A downtown Eastside pharmacy is shown in the file photo.John Lehmann/The Globe and Mail
The College of Pharmacists of B.C. plans to conduct at least six undercover operations over the next three years as part of an effort to rein in problem methadone pharmacies, according to a new action plan obtained by The Globe and Mail. The plan also calls for at least 40 "priority inspections" of pharmacies that have come under scrutiny for questionable billing or other practices through PharmaCare, the provincial drug plan.
The college's action plan follows a Ministry of Health review of B.C.'s Methadone Maintenance Payment Program that flagged several concerns, including improper billing of methadone claims; lucrative dispensing fees that can add up to $6,500 per year for each methadone client; and clusters of pharmacies in Surrey and Vancouver's Downtown Eastside that cater almost exclusively to methadone patients.
Those concerns, along with a Ministry of Health crackdown on problem pharmacies through a new regulation introduced last year, have been detailed in recent stories in The Globe and Mail.
"Although the college has taken a number of significant steps towards improving [methadone maintenance treatment] pharmacy care in B.C. over the past eight years, concerns still exist," the report, which outlines an action plan to be carried out between 2015 and 2018, says.
"Those concerns have been identified through the findings of the College's complaints resolution department, recent media reports, and the College's MMT patient liaison group which also aligns with the recent ministry report findings."
The plan calls for a minimum of six undercover investigations to identify questionable practices – such as offering incentives – that are tough to spot during regular inspections.
Similar "sting" operations have been used before: Between 2010 and 2012, nine pharmacies and 31 PharmaCare registrants were subject to undercover investigations, which were a joint initiative by the Health Ministry and the college.
As a result, six pharmacies had their PharmaCare access terminated and subsequently closed, one pharmacy was sold and one case remains outstanding.
Part of the push for reform has come from a methadone maintenance patient liason group, which flagged concerns including patients being coerced to use a specific pharmacy in exchange for housing or other incentives, the plan says.
Methadone is used to treat people who are addicted to heroin or other narcotics. The drug eliminates withdrawal symptoms and reduces cravings but does not result in euphoria.
B.C. introduced its Methadone Maintenance Payment Program in 2001, and there are now more than 15,000 patients in B.C. on the program, according to the January review.
But PharmaCare has "struggled to find the right remunerations scheme to support optimal dispensing of maintenance methadone," the review said, adding that the existing system has resulted in unintended consequences and that for over a decade, "the Ministry [of Health] has been dealing with cases of impropriety and methadone dispensing, such as improper billing of methadone claims and offering inducements."
The review also found the cost of methadone and its associated fees had grown by an average of 7.6 per cent per year since the program began and accounted for $44-million, the second-highest drug expenditure for PharmaCare last year.
Over the past two years, the college has received more than 130 complaints and tips related to methadone maintenance therapy from pharmacies, the plan states. Investigations related to those tips turned up concerns including pharmacies paying "inducements" – both monetary and non-monetary – to attract or retain methadone patients and pharmacists' failure to witness ingestion of methadone as required by prescription.
Wendy Stueck