The B.C. government intends to effectively shut down as many as 46 Lower Mainland pharmacies by excluding them from the PharmaCare program in the wake of a review that flagged various abuses.
Letters have gone out to the pharmacies giving them three weeks to argue why they shouldn’t be denied the ability to bill the publicly funded drug plan effective next month.
There have been past allegations of kickbacks paid by methadone-dispensing pharmacies to retain addicted patients, among other concerns about their practices.
Health ministry officials aren’t releasing specifics or the locations of the pharmacies involved.
“Many of these pharmacies are dispensing methadone,” Health Minister Terry Lake confirmed.
A regulatory change that took effect in December now allows the ministry to refuse to do business with pharmacies with a history of problematic business and billing practices, and forces them to disclose their ownership, management and track record.
“Until now, it could be hard for the ministry to cancel the enrolment of a pharmacy taking advantage of patients or breaking PharmaCare’s billing rules,” Lake said.
Recent audits of pharmacies have turned up hundreds of thousands of dollars in billing irregularities.
The ministry says some pharmacies improperly filed drug information for patients into the province’s prescription-tracking network, potentially risking their health, while others gave false information on their enrolment applications.
A health ministry spokesperson would not release specifics or the locations of the 46 targeted pharmacies, but said some are being excluded for problems unrelated to methadone.
The 20 highest billing methadone pharmacies in B.C. include four each in Surrey and Vancouver’s Downtown Eastside, five elsewhere in Vancouver, three in Abbotsford, two in Victoria and one each in Nanaimo and Kamloops.
Together they were paid more than $12 million from the PharmaCare program to supply methadone in 2013, according to a provincial review of the methadone maintenance program completed in January.
The review found methadone costs covered by PharmaCare have climbed by an average of 7.6 per cent a year since 2001 to nearly $44 million, making it the program’s second-highest drug cost.
More than 15,000 drug addicts received PharmaCare-funded methadone in 2013 – about 5,200 in Vancouver, 3,400 in Surrey, 1,200 in Burnaby, 1,000 each in Abbotsford and Greater Victoria, and another 2,000 split between Coquitlam, New Westminster and Nanaimo.
The review notes the ministry has for more than a decade dealt with methadone dispensing problems, including the offering of inducements to patients and improper billing.
“There appear to be significant concerns relating to the safety, acceptability, equity and efficiency of the [program],” the review found.
It also pointed to B.C.’s “generous” dispensing fees, including a witnessing fee to make sure patients drink methadone at the pharmacy, that together make it a lucrative business.
Dispensing methadone to a single patient is worth nearly $6,500 a year in fees to a pharmacy net of the drug costs, the review said, and dispensing other drugs to the patient can triple that.
Lake defended B.C.’s policy on fees.
“The witnessing fee is important to ensure that the person who is prescribed the methadone actually takes the methadone, because there is a market value on the street and we want to ensure that the proper person is getting the medication,” he said.
“There’s just a very small number of pharmacists and pharmacies that have been shown be not following the rules.”
Other pharmacies exist near each targeted one, Lake said, and a smooth transition of patients and their prescriptions is expected.