Pharmaceutical expenditure weighs heavily on the wallets of Quebecers. Nearly a third of the budget of the Régie de l’assurance maladie du Québec goes to it, the RAMQ budget itself monopolizing a quarter of health and social services expenditures. However, the medicine of tomorrow is taking shape as tailor-made, as evidenced by the sustained growth of expensive so-called specialty drugs, the deployment of which calls for increased vigilance on the part of all players in the health sector.
The duty we learned this week that turnkey programs related to these drugs used to treat rare or serious diseases such as cancers – and whose value exceeds 10,000 dollars per patient annually, if not more – have opened up urgent breaches to plug. An investigation by Ulysse Bergeron reveals that over the past three years, eight pharmacists have been convicted by the Disciplinary Board of their professional order for “obtaining” clients through patient support programs (PSP), a service funded by pharmaceutical giants.
Some of the pinned pharmacists also pleaded guilty to having paid, in return to the PSP manager with whom he was doing business, a percentage of the income generated by the lucrative clientele thus obtained. One would have thought that this raiding and dismissals were a thing of the past. The unveiling of discount rents granted to doctors by pharmacists to encourage them to practice near their pharmacies, in 2004, caused a stir before leading to in-depth ethical changes in the former as in the latter.
In 2016, the removal of the cap on rebates offered to pharmacists by generic drug manufacturers had provoked a war of such intensity that Quebec had to go back, with a 15% cap. The use of these allowances is moreover carefully defined by the law on prescription drug insurance so that they remain for the primary benefit of patients.
The same cannot be said for the PSP. Make no mistake, this system is legal. It even has certain advantages. Patients who use it are fully supported by the private company that manages said PSP. It is she who bridges the gap with everyone: pharmacist, doctor, nurse, insurer (whether private or public), lark. For the patient left to himself (the public network does not offer this type of support), it is a blessing.
Because the specialty drug comes with close and sustained follow-up which militates in favor of local services, ideally personalized. The very essence of the work of a community pharmacist, what. But since this system operates on the fringes of the public system, it escapes the gaze of the usual authorities, allowing some to impose exclusivity agreements that violate the right of patients to choose their pharmacist. Contrary to the law, this practice leads to the splitting of the records of captive patients of their PSP, with all the risks that this entails for their health.
Worse, the web has been woven so well by the handful of companies (mainly BioScript, Bayshore, McKesson and Innomar) that have taken root in this lucrative market that most pharmacists are excluded. The Quebec Association of Proprietary Pharmacists (AQPP) speaks bluntly of an “opaque” system for the benefit of “a handful of heavyweights who control […] distribution system for the majority of specialty drugs. In the wake of our investigation, the AQPP on Tuesday called for an outright end to PSPs who act against the rules.
It seems inevitable. In 2021, public insurance plans in Canada committed 34.7% of their spending to specialty drugs (benefiting 2.5% of beneficiaries). However, Accessa, the company created by pharmacist owners to reclaim the reins of PSPs in compliance with Quebec ethical rules, calculates that the 50% bar will be passed by 2025. And the movement will not stop there. More than 300 cell or gene therapies are currently in development worldwide.
We cannot afford to see this expanding ecosystem hijacked to the advantage of a handful of companies and professionals. This primarily concerns the Order of Pharmacists, which we would like to be more combative in this matter, of course, but just as much the Ministry of Health, the RAMQ, the College of Physicians and the Order of Nurses.
Seal the breaches detailed by The duty is, in fact, only one step. It is a whole legal and effective architecture for monitoring patients subscribing to these targeted treatments that must be secured if we want to stick to the principle of the right professional, at the right time, in the right place dear to Minister Dubé.The sequel therefore promises to be robust and deserves its own construction site if we want to follow the advances promised by science, for the benefit of the collective and without spending our entire wallet on it.