Another pharmacist said the regional pharmacy director frequently urged staff to do medication reviews at the drive-thru window.

The pharmacist, who spoke to CBC's Marketplace on condition of anonymity, refused to comply with the request, telling the boss that listing someone's prescriptions over a speakerphone was a gross violation of patient privacy, as well as a violation of program guidelines.

This information comes on the heels of a months-long investigation by CBC News and Marketplace into pharmacies and government-funded services.

Medication reviews — known as MedsChecks in Ontario — are publicly funded safeguards designed to make sure people are taking prescription drugs correctly.

In provinces with these programs, pharmacies can bill provincial governments anywhere from $52.50 to $150 each time an annual medication review is performed, and a lesser amount for follow-ups.  

According to provincial guidelines, they are supposed to be conducted in a private setting and take anywhere from 20 to 45 minutes.

'Highly inappropriate'

In a statement provided to Marketplace, the drugstore chain says, "Rexall has never indicated or suggested to any employee that conducting a MedsCheck at a drive-thru is acceptable. It is highly inappropriate and Rexall does not condone this or any other patient-focused service being provided in this manner."

Internal emails supplied to Marketplace show that managers have used unusual means — such as food, gift certificates and parties — to motivate pharmacists to do more medication reviews and other services for which they could bill the provincial government.

Rexall interior

Rexall tells Marketplace that conducting reviews and other services at drive-thru windows is 'highly inappropriate and Rexall does not condone this or any other patient-focused service being provided in this manner.' (CBC)

"Our goal: 24 PFS [patient-focused services]

on the 24th, all stores. There will be prizes for those stores that are creative and pull out some tricks from their magic box," Sejal Kothari, regional pharmacy director for the Toronto area, wrote in an email dated September 2013.  

She has since been promoted to a position designed to drive prescription growth and professional services in stores across Canada.  

In southwestern Ontario, regional manager Mike Jorgenson offered pharmacists a pizza party if stores met the daily quota for MedsChecks.  

In an email to staff, Jorgenson says: "Talk to your store. Coach them to win and let them have some fun with this."  

Jorgenson was the regional director of operations for southwestern Ontario from February 2012 until January 2014. During that period, Jorgenson managed pharmacy operations in close to 30 stores.

When asked about the pizza party, Jorgenson said Rexall frequently used contests to encourage staff to do medication reviews and other professional services, but that the goal was to raise "awareness" rather than money.

Seniors targeted

Documents obtained by Marketplace show senior Rexall managers imposed high quotas for those services on pharmacists and appear to have targeted seniors.  

In one email, Jorgenson says: "How do we go from good to great? Next Tuesday is bonus seniors day. My ask:  Prebook 100 customers for Tuesday."

Pharmacists told Marketplace that the expectation was that only 25 of the 100 would show up.  

Rexall interior

A Rexall pharmacist told Marketplace: 'I work as a lone pharmacist and find it almost impossible to do a quality MedsCheck in a busy store. I found it appalling that it was made into a “contest” to see which store could do the most.' (CBC)

However, they say, conducting even 25 medication reviews would take a pharmacist at least eight hours if done according to provincial standards.   

It's clear senior managers themselves were under pressure to meet quotas. In one email obtained by Marketplace, Jorgenson tells staff: "I am unfortunately well below plan and that will put added pressure next week to drive up our results."  

He then points out staff fell short of reaching their financial target for professional services, saying: "Our weekly plan was to achieve $33,709 and in fact we achieved $26,493 or a miss of $7,216."  

Jorgenson writes there needs to be a shift to focus on these services because they soon "will represent  25% of all profit revenue."  

While Jorgenson was the regional manager in charge of pharmacies, pharmacists in the area say pressure was also coming from managers on the retail side of Rexall stores.  

Looking for more revenue

Emails shared with Marketplace show retail operations manager Marco D'Alfonso, a non-pharmacist, requested pharmacists to compete in a national challenge, with the goal of racking up the more billable services.

He gave staff specific targets and wrote, "At noon, 3 pm and 6 pm you will send your PFS results." In another email, D'Alfonso warns staff: "We have fallen off the rails on meds checks. This is our biggest revenue stream we can use to deliver our plan."

Provincial governments spend millions on professional services programs like medication reviews.  

In Ontario last year, the province spent close to $100 million on its MedsCheck program.

Pharmacists say when conducted properly with the right patient, medication reviews can be a valuable health-care service, but they insist pharmacists must be able to decide when and with whom they conduct reviews.

Marketplace has received many internal emails from current and former Rexall pharmacists regarding medication review problems.

One pharmacist wrote: "I applaud all of my colleagues who have weighed in on the issue of our directive from head office regarding the expectation of 10 MedsChecks per day. As are most of you, I work as a lone pharmacist and find it almost impossible to do a quality MedsCheck in a busy store. I found it appalling that it was made into a 'contest' to see which store could do the most."

"Is this what our profession has been reduced to?" the pharmacist wrote.

Marketplace asked Rexall to respond to the latest allegations. Derek Tupling, Rexall's vice-president of communications, repeatedly denied the drugstore chain imposes specific quotas on pharmacy staff. 

With files from Lindsay Sample