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.

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.