The Quebec Association of Pharmacists Owners (AQPP) files a request for authorization of class action against 10 pharmacists who, according to what is alleged, share a market related to specialized drugs estimated at 1.5 billion dollars thanks to to “anti-competitive practices”.
The pharmacists targeted by the AQPP have mostly been condemned in recent years by the disciplinary council of their professional order for having “obtained” clients through what are called patient support programs (PSP). The judgments of some have made headlines in recent years, including those of Martin Gilbert, Daniel Vermette and Marc Chabot as well as Michael Assaraf.
PSPs are turnkey programs, financed by giants of the pharmaceutical industry, which support patients in all stages of therapies linked to specialty drugs, i.e. expensive molecules which treat complex diseases.
Through “formal or informal agreements,” these pharmacists would maintain “privileged and preferential relationships” with certain infusion clinics and PSP managers, we read in the motion.
They would direct their patients to these pharmacies which may be hundreds of kilometers from their place of residence. This contravenes “the principle of patient freedom of choice in health,” believes the AQPP.
In the request filed Tuesday, the association mentions the imbalance created in the industry. More than 40% of the distribution of specialty drugs would be concentrated in the hands of less than 0.5% of pharmacies in Quebec. This model would allow this handful of pharmacies to control 90% of the volume of prescriptions for certain most expensive permitted medications, estimates the AQPP.
However, as a pharmacy’s remuneration is closely linked to the value of the drugs – which generally exceed $10,000 per patient – the average annual turnover of a specialty pharmacy would reach $310 million while that of A Quebec pharmacy hovers around 7 million.
But beyond financial considerations, the AQPP maintains that directing patients from programs to a handful of pharmacists leads to a fragmentation of pharmaceutical files.
This fragmentation “increases the risk of drug interactions by preventing patients’ regular pharmacists from managing their complete files, which impairs their ability to provide appropriate clinical services,” the petition reads.
A situation which “also increases the risks of transmitting incomplete pharmaceutical profiles to other stakeholders in the health sector”, it is added.
Despite the judgments of the professional order against these pharmacists, “the practices do not change and do not evolve in the right direction, even though we have the feeling that the situation is getting worse”, declared in an interview Benoit Morin, president of the ‘AQPP.
A reality that is all the more worrying as these specialty medications are gaining popularity and patient files are divided between several pharmacists. Already, specialty drugs represent 40% of the total drug market in Quebec.
And it is the patient who loses, believes Mr. Morin. “Who is this model for? It doesn’t serve the patient. It is commercial interests that take precedence over the interests of the patient. These pharmacists are there for the product; they serve the product, not the patient,” according to him.
This situation, which he describes as “worrying”, does not meet the objective of the Minister of Health, who – with the tabling of Bill 67 – wants to offer more powers and autonomy to health professionals, including pharmacists.
In addition to the 10 targeted pharmacists, the class action request targets major PSP managers as well as infusion clinic networks, including Innomar Strategies, Bayshore, Bioscript and Coverdale Infusion. “These are opaque networks where program managers direct clients to these pharmacies,” according to Benoit Morin.