B.C. pharmacist says store’s exclusion from PharmaCare will affect clients

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A long-time pharmacist caught up in a provincial crackdown on problem pharmacies is fighting back against the government's decision to deny his store's enrolment in the provincial drug plan, claiming problems uncovered in an audit earlier this year have been fixed.

And not being able to supply drugs, including methadone, through PharmaCare would mean hardship and confusion for regular clients – many of whom are grappling with drug and alcohol abuse, along with physical and mental-health concerns, pharmacist Alex Tam maintains.

"We actually inherit clients who nobody wants," Mr. Tam said Thursday in his tidy pharmacy.

"It's not simply, 'Here's your meds, see you tomorrow,'" he said. "I'm the eyes and ears for the doctors. … I'm very observant."

Mr. Tam's pharmacy – called Eastside Pharmacy Ltd., located at 398 East Hastings St. in the city's Downtown Eastside – is one of dozens targeted by the provincial government in a program that began in May that aims to weed out pharmacies with a history of problematic billing or business practices.

By refusing to enroll pharmacies in the provincial drug plan, the Health Ministry is essentially putting them out of business.

The clampdown was enabled by legislation that took effect last year, and the province did not specifically refer to methadone when it announced its action in May.

But the program followed years of complaints related to methadone dispensing practices, including pharmacists providing cash or other incentives to patients. A review of B.C.'s Methadone Maintenance Payment Program earlier this year found that dispensing methadone to a single patient results in nearly $6,500 a year in fees.

The review also found that methadone, and its associated professional fees, amounted to $44-million last year, the second-highest drug expense for the province's $1-billion PharmaCare program.

Until Thursday, Eastside Pharmacy was to be denied enrolment in the drug plan as of 12:01 a.m. on Saturday. But on Thursday, that was extended to Dec. 5.

In an e-mail, a Health Ministry spokeswoman said the ministry provided the extension to "help properly transition patients."

In a letter sent last month, the ministry said Eastside Pharmacy owes the province $1.1-million for invalid or ineligible claims and that enrolling it as a PharmCare provider would not be in the public interest.

Mr. Tam insists the problems identified by the audit have been fixed.

More than a dozen doctors, nurses and outreach workers have written letters supporting Mr. Tam. The letters were addressed to Mr. Tam's lawyer and provided to The Globe and Mail by a public relations firm retained by Mr. Tam.

Most of the letter writers said they were aware of the audit but could not comment on its findings, and instead focused on their dealings with Mr. Tam.

"If Eastside were to close, this would jeopardize the ongoing health and well-being of our HIV-positive patients who currently receive their HIV pharmacy care at Eastside," Dr. David Henderson, a general practitioner with the Vancouver Native Health Clinic, across the street from Eastside, said in a letter.

Health Minister Terry Lake was not available for an interview.

In an e-mail, a ministry spokeswoman said all of the pharmacies that have been refused enrolment had time to appeal the decision and that "the refusals to enroll are now final."

The ministry has contacted affected patients and their doctors, so they have enough time to transfer their prescriptions to nearby pharmacies, she said, adding that "all affected pharmacies are located in areas with several other pharmacy options for patients nearby."

Tiffany Tam, Mr. Tam's daughter and a six-year employee at the pharmacy, said she hoped the province would reconsider, adding that she and her father would have been willing to work under conditions imposed by the Health Ministry.

"We haven't been given any opportunity to redeem ourselves – PharmaCare is the only group I know of that would rather shut you down than work with you."

In its letter to the pharmacy last month, assistant deputy minister Barbara Walman said she considered that option, but that given the audit findings, there were no limits or conditions that could be imposed that would minimize risk to the public.