The Quebec Association of Proprietary Pharmacists (AQPP) files a request for authorization of collective action against 10 pharmacists who, according to what is alleged, share a market related to specialized medications estimated at $1.5 billion 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.
The pharmacists targeted by the AQPP work for six establishments which, according to the association’s estimates, share annual revenues estimated at nearly $1.5 billion.
Thanks to “formal or informal agreements”, these pharmacists maintain “privileged and preferential relationships” with certain infusion clinics and PSP managers, we read in the request.
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.
A disorder
In the request filed Tuesday, the association cites the imbalance created in the industry. More than 40% of the distribution of specialty drugs is 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 the remuneration of a pharmacy 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 in addition to financial considerations, the AQPP maintains that directing program patients to a handful of pharmacists leads to fragmentation of pharmaceutical files.
This fragmentation “increases the risks of drug interactions by ensuring that patients’ usual pharmacists cannot take charge of their complete files, which harms their ability to offer appropriate clinical services,” we read in the request.
A situation which “also increases the risks of transmitting incomplete pharmaceutical profiles to other stakeholders in the health sector”, it is added.
“Practices do not change”
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 does this model serve? 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, which includes pharmacists.
In addition to the 10 targeted pharmacists, the class action request targets major PSP managers as well as networks of infusion clinics, including Innomar Strategies, Bayshore, Bioscript and Coverdale Infusion. “These are opaque networks where program managers direct customers to these pharmacies,” according to Benoit Morin.