The regulatory body for B.C.'s pharmacists says there is little it can do about pharmacies that violate billing rules and other infractions, nearly four dozen of which the province put on notice this week.
The Globe and Mail reported this week that British Columbia offers the most generous compensation scheme in Canada for dispensing methadone: A host of fees, such as a "witnessed ingestion fee," means a single methadone patient can generate about $6,500 a year in pharmacy fees. The No. 1 pharmacy for methadone claims, located in Vancouver's Downtown Eastside, billed PharmaCare for $1.1-million in methadone claims last year, with $983,000 consisting of fees.
But the College of Pharmacists of B.C., which licenses and regulates pharmacists and pharmacy technicians, says it cannot take disciplinary action against those problem pharmacies because issues of billing and payments fall under the jurisdiction of the Ministry of Health.
"What [the college deals with] is standards of practice, standards around professional conduct," spokesman Mykle Ludvigsen said in an interview on Thursday.
"That being said, we will be very interested in learning if there's anything to come out of [the government's crackdown] from our perspective as well."
At the heart of the issue is the idea that some pharmacies are targeting vulnerable populations by catering almost exclusively to methadone patients. Patients have reported being paid money or given items such as bus passes and coupons for fast-food restaurants, to go to a certain pharmacy, which in turn receives thousands of dollars a year in PharmaCare payments.
The college has made efforts to regulate such pharmacies, briefly having banned locations from offering loyalty rewards points and other incentives on drug purchases.
However, B.C. Supreme Court Justice Christopher Hinkson found the rules to be too broad, saying in a judgment last July that they are "harmful to the public interest in obtaining pharmacy services and prescriptions at the lowest price." The college is appealing.
Mr. Ludvigsen said he could not comment on any continuing investigations. When asked for figures on the college's past disciplinary actions regarding inducements, he said there were "none where that was the central issue of the action."
As part of a government crackdown announced this week, pharmacies will be required to re-enroll with PharmaCare to charge the plan for medications and dispensing fees. As part of that process, they will have to disclose previous regulatory problems and ownership details.
B.C. Health Minister Terry Lake said while the college has a responsibility to protect the public and ensure ethical standards are met, the province wants to "make sure we have our own systems in place to make sure taxpayers' money is being spent appropriately.
"I'm sure if you talk to the college … and the pharmacy association, they would not condone some of the behaviour that we hear about, but we can't go on hearsay; we have to have information so these regulations give us another tool to make sure everyone is following legitimate rules."
Mr. Lake defended the cost of the program, saying it is a small number of pharmacies that have been abusing it.
"It's really important that pharmacists and physicians involved in the methadone program ensure that the right person is getting the medication," he said. "We know there is a street value for the drug and that is why we have witnessing fees.
"Having said that, it's important that we have rules and regulations in place and enforced to ensure there aren't people taking advantage of vulnerable people and taking advantage of B.C. taxpayers."
The 46 pharmacies put on notice this week have three weeks to respond and make their case. The new regulations come into effect June 1.