Published Wednesday January 13th, 2010 By Eric Lewis Times & Transcript Staff   Pharmacists in New Brunswick say they may not be able to offer the same level of service they currently do if changes to a prominent third-party insurance provider's payment plan become permanent.   However, that insurance provider, Medavie Blue Cross, says by changing the amount of money it reimburses pharmacies, it is simply passing along savings that pharmacies are currently enjoying to its own policy holders.   Meanwhile, others are questioning how this current dispute will affect New Brunswickers who simply need to get their medications and can't afford to pay out of pocket for them.   The contract between Medavie Blue Cross and pharmacies in Atlantic Canada expires this year. One part of that agreement is the payment schedule, which indicates how much the company will reimburse pharmacists for filling specific prescriptions.   The payment schedule changes are being unrolled across Atlantic Canada in the first half of this year, with the first ones taking effect last week. Many New Brunswick pharmacies are already feeling the impact, and some have stopped accepting Blue Cross drug cards, as they were told that submitting electronic claims after a certain date to the insurer would be taken as a sign that they accept the new payment schedule.   If pharmacies aren't accepting the cards, it means customers have to pay the entire price of their drug up front and seek reimbursement from Blue Cross either through a quick-pay office such as the one on Main Street in Moncton or by mail if they don't live near a Blue Cross office.   Dyson Jones, pharmacist and owner of Salisbury Pharmacy, has stopped accepting Blue Cross cards. He says the new payment schedule laid out by Blue Cross would cost his store roughly $20,000 a year.   "It's fairly significant, especially where we're a smaller store, and you can imagine with a bigger, busier store, it would be that much more significant."   He says his pharmacy is simply not prepared to absorb that additional cost.   Blue Cross spokesman Mike Randall says the insurer is simply passing savings along to its policy holders that pharmacies have been enjoying for some time.   He explains that the bulk of the changes to pharmacies' payment schedules have to do with generic drugs that cost less than brand-name drugs.   Once a brand-name drug has been on the market for a certain amount of time, the company that makes it loses its patent, opening the drug up for other companies to make copies of it that they sell at a lower price. Pharmacies receive rebates from the generic-brand makers for offering these drugs from the companies, and in recent years, many generic brands have hit the market, with many more expected to come over the next year, Randall says.   "What's happened, and this has been well documented across the country, is that those generic drugs, while consumers were still being charged, in some cases, 70 per cent of what they were paying for let's say a brand drug, pharmacies at the end of the day are paying considerably less than that," Randall says.   He uses the example that a pharmacy might charge a consumer $10 for a generic-brand product where the brand-name product had been $15. But he says the pharmacy itself might only be paying $5 for the generic brand because they're getting rebates to entice them to sell it. Medavie Blue Cross's new policy would effectively pass those savings from the generic drugs on to its policy holders, he says.   However, Dyson Jones says it costs about $10 to $12 to fill a prescription in his store, when staff, heat and lights and computer costs are considered. The dispensing fee Blue Cross pays him right now is $8.72, he says.   "So those rebates that do come in from the generic companies, they are there, but they actually help subsidize the fact that we're not really getting from the insurance companies, and from the government third-parties as well, what it actually costs us to fill a prescription," he says.   Natalie Barry, a pharmacist with The Medicine Shoppe in Fredericton, says that the rebates pharmacies receive have been a part of the industry "historically, since the beginning of the industry."   "And that is part of our current economic system, and that enables us to do what we do," she says. "So when you call the pharmacy, a pharmacist speaks to you for free. If you remove an enormous chunk of revenue from our industry, you certainly can not expect that we will be able to supply the same level of service."   Barry says the new payment schedule could pull as much as $20 million out of pharmacies in New Brunswick. She says many more brand-name drugs are expected to lose their patents in the coming year, injecting roughly $1.9 billion in sales to the market and a price decrease of 50 to 60 per cent on certain drugs, a decrease she says Blue Cross will benefit from.   But she says the savings they are trying to secure now for policy holders will only eat into a pharmacy's ability to provide services.   "Despite the savings that they might be able to pass onto their consumers, their consumers would then potentially get less service from their community pharmacy and pharmacist," she says, "because we have been able to do the things that we do based on the revenues that we have received over the years, and that they are now trying to take away from us."   Barry says the issue is bigger than Blue Cross because they are "the leader in the market" and other insurers are likely to follow their lead, resulting in even less money for pharmacies.   She says with less money to operate, pharmacies may begin lowering pharmacist salaries. She says New Brunswick is already experiencing a shortage of pharmacists and this may only hurt the industry further.   In the meantime, the fact that some pharmacies are not accepting Blue Cross cards is causing concern for some.   Robert LeBlanc, president of the New Brunswick Senior Citizens Federation, is concerned about the impact this situation between Blue Cross and pharmacies will have on senior citizens in New Brunswick.   "A lot of the seniors have really expensive prescription drugs, and they are on fixed incomes and for something to come along and all of a sudden the pharmacy says, 'You have to pay us and wait to get reimbursed,' it's certainly not in the best interest of our seniors," he says. "And I hope that this negotiation can be settled as expediently as possible."   Jones says he doesn't believe any pharmacies would accept the Blue Cross changes and then pass their losses from the deal on to customers, but adds that he can't speak for everyone. He says he doesn't expect most pharmacies to accept these changes in the first place.   Randall says when Blue Cross announced its new payment schedule in November, it said at the time pharmacies may come back with a counter-proposal, but none did. However, he says the insurer is still willing to sit down with pharmacies and discuss the new payment schedule, but he adds that Blue Cross's goal is to offer savings to its policy holders. Randall says the cut amounts to 5 per cent to pharmacies, but he says it's more significant when looking at individuals who pay more for drugs than they should be.   He notes that this entire move is not a result of Blue Cross trying to increase its own profits, but it is Blue Cross trying to pass savings along to its customers.   John Staples, owner of Staples Drugs on St. George Street, says this situation "really shouldn't have happened" in the first place, and that Blue Cross should have negotiated with pharmacies months ago to avoid any delays for customers. But he says he's been in discussions with Blue Cross and anticipates coming to an agreement fairly soon.   A representative from Shoppers Drug Mart said yesterday that the company is still accepting Blue Cross cards, but they can't comment on what the future may hold.