The brutal math of BC PharmaCare's new fee plan

In a recent article about our province's decision to raise dispensing fees but at the same time reduce the number of dispensing services pharmacists can provide ("B.C. to raise PharmaCare dispensing fees while limiting daily dispenses per patient"), the B.C. Pharmacy Association (BCPhA) and Ministry of Health say they are "pleased to announce $1 fee increase” and to work together “to ensure there are no unintended consequences of this decision that will could impact other patient populations.”Since the BCPhA and B.C. PharmaCare are so pleased to announce the first dispensing fee increase in 15 years— from $10 to $11 —let me share how pleased the province's pharmacy owners and practising pharmacists are with the notice we received on Dec. 2, 2025.We are so pleased that PharmaCare is punishing every pharmacy in B.C. for a handful of naughty pharmacies in opioid addiction treatment (OAT) programs that are still !!! (seriously—would you just stop!) oﬀering incentives to patients by reducing the daily remittance fees from 3 x $10 to 2 x $11. We are so happy that we can now remove these patients from our care and stop the time consuming, labour intensive, and burdensome task of seeing patients daily in their homes providing care. This population requires so much time and care! We are pleased that the Ministry of Health now has the money and time to take geriatrics, diabetics, OAT and First Nations' patients care back in their budget.And all the pharmacies that keep thousands of patients with diabetes and geriatric patients in their homes providing nursing care for $30/day ($900) per month we will now be able to unload these patients back onto the public health authorities and add them to their waiting lists for assisted living, Long-term care and emergency rooms. We will have so much time now that we will no longer be running these multifaceted teams of pharmacists, nurses and physicians which are essentially hospitals on wheels. For $900 a month. One ER visit costs the system $750 minimum. And assisting living or LTC? I am sure PharmaCare will have no problem finding homes and care in facilities for $900 a month. Glad to hear they have a solution.We will have so much time now that we are not monitoring the nurses visits from 7 am to 7 pm as they visit thousands of patients on dozens of routes every day of the year. We will not be working Christmas day—or every other holiday of the year. We will not be responding to the dozens of daily order changes which need to be ready for the next morning, monitoring blood sugar readings or adjusting insulin. No more monitoring the safety of patients and nurses, running a batch of 800 to 2000 prescriptions daily with all their attached changes and the review of the quirky billing involving up to four plans and doing so appropriately as per each insurer's rules to avoid audit risk.We can just refer them back to the ER; which is were they were two days a week prior to being on our programs.I have seen blood sugars reduced from 28 to 12 in under two weeks with our nursing programs. This is in patients who had previously been over 20 for months or years. One-third of our patients are First Nations' people, most of the other two thirds are geriatrics, whom we assist in keeping in their homes for years instead of on the public purse in assisted care. All for $30 a day.But again, so pleased that the Ministry of Health has a plan for them.I am sure the OAT patients will be pleased. To my understanding, even though the COVID crisis officially ended July 2024 (and in case you need a reminder, during the critical months of the pandemic, pharmacists were the only 100% accessible healthcare staﬀ other than paramedics, ER workers and firefighters) the opioid crisis is still ongoing in BC and across the country.And the witness fees have been neglected since new OAT regimens were implemented—but not funded—back in 2017. Now, we can happily bill a reduced fee, if we see patients repeatedly throughout the day for various on demand treatments.Again, governments are pleased to oﬀer access to healthcare for the most vulnerable of our population by de-funding the processes that assist geriatric, First Nations' and opioid-addicted patients. It's obvious to us that care for these patients will cost the government so much more through decreasing daily dispensing fees from $30/ day to $22. But they will be pleased that this increases in the cost of care show up on a diﬀerent balance sheet than the Pharmacare Pharmacy Remittance statement.No other program /profession would take this on these programs; and that is our flaw, as noted in a recent article. We take on too much and do not get paid for it. And it is just not a matter of making a profit or reaching for excessive profit; pharmacies can barely aﬀord to operate. We are pleased that we can now research other areas of revenue to maintain pharmacy care in every city and town in BC (try being the only pharmacist for 500 km, or having to reduce your hours because for the last decade, you have been the only pharmacist in your town—and only 2 hours outside a major centre).I am next SO pleased to move onto how to use the $1 extra in fee we will be receiving as of January 2026. It will take all my mental energy (energy that I will now have by removing myself from daily caring for my 400 patients in their homes) to make this $1 stretch as far as it can. I know there is a formula that will calculate how to make up for the $5 to $10 hourly increase in assistant wages since 2019. And, the $15 to $30 hourly increase in pharmacist wages. Oh, wait, but if I practise on Vancouver Island or interior B.C. or really anywhere outside the lower mainland, pharmacists wages are more like $50 to $60 per hour more than they were in 2018.The Ministry of Health must be pleased that they have worked with the local health authorities to provide housing and medication assistance to the thousands of patients who are now going to be dumped out of the care of pharmacies. How many will it aﬀect? In just the few pharmacies I know of, there are 600 patients immediately in need of care from three pharmacies. Across the province, it's likely in the area of 10,000 patients. I am sure the health authority regions are well staﬀed and have open beds in ERs and longterm care homes, and placements ready in assisted living facilities.Likely the patients are also so pleased that they now have to move out of their own homes for care, or alternately, that they wisely saved to pay out of pocket $1000 to $4000 for nursing care in their own home.And the paramedics, fire fighters, and ER staﬀ on the front lines will appreciate that the Ministry of Health will be adding to their care budgets to deal with the influx of patients no longer attended by their prior pharmacy/nursing teams. Were the local health authorities consulted?I am sure they were. Just as the pharmacists were.And pharmacists? We're all so pleased.Corrine Wilson is a pharmacist practising on Vancouver Island.

The brutal math of BC PharmaCare's new fee plan

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