Pharmacies still paying patients kickbacks, DTES sources say

Frontline workers and community members in Vancouver's Downtown Eastside say some pharmacies are paying its patients kickbacks for prescriptions despite the practice being banned more than a decade ago.

CBC News has spoken to more than a dozen people in the community, including pharmacists, nurses, doctors and patients with first-hand experience, who claim some pharmacies are paying customers a share of the money they claim from the B.C.'s PharmaCare program.

They say payments can range between $100 and $200 per month depending on the number of daily prescriptions per person.

"The fact that these sort of behaviours are so common, and particularly within this population, without remedy over all these years is of great concern to me," says Dr. Susan Burgess, a semi-retired outreach doctor who works in the area and is among those speaking out.

The more medications a person is required to have dispensed daily, the more money a pharmacy can make.

For eligible low-income patients whose prescription fees are subsidized, pharmacies can bill PharmaCare a daily $10 fee for up to three different medications, as well as a $7.70 "interaction fee" for every time a pharmacist witnesses methadone ingestion. It means pharmacies can bill back more than $1,000 a month per patient.

Dr. David Tu raised the issue more than a decade ago in a hidden-camera investigation on CBC News. He says the practice hasn't stopped.

Of his approximately 100 patients who are on daily prescriptions, he estimates about half are connected to pharmacies that are paying cash incentives, based on his conversations with them.

"We've created a strong financial incentive for this format to happen and there isn't significant enough oversight to prevent this practice, clearly," says Tu.

'Like a nasty drug dealer'

Both Burgess and Tu say they've seen patients reconsider treatment options based on how it could affect their kickback payments.

As an example, Burgess says she's had patients who were ideal candidates for once-a-month injectable Suboxone, but chose to remain on daily doses of methadone after realizing they might lose their weekly cash incentives from their pharmacy.

"A pharmacy is actually interfering with their physician and the patient's choice," she said.

She adds she's had patients tell her they're at risk from medications being withheld or threatened if they try to transfer away from pharmacies that are paying them.

"These are behaviours that totally no one should be exposed to — a profession that sounds more like a nasty drug dealer might do to you," Burgess said.

"But this is happening and our tax money is going to these ... particular pharmacies."

Patient speaks out

One patient, whose name CBC News is withholding due to concerns that ongoing tensions over the issue could threaten his safety, says he used to be paid $120 a month by a pharmacy but chose to switch after they gave him methadone that he believes was around five times his usual dose.

He says it knocked him out for days, and it ended up being a wake-up call that prompted him to speak out.

He says he's now at a pharmacy that doesn't offer any incentives.

"People down here, they're getting controlled. They're broke, they're homeless, and then they get these people, they prey on them," he said referring to the pharmacies that pay incentives.

"The medication is sometimes given wrong ... they don't care."

Unfair business advantage

Gary Siu, the owner and pharmacist at Garlane Pharmacy on East Hastings Street, says his business doesn't pay kickbacks but feels the ongoing practice puts his business at an unfair disadvantage.

He says several times a month he gets calls from pharmacies — some outside the Downtown Eastside, and from as far away as the neighbouring city of Burnaby — who say his patients are being transferred there.

Siu says he asks those patients why they're leaving him and they tell him they're getting paid elsewhere.

"You can't do anything because the patient has the right to transfer to any pharmacy they want," he says. "So we comply."

Like others in the community, he's demanding "corrective action" from the regulatory body, the College of Pharmacists of B.C.

Siu says employees at his pharmacy have complained to the college but after what felt like a lack of response, gave up on the issue.

"If the college is [doing] something about it, that situation would not exist today, right? But right now, it still exists. That means it's not being done correctly, or inefficiently, or not being done."

Response from regulatory body

The College of Pharmacists of B.C. and B.C.'s Ministry of Health declined an interview with CBC News and sent emailed statements instead.

The college says it has a "long-standing concern about the negative effects of incentive programs" but does not comment publicly about complaints due to privacy reasons.

It said the only exception would be "if we become aware of a significant risk of harm to the public or a group of people that would justify such disclosure."

In 2013, the college established professional practice standards to prohibit pharmacists from providing incentives to patients, a decision that was upheld by the B.C. Court of Appeal in 2016.

The college later detailed a specific action plan against pharmacies that were not complying with rules around methadone dispensing, such as paying as incentives. It launched a round of undercover investigations to tackle the issue.

Disciplinary action included fines, suspensions and pharmacists losing their licence. The worst offenders could also be expelled from the PharmaCare program.

In an email, B.C.'s Ministry of Health said the last time a pharmacy lost its PharmaCare billing privileges over incentives was in March 2016.

Both the ministry and college said anyone with complaints or tips about poor practices should contact the college.