Over the past three years, eight pharmacists have been convicted by the Disciplinary Council of their professional order for “having obtained” clients through an intermediary, which is prohibited by their code of ethics. These came from Patient Support Programs (PSP), a special service funded by pharmaceutical giants and offered to patients in need of very expensive specialty drugs for rare diseases. Operating on the fringes of the public health system but completely legally, this system affects the “commercial ecosystem” of pharmacies and risks creating “distortions” harmful to the health of patients, denounce its critics.
Nancy Ouellet has come into close contact with the “ecosystem” of patient support programs (PSP). For more than 30 years, this resident of L’Ascension-de-Notre-Seigneur, near Alma, has suffered from Crohn’s disease, a chronic inflammatory bowel disease causing very strong symptoms. Every month, she must inject herself with a dose of Stelara, a complex antibody that reduces inflammation in the digestive tract and whose annual cost is around $50,000.
But in 2021, the nurse in charge of her PSP told her that her new insurance company would not cover the full cost of her medication. However, the manufacturer of Stelara which finances the PSP, Janssen, undertook to offer it free doses every other month, on condition that Mme Ouellette accepts that these be delivered to her by the Martin Gilbert pharmacy in Châteauguay, located more than 500 kilometers from her home.
“It was stressing me out. If I don’t receive them? If I have them stolen? » she confides to the Duty, stating that she did not understand the need to have both her own neighborhood pharmacist and a second that was imposed on her. “I have been followed by the same pharmacy for 25 years. My pharmacist is part of my safety net, he knows the interactions between the four medications I take daily. »
After several discussions and as many categorical refusals from Mr.me Ouellet, BioScript accepts that his pharmacist in Alma takes care of his file. “Leaving Châteauguay by Purolator didn’t come into my head. I didn’t want to do business with the Martin Gilbert pharmacy. I don’t know him at all. »
Martin Gilbert is one of eight pharmacists who have been convicted in recent years by the Disciplinary Council of their professional order for “obtaining” clients through an intermediary, which is prohibited by their code of ethics. Sentenced in November 2022, Mr. Gilbert, who did not wish to answer the questions of the Dutyis currently awaiting his sanction and, when it is communicated to him, he will be able to appeal the decision.
His pharmacy has nothing to do with a neighborhood pharmacy. Established in the Châteauguay industrial park, wedged between a concrete manufacturing plant and an excavation company, it has no sign to attract the eye of potential customers.
Inside, the facility looks more like a drug distribution center. There is no sales area or prescription counter. Cardboard boxes with pharmaceutical company logos pile up along the walls. In the center, employees are busy preparing prescriptions and filling pillboxes.
This pharmacy is dedicated to specialty drugs. These will be sent to the four corners of the province to clients who, for the most part, have never met in person one of the fifteen pharmacists who are part of the team of 90 employees who work there.
The pharmacy does not need to have a storefront in a busy neighborhood or adverts to make itself known. Martin Gilbert’s company receives the majority of its clientele from patient support programs (PSP), funded by giants of the pharmaceutical industry.
The Disciplinary Council of the Order of Pharmacists of Quebec (OPQ) condemned Mr. Gilbert for obtaining clients from two PSPs. The first program involves the prescription of Calquence, manufactured by AstraZeneca, a drug that treats rare types of cancer and costs up to $8,200 per month. The second program is dedicated to Janssen’s Remicade which treats inflammatory diseases at around $6,500 per month. However, this practice contravenes the pharmacists’ code of ethics, which strictly prohibits them from “obtaining customers through an intermediary”.
Since pharmacists set their fees, in part, based on the cost of drugs — about 10% of the price — a PSP’s clientele proves to be lucrative. The annual cost of specialty drugs typically exceeds $10,000 per patient.
No wonder Martin Gilbert’s pharmacy is very profitable. Alone, the services rendered for the PSP of the drug Remicade amount to at least 40 million dollars in eight months, according to the documents of the Disciplinary Council of the OPQ. This drug alone has produced in a few months revenues nearly seven times higher than the average of the total turnover of pharmacies, or 6 million dollars per year, according to the Quebec Association of Proprietary Pharmacists.
Last December, contacted as part of this investigation, Mr. Gilbert wrote to us: “We intend to act in accordance with all the laws and regulations that govern our activities. […]. Given the ongoing judicialization of the file, we will not issue any further comment. He has since declined our most recent interview requests.
A “package of distortions”
In less than three years, eight pharmacists have been convicted by their professional orders for obtaining clients participating in patient support programs (PSPs) for around 40 specialty drugs, found The duty. “We are extremely concerned about what is being done and what continues to be done,” said Benoit Morin, president of the Quebec Association of Proprietary Pharmacists (AQPP).
A patient usually does business with a pharmacy that has an overview of their medication. Not only does the PSP system shake the “commercial ecosystem” of local pharmacies, but, above all, it splits the files of its patients, according to Mr. Morin. “We often realize that a patient is being followed by another pharmacist or that he is taking another medication when we notice an unwanted interaction,” he laments. This way of doing things makes the patient captive “because he is told where to go and he thinks he has no choice if he wants his medicine”.
The PSP model generates a “package of distortions” potentially harmful to patient health, says the president of the Order of Pharmacists of Quebec, Bertrand Bolduc, who does not target any pharmacist in particular.
However, he wonders about the close relationships of some of them with PSP managers. He is concerned that if there is a side effect for the client, the pharmacist and PSP representatives will not advise him to consider another medication because they have a personal interest in the client continuing on that medication- there: “The first reaction will be to get organized to adjust the dose or try to counter the side effects by other means. ” And why ? “They work indirectly for the companies that fund these programs where their clientele comes from. »
The business ecosystem
Beyond the clientele obtained, the investigation by the syndic of the OPQ reveals that Martin Gilbert’s pharmacy is in fact an important cog in a larger business “ecosystem”, developed and controlled by BioScript. “The PSPs, BioScript and the respondent’s pharmacy are part of an ecosystem which, although designed around the needs of the patient, serves private interests”, considers for his part the trustee quoted in the decision.
A New Brunswick company, Bio-Script has established itself as a Canadian leader in complex drug treatments. It is both a distributor of specialty drugs and the owner of infusion centers and pharmacies. But, above all, it manages patient support programs (PSP) funded by such major manufacturers as Amgen, Boehringer Ingelheim, Novartis and Roche, among others.
BioScript did not respond to communications from the Duty.
During his hearing before the OPQ, whose The duty listened to the recordings, Martin Gilbert details his model. He affirms that his pharmacy must agree to respect the standards of practice required by BioScript which, moreover, offers “a lot of support at the level of operations in the day to day “. She is involved in the administration of her business: human resources management, IT tools, accounting and finance.
Mr. Gilbert explains why, in his opinion, this system is to the benefit of the patient. He maintains that a specialization in around fifty complex molecules allows him to offer “added value” to patients. Its employees undergo training on specific conditions and offer a 24-hour service: “There are more and more complex molecules. […] By focusing on specific pathologies, we become a little expert in these pathologies. And that gives us a lot of time to spend with patients. »
Pharmacist Martin Gilbert is not the first to be condemned by the OPQ for his close business relationship with BioScript. In fact, in June 2020, he bought the Châteauguay pharmacy, already affiliated with BioScript, from Martin Manseau, a pharmacist with whom he had previously co-owned two pharmacies in Montreal.
He had been sentenced six months earlier by his professional order because of an agreement with BioScript which had “the effect of undermining the right of patients to choose their pharmacist”. During the OPQ hearings, Martin Gilbert asserted in his defense that he had taken measures to comply with the order’s code of ethics by hiring, among other things, a full-time lawyer to ensure compliance with all ethical requirements. He maintains that everything was done to “ensure that it was a pharmacy that I could operate ethically”.