Anti-competitive practices and abusive concentration in the distribution of specialty medications: Québec's association of owner-pharmacists seeks class action lawsuit against some of its members Français
Nearly $1.5 billion in revenues in the hands of six Québec pharmacies
MONTRÉAL, June 12, 2024 /CNW/ - The Association québécoise des pharmaciens propriétaires (AQPP) has filed an application with the Québec Superior Court for authorization to institute a class action lawsuit against ten of its pharmacist members who are owners of six pharmacies, as well as against three patient support program (PSP) managers and three private infusion networks. The AQPP is seeking, among other things, to establish proof of and obtain compensation for financial losses suffered by the members of the AQPP.
It is stated that owner-pharmacists are being denied substantial revenues as a result of unlawful and wrongful commercial practices. These practices have resulted in a concentration of specialty medication distribution in the hands of a few owner-pharmacists and in turn are jeopardizing the long-term sustainability of the Québec pharmacy network as it is known today. "If this worrying situation continues, the Minister of Health's objective, reflected in Bill 67 tabled last week in the National Assembly, to improve access to front-line care by increasing pharmacists' professional autonomy could well be compromised," says Benoit Morin.
Revenues estimated at nearly $1.5 billion from that category of medications are being shared by just six of the approximately 1,900 community pharmacies in Québec. In fact, more than 40 % of specialty medication distribution is concentrated in the hands of less than 0.5 % of all pharmacies in Québec. The approach is so audacious that some of these pharmacies control 90 % of the volume of prescriptions for some of the most expensive drugs.
To paint a portrait of the current financial imbalance and market concentration, one needs only compare the average annual sales of Québec pharmacies, $7 million, with those of certain so-called specialty pharmacies, which can be as high as $310 million.
At the core of this specialty medication distribution ecosystem is a small group of individuals engaging in wrongful, anti-competitive behaviour to capture a vulnerable group of customers. Simply put, patients are directed to a designated pharmacy, which is not their usual community pharmacy, to obtain a medication dispensed by that pharmacy. This approach, which has come to be known as dirigisme (patient steering), is occurring in spite of the fact that it violates the laws and regulations governing pharmacy practice. In fact, a pharmacist is not allowed to acquire customers by means of an agreement with a third party, and patients must be able to exercise their right to choose their health professional with complete freedom and without any constraints.
This small group of pharmacists is not only acting to the detriment of their pharmacist colleagues and jeopardizing the survival of the current pharmacy network; their practices are also putting the safety of patients at risk, because patient records are being fragmented as a result. This prevents a patient's usual pharmacist from properly monitoring that patient's entire pharmacological profile.
An invaluable local network that must not be weakened
"For our pharmacy network to continue to play its role in providing front-line care, owner-pharmacists must have access to the specialty medication market," says AQPP President Benoit Morin. "That access is necessary so that they can continue to develop service offerings adapted to the needs of the local population, for example, providing clinical services to treat common health conditions and administering vaccines." He continues: "All Québec pharmacists are empowered to provide the full range of prescription drugs, including specialty medications. In fact, they are uniquely qualified to support and guide their patients in their treatment, and to comprehensively manage and monitor their therapies. Why? Because this is part of an essential continuum of care. We know our patients better than anybody."
The AQPP reminds the public that in recent years, the community pharmacy network has become a vital link in ensuring access to front-line care in Québec. People feel secure in the knowledge that they can count on a health professional who is often right next door, and not have to visit an overcrowded emergency ward to seek treatment for a minor condition.
"If the prevailing situation, whereby a handful of offenders are being allowed to control a huge share of the specialty medication market, does not change soon, the entire network will pay the price: pharmacists' ability to remain an accessible local network for patients will be compromised," Mr. Morin warns.
While the six so-called specialty pharmacies are currently sharing a disproportionally high percentage of the market in question, they provided practically no vaccination services or treatment services for common conditions in 2023. Instead, the so-called specialty pharmacies mostly resemble distribution centres, and are often located in industrial parks, dispensing only certain specialty medications and no everyday prescription drugs. In the majority of these establishments, patients cannot enter freely, cannot obtain a routine prescription and cannot access clinical services as they can in any of the community pharmacies across Québec that play a prominent role in frontline care in the province.
Patients are hostages in an opaque system
In recent years, new pharmacological treatments have been developed to treat severe and/or complex diseases. These specialty medications, which doctors are increasingly prescribing, sometimes require specific patient support. This context has unfortunately given rise to an ecosystem in which patients are being held hostage.
"In conversations with their patients, pharmacists sometimes learn that the patient must deal with a pharmacy they are unfamiliar with and in which they will never actually set foot," Mr. Morin explains. "When a patient expresses the wish to be served by their usual pharmacist, there are obstacles to this. For example, they may be refused the right to have the medication delivered by their usual pharmacy to an infusion clinic, and instead be forced to transport the expensive drug themselves and ensure it is refrigerated. So these patients, who are vulnerable and living with illnesses requiring access to that medication, will often resign themselves to the situation."
Flouting laws and regulations
In Québec, all pharmacists have the same status and are bound by the same laws and regulations. These six pharmacies' self-proclaimed status as so-called specialty pharmacies, and their wrongful business methods, in collaboration with PSP managers and infusion clinics, are resulting in serious financial harm to all community pharmacists in Québec, depriving them of revenues that they need to continue operating.
The AQPP has engaged in awareness-raising discussions with the Department of Health and Social Services and the Minister's office while proposing solutions to better supervise and facilitate interventions to put an end to these prohibited and wrongful commercial practices. It has sent more than 40 complaints to the Régie de l'assurance maladie du Québec (RAMQ) since 2020. It has also held numerous meetings with a number of manufacturers of innovative medications and generic drugs and their representative organizations (Innovative Medicines Canada and the Canadian Generic Pharmaceutical Association) to explain the issues. Unfortunately, their suppliers' practices have remained unchanged.
Québec's professional order of pharmacists, the Ordre des pharmaciens du Québec, is also concerned about this matter. Its disciplinary board, responding to a complaint from its syndic, has imposed penalties on the owners of so-called specialty pharmacies for various faults of which they were accused relative to their involvement with PSPs. Unfortunately, those penalties have had no impact on the unlawful practices.1
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A dominant market in the prescription drug industry
The specialty medication market has been expanding since 2015, and growth will remain exponential in the years to come. Some sources expect the global market for these drugs to grow by 35 % by 2030. Within just a few years, more than half of all spending by insurance plans is likely to be on specialty medications.
About the AQPP
The Association québécoise des pharmaciens propriétaires, incorporated under the Professional Syndicates Act, is the only association that represents owner-pharmacists in Québec before official organizations and the government. It represents the 2,064 owner-pharmacists of Québec's 1,891 pharmacies, regardless of whether they are affiliated with a commercial chain or banner. Community pharmacies, which employ nearly 49,000 people across the province, make up one of the leading private-sector employers in Québec. More than a million consultations are performed in pharmacies each week, making pharmacists among the most available and appreciated health professionals in Québec.
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SOURCE Association québécoise des pharmaciens propriétaires
Association québécoise des pharmaciens propriétaires, Media line: 438 887-0519, [email protected]
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