Sitting at her home in Ottawa earlier this month, Mary Fernando received an outgoing call from the pharmacy at Shoppers Drug Mart.

The employee on the other end asked if she was still using the inhaler medication to control her asthma, as she had consistently done for years. She said yes.

Then the employee asked if she was happy with the medication. Again, Fernando said yes, then ended the call quickly – all within five minutes, she said, "It was just a weird conversation."

Fernando later realized that Shoppers Drug Mart had used the phone call as a virtual medication review under the Medscheck program in Ontario, which requires pharmacies in Ontario to meet with patients to review prescriptions.

"I couldn't imagine a patient more moderate than me, and useless," Fernando said, noting that the money should be used more wisely.

CBC News spoke with former pharmacists at Shoppers Drug Mart who believe the company profits from the MedScheck service by pushing employees to conduct consultations that patients don't necessarily need. The company can then bill the province up to $75 per call.

Eight former Shoppers Drug Mart employees said intense pressure from management pushed staff to regularly make cold calls to customers, and in an internal message obtained by CBC News which was emailed to company leadership last July, a group of pharmacy owners said the pressure to do more Medscheck calls affected their ability to provide better patient care.

Pharmacist John Nahan said, "It's a shame, it's a disappointment, I'm concerned that something like this could really set us back as a profession, as a healthcare system, and for patients — in the end, they're the ones who suffer."

In an interview on Tuesday, Jeff Leger, president of the Mart, said the company does not "pressure pharmacists to conduct review calls just for profit."

Leger said, "Obviously, we monitor this closely, we take these allegations seriously, but we truly believe that Medschecks and Med reviews have a positive impact on Canadians."

Medscheck is a government program that pays pharmacies in Ontario to review customers' medications to ensure they are informed about prescriptions and taking the correct doses, and eligible people for review are those taking at least three drugs for a chronic condition, or living in licensed long-term care homes or receiving treatment for diabetes.

At the start of the Covid-19 pandemic, the Ontario government allowed consultations over the phone.

The service is free to the public, but the provincial Ministry of Health pays pharmacies up to $75 per call – nearly double the $38 bill for a family doctor's patient visit.

Nahan said it "was generally a valuable program," but he and other pharmacists who spoke to CBC News said they believe Drug Mart is exploiting the service in some cases.

Several pharmacists explained that pressure from "the corporate" or "upper management" led them to schedule or make "unnecessary calls" to customers who were technically eligible for the program but not considered high-risk.

Employees ended some calls in five minutes or less, as in Fernando's case, although the program states that proper reviews should last 20 to 30 minutes.

Nahan added that he personally did not feel pressure from Medscheck because his manager at Shoppers Drug Mart protected his staff – but the new owner "explicitly mentioned" that new billing targets were part of the reason for his resignation last year.

Nahan said, "That was the last straw."

Leger said internal data showed Medschecks helped patients with their medications or reduced the risk of "something harmful" by 40 percent, noting that the company does not have medscheck quotas.

Leger added, "It’s a meaningful service, and that's particularly important in a scenario where access to healthcare is lacking," "We don't have targets or any other kind of personal interests like that."

A former Pharmacy Assistant at Drug Mart in Ottawa said they were tasked with scheduling cold calls to customers from 2022 to 2023.

They said their manager would bring up the issue daily, asking them to make up to 20 calls per shift, which they said were booked for reviews.

The former assistant, who was anonymous to CBC News because they now work at a different Loblaws-owned pharmacy, said, "I definitely felt I was bothering people."

"When I didn’t push to fulfill my scheduled periodic calls, there would be some annoyance from management, which was frustrating to me because I didn’t apply to work as a telemarketer."

The assistant added that the pressure to schedule Medschecks was an "important" factor in their decision to resign last year, "When I found out MedChecks money was basically the target, well, I didn’t want to be part of corporate greed."

Often, former pharmacists who spoke to CBC News said, patients were unaware the review was an official Medscheck conversation – or that Mart was being compensated in return.

The Ontario Ministry of Health said in a statement that "all professional virtual services, including Medschecks, must be conducted from the licensed pharmacy site," "Convenience is not a legitimate reason" for virtual calls.

Last month, the Drug Mart site in Milton, Ontario, posted a job ad looking to hire a pharmacist whose job would "specifically" focus on doing "virtual medication reviews consistent with the Medschecks program."

The letter sent by a group of pharmacy owners to Shoppers Drug Mart leadership said performance expectations – including MedsChecks – contributed negatively to company culture.

"The pressure ... being placed on front-store metrics, pharmacies, and professional services is a boundary violation and creates safety concerns for providing good medical care to patients and customers," part of the letter emailed to Shoppers Drug Mart management on July 5 read.

"The pressure is unsustainable and relentless to the point it seriously affects the mental health of many partners and severely harms the quality of care for our communities and ultimately Shoppers Drug Mart’s amazing brand."

The letter added, "This pressure is inconsistent with the spirit of how true MedCheck review is supposed to be conducted."

The group said a senior leader was "intimidating and threatening the livelihoods of colleagues and pharmacists who have to drive professional service billings by setting daily “targets” monitored by area managers."

Leger confirmed he received the email.

"I read the letter and we take these matters and these issues seriously and continue to review the situation," he said on Tuesday.

Pharmacy staff who spoke to CBC News said MedsChecks take time that pharmacists could spend on prescriptions, immunizations, and other aspects of patient care.

Calls also waste family doctors’ time, according to two doctors who spoke with CBC. The patient's doctor must sign every MedsCheck call record – even if the client did not raise any concerns during the call.

Dr. Michelle Cohen, a family physician, said, "It’s not uncommon to have several [MedsCheck call records] in one day ... and in the vast majority of cases, the “no issues” box is checked, so there’s really nothing to do." In Brighton, Ontario.

She added, "It’s very frustrating. It literally takes me away from my patients because I have to allocate time for paperwork."

The Ontario Ministry of Health said it paid $60 million for MedsChecks in the 2022-2023 fiscal year but refused to provide financial details showing how that money was distributed among various pharmacies.

The Ontario College of Pharmacists, the province’s regulatory body, said it is aware of general concerns that pharmacists are pressured to provide certain services – including MedsChecks – but had not received any formal complaints until late February.

CBC News contacted Rexall, London Drugs, Costco, and McKesson – the parent company of Guardian, IDA, Remedy'sRx, and The Medicine Shoppe – for information about their MedsCheck practices.

A representative for Rexall said they "would under no circumstances encourage providing any clinical services that are not in the patient’s interest." A statement from McKesson said that independent owners are responsible for setting and managing their own policies in individual pharmacies.

In an email, a representative from one public relations firm said London Drugs "respectfully declines the opportunity to participate in this matter."