An industry group representing Quebec pharmacists is seeking court authorization for a class-action lawsuit against some of its own members, raising concerns about patients being directed to certain pharmacies to fill specialty medications.
L’Association québécoise des pharmaciens propriétaires (AQPP) filed the application in Quebec Superior Court on Monday, and argues that the distribution of these expensive drugs is restricting patient choice – in violation of provincial law and the industry’s own regulations.
When people receive prescriptions for specialty medications – which treat both niche conditions and more common ailments such as arthritis and inflammatory bowel syndrome – the drug’s manufacturer or an insurance company may direct them to a “patient support program” (PSP), often managed by a third-party company such as Innomar Strategies Inc., BioScript Solutions or BayShore Healthcare.
“Those PSP managers seem to have preferential commercial – direct or indirect – engagements with specific pharmacies,” said Geneviève Pelletier, the AQPP’s senior director of external and pharmaceutical affairs. This practice has become more common over the past two decades, she added. As a result, the group estimates that roughly 40 per cent of specialty drugs are now being distributed by just 0.5 per cent of the approximately 1,900 pharmacies in Quebec.
Concerns over patients being steered to certain pharmacies have received more attention since Manulife Financial Corp. walked back a controversial exclusive arrangement with Loblaw Cos. Ltd. and its Shoppers Drug Mart chain earlier this year. Such deals, known as “preferred pharmacy agreements” or “preferred pharmacy networks” (PPNs), are now under scrutiny from several provincial regulators of the pharmacy profession. The Ontario College of Pharmacists has called for stricter regulation of PPNs.
Quebec is an exception, because it has existing legislation that effectively bans PPNs through wording that guarantees people’s rights to choose their providers of health and social services. But while the conduct of patient support programs is slightly different from PPN deals between insurers and pharmacies, Ms. Pelletier said, they are related issues.
“You have commercial entities that are steering patients to a preferred network,” she said. “In our case, it’s the PSP managers and the pharmacies that are doing the steering, so they capture the patient within their network. In PPNs, it’s the insurer that steers the patient. It is similar, in the sense that it comes down to the issue of patient choice.”
According to the AQPP, the practice violates the industry’s code of ethics. The provincial regulator, l’Ordre des pharmaciens du Québec, has sanctioned pharmacists in the past for “acquiring” patients through third-party PSPs, Ms. Pelletier said.
The court application names as defendants of the proposed lawsuit 10 of AQPP’s member pharmacists who own six pharmacies. It also names three companies whose services include PSP managers: Innomar Strategies Inc., Bayshore Healthcare and BioScript Pharmacy Ltd. And it names three infusion clinic networks – clinics that administer specialty drugs intravenously – which are owned by the same companies as the PSP managers.
The Globe and Mail reached out to all of the defendants seeking comment, most of whom did not respond.
Michael Assaraf, one of the pharmacists named in the application, wrote in an e-mail to The Globe that his pharmacy is solely focused on specialty medication services. “We have been and will continue to be open to collaborate with any pharmacy wishing to offer specialty medication services,” he wrote. “Nonetheless, any engagements we have with patient support programs are based on a written agreement that patients can use any pharmacy for their specialty medication.”
A group representing specialty drug pharmacies, Le Regroupement des pharmacies de médicaments de spécialité du Québec (RPMSQ) sent a statement saying its member pharmacies work in the interest of patients and adhere to the industry code of conduct. The lawsuit “seems to be motivated more by commercial issues, and by a desire to protect a traditional business model, rather than defending the interests of patients,” said the statement in French.
In addition to restrictions of patient choice, commercial issues are indeed part of the AQPP’s concerns, Ms. Pelletier said. While pharmacists are paid for services such as diagnosing minor ailments, a much larger portion of their revenues come from drug distribution. When a small number of pharmacies are distributing a disproportionate amount of the most expensive medications, it can deprive other pharmacies of much-needed revenue, she said.
Ms. Pelletier added that legislation was recently tabled in Quebec to expand pharmacists’ scope of care. “To be able to be front-line care providers for patients, we need to be financially viable,” she said.