A pharmacist who was hit with a record $17 million claim imposed by the Régie de l’assurance santé du Québec refuses to reimburse the bill which he considers exaggerated.
Martin Manseau contested in court the invoice imposed in 2021 for purchasing from an unrecognized wholesaler for an expensive medication sold at his former pharmacy in Châteauguay.
Last November, he won his case in part before the arbitration council which heard his challenge request. A decision quickly contested by the Régie.
The pharmacist was one of the only suppliers for Quebec of the exceptional drugs Lucentis and Eylea, sold at around $1,500 for each prescription. Patients who needed these drugs for macular degeneration, an eye disease, were largely referred to his pharmacy. For each prescription, the pharmacist’s profit margin was $39.
Martin Manseau obtained his supplies from A&D Wholesale inc., a wholesaler who was not on the list of suppliers authorized by the Régie. To obtain reimbursement for the medications and his fees, he instead provided the number of another wholesaler, McKesson, which was authorized by the RAMQ.
Never seen
In addition to demanding $15 million from him for the value of the drugs and fees of $83,000, the Régie imposed an additional sanction of $1.5 million. This is the heaviest claim in 15 years to a single health professional.
At the time, the pharmacist’s name was confidential, but as he contested the decision before the Régie’s arbitration council, his identity became public.
In her decision, the president of the arbitration council judged that the sum claimed was colossal and asked the Régie to reduce the bill.
“Obliging the pharmacist to reimburse $14 million (Editor’s note: It’s more like $15 million) for medications correctly served to patients is excessive. No legislative or regulatory provision requires it or provides for it,” writes Francine Lamy in her decision.
She even criticizes the Régie for having exceeded its duties by inflicting a disproportionate punishment.
“There is nothing fair in requiring pharmacists to reimburse their fees and the cost of medications they provided to patients by correctly filling their prescription with the listed product, at the authorized cost. This results in an undue advantage for the regime and a flagrant injustice for the pharmacist,” she writes.
Subterfuge
The arbitrator gave the Régie 30 days to review the amount claimed. However, the Régie instead chose to file a motion just before Christmas to appeal this decision, which it considers unreasonable.
In her request, she insists on the fact that the pharmacist requested, without being entitled to, reimbursement for the medications.
“The conscious or negligent use of the code of a recognized wholesaler in order to circumvent the rules is a subterfuge which must be punished,” it is indicated.
- In 2020, Martin Manseau was disbarred for 12 months by the Order of Pharmacists in addition to having to pay fines totaling $70,000. He was criticized in particular for not having respected the free choice of the pharmacist for the purchase of their drugs Lucentis and Eylea.