British Columbia is cracking down on dozens of pharmacies in Vancouver, sending them warning letters that they will not be allowed to do business because of billing infractions and other problems, including some related to methadone.
The crackdown follows a provincial review – completed in January and reported this week in The Globe and Mail – that found B.C. offers the most generous compensation scheme in Canada for dispensing methadone and is one of only three jurisdictions to pay pharmacists a "witnessed ingestion" fee. (The others are Saskatchewan and the federal Non-Insured Health Benefits program.) Those fees mean a single methadone patient can generate about $6,500 a year in pharmacy fees and helped the number-one pharmacy for methadone claims, located in Vancouver's Downtown Eastside, bill PharmaCare for $1.1-million worth of methadone claims last year, with $983,000 consisting of fees, the review states.
The pharmacies were sent warnings from the province, beginning May 1; they have 21 days to appeal. Forty-six pharmacies, all in the Lower Mainland, are involved. The ministry said the infractions involve some or all of these concerns: billing issues; problematic record-keeping; submitting false information as part of the enrolment application.
"We are talking about taxpayers' money and PharmaCare," B.C. Health Minister Terry Lake said this week in Victoria about the warning letters, which he confirmed had been sent out, in response to inquiries from The Globe and Mail.
"We needed a better system to assure ourselves that everyone enrolled in providing PharmaCare services was doing so in the right manner – so we have created new regulations and we have found a few dozen pharmacies that at this point, we have given notice [to] that we are not going to list them [as providers]. They have three weeks to make their case and have that decision reversed."
Methadone and associated fees accounted for nearly $44-million of PharmaCare expenses last year, making the drug the second-biggest cost for the plan, according to the provincial review of the program.
Launched in 2001, B.C.'s methadone maintenance program was designed to make methadone more accessible to addicts in all parts of the province. While that goal was largely met, the program has become steadily more expensive and a windfall for some pharmacies that cater almost exclusively to methadone patients.
The pharmacy warnings are related to new enrolment regulation, enacted last year, that requires all pharmacies in the province to re-enrol with PharmaCare by June 1. As part of that process, pharmacies must disclose ownership details and past regulatory problems. Previously, the province says, it could be difficult to deny or cancel enrolment of a pharmacy that had broken the rules.
The B.C. College of Pharmacists is the regulatory body for the profession and has taken some steps to rein in problem operators. In one case, the college in 2010 cancelled a pharmacist's registration and fined her $35,000 after finding a number of problems at a Downtown Eastside pharmacy, including unsafe storage of methadone. The pharmacist appealed that decision and the matter wound up in court.
As part of that process, she argued that working in the Downtown Eastside was a "mitigating circumstance" that should face less severe sanctions. A disciplinary panel disagreed and "is of the strong view that the residents of the Downtown Eastside are entitled to the same standard of practice as the residents of other communities," court documents state.
The college said it would monitor any changes resulting from the letters.
"Patients are the College's top priority," spokesman Mykle Ludvigsen said in an e-mail. "While we are not privy to the details surrounding this decision by the Ministry, we will be taking active steps to ensure that patients are supported in the event their care is impacted."
Pharmacies are known to offer cash, bus passes and other inducements to attract methadone clients, said Laura Shaver, a spokeswoman for the B.C. Association of People on Methadone. Such incentives can be helpful for people who are poor, including many who live in the Downtown Eastside, but a bigger problem is bullying and intimidation of methadone clients at some pharmacies, she said.
The methadone maintenance program is complex and needs more than a shakeup to get rid of a few problem players, said Evan Wood, medical director for addiction services at Vancouver Coastal Health.
"I am enthusiastically in support of the ministry's efforts to find a system that does not exploit vulnerable methadone patients," Dr. Wood said, adding that he hopes the province will also look at other aspects of the program, including alternatives to methadone.
Mr. Lake said any potential closures would not result in patients not being able to get methadone services.
"We don't want to leave vulnerable people without access to the medication they need," Mr. Lake said. "And I looked at the map – in all cases [of pharmacies that received a warning letter] there are pharmacies in very close proximity that can provide those services."
The review found clusters of methadone pharmacies in several Lower Mainland neighbourhoods, including the Downtown Eastside, where the review found there are eight pharmacies in a six-block stretch of Hastings Street, and in Surrey, where there are 15 pharmacies in a 20-square-kilometre area.