4 PHARMACIES (let's call them DRUG STORES) almost $3Million from PHARMACARE for METHADONE

The B.C. government is taking steps to crack down on problem pharmacies, including those that rack up PharmaCare payments by catering almost exclusively to methadone patients.

That practice has helped make methadone and its associated fees the second-biggest drug expense for B.C.’s drug plan and resulted in clusters of methadone-dispensing pharmacies in parts of Surrey and Vancouver’s Downtown Eastside.

Under a new rule that takes effect June 1, pharmacies will have to re-enroll with PharmaCare, B.C.’s provincial drug program, to charge the plan for medications and dispensing fees. As part of that process, pharmacy owners will have to disclose previous regulatory problems and ownership details.

Pharmacies can make almost $6,500 a year in fees per patient dispensing methadone and up to an additional $13,800 a year dispensing other drugs to the same patient. The hefty amounts were noted in a review that was prepared for the Ministry of Health in January – a copy of which was obtained by The Globe and Mail.

“Until this regulation, it could be hard for the ministry to deny or cancel the enrolment of a pharmacy that was taking advantage of vulnerable patients, or breaking PharmaCare’s billing rules,” Ministry of Health spokeswoman Cindy MacDougall said in an e-mail. “It was also hard to make sure pharmacies weren’t employing or owned by people who had previously broken PharmaCare billing rules or lost their licence to practise pharmacy.”

The new enrolment regulation falls under the Pharmaceutical Services Act of 2012 and was enacted last November and so has been on the horizon for some time. The January review stated that most people on methadone – which is prescribed to treat addiction to heroin or other narcotic drugs – are on other medications, creating a powerful financial incentive for pharmacists to dole out methadone and other medicines on a daily basis.

B.C. features one of the highest fees in Canada for dispensing the drug, at $10 a day, and is only one of three jurisdictions in Canada that provides a fee – $7.70 a day – for witnessing ingestion. By comparison, Saskatchewan pays $3.50 a day and the federal Non-insured Health Benefits Program pays $4.60 a day for a witnessed ingestion.

The review said methadone-related PharmaCare costs have grown by an average 7.6 per cent a year since the methadone payment program was introduced in 2001 and now make up the second-highest drug expense for PharmaCare, accounting for $44-million in costs last year.

Professional fees – for dispensing and witnessing ingestion – account for about 88 per cent of that amount.

B.C.’s methadone maintenance program was set up in 2001 to improve access to methadone treatment for people around the province. The Ministry of Health, the College of Physicians and Surgeons of B.C, and the College of Pharmacists of B.C. each oversee different aspects of the program.

In 2010, the Ministry of Health and the College of Pharmacists ran a joint investigation of Lower Mainland pharmacies that looked into issues such as improper billing and inducements to customers. In an update, the province says six pharmacies lost their PharmaCare access and subsequently closed, one pharmacy was sold and one case is still in process.

Clusters of methadone pharmacies have popped up in several areas, including parts of Surrey and Vancouver’s Downtown Eastside. That neighbourhood contains four of the 20 highest-billing methadone pharmacies in the province; together, those four pharmacies received $2.9-million in PharmaCare payments, most in professional fees, last year, the review states.

One methadone client, who gave her name as Ariana, said she is now dealing with a well-run pharmacy that does not offer inducements, which can include things such as bus passes and coupons for fast-food restaurants.

That has not always been the case. Saying she has been on methadone for 10 years, she named one pharmacy that paid her $20 a week to fill her methadone prescription and $5 a week for each of her three other medications.

“They are preying on us, who are in poverty – and they get rich,” Ariana said.

The January review cautioned against any quick changes, saying methadone maintenance treatment is complex and “any hasty changes to its service delivery, [Methadone Maintenance Payment Program] or otherwise, could have immediate and detrimental impact on methadone patients – an already extremely vulnerable population.”

The review said consultation with stakeholders would begin in early 2015.