On April 1, Stéphanie Grammond wrote an editorial denouncing the fees charged by certain pharmacists by presenting two non-standard examples of more than 300 million prescriptions served in pharmacies in Quebec. The challenge, in our view, lies elsewhere and relates more to the cost of ultra-expensive drugs, used to treat rare diseases: an important societal subject that deserves to generate discussions between all parties concerned.

Indeed, these so-called specialty drugs will be more and more numerous on the market and we must, collectively, find solutions to manage their costs.

First of all, it should be noted that the pharmacist does not take any profit on the cost price of the drug. In complex therapies, some pharmacist-owners may invest over $1 million to purchase a hyper-specialty drug from a pharmaceutical company before they have even generated any revenue. They then charge professional fees based on the level of involvement and services rendered to the patient struggling with a rare disease.

Ensuring the follow-up of these therapies sometimes requires colossal work on the part of the pharmacist, both because of the complexity of the follow-up and the time spent with the patient. For example, monitoring the efficacy and safety of therapy often requires numerous meetings with the patient and with the treating team, not to mention the prescription and analysis of laboratory tests, essential to treatments, which often continues for months.

It is work invisible to the public eye, and probably to the eyes of private insurers, but which is essential for the success of a therapy. It’s hard to imagine such paid work according to what the Régie de l’assurance maladie du Québec (RAMQ) agrees to the pharmacist, i.e. $9, not to mention that these fees must cover the pharmacy’s operating costs, including those related staff, rent, computer systems, electricity, business insurance, drug deliveries, supplies, etc.

The manipulation of these drugs as well as the adjustments or abandonment of therapies often cause major financial losses, all absorbed by the pharmacies, jeopardizing the survival of these local community businesses. Take the example of Soliris, whose annual cost for the drug alone is nearly $700,000 per patient.

It should also be considered that the dirigisme issue that currently prevails in the dispensing of specialty drugs means that this type of drug is found in a very small number of so-called specialty pharmacies and remains beyond the reach of traditional pharmacies, to the detriment of patients. With restricted access to the market, community pharmacists have a limited ability to take on the financial risk associated with these expensive drugs on their own.

For several years, the Quebec Association of Proprietary Pharmacists (AQPP) has been asking the government to regulate the management of specialty drugs. With the increase in the number of treatments for rare diseases and the arrival on the market of very expensive drugs, it is perhaps time to review the mode of operation and the sharing of the financial risks of this type of therapy, but also all the market dynamics surrounding the distribution, dispensing and reimbursement of these drugs.

In this regard, insurers themselves have a long way to go. As Ms. Grammond mentions in her text, they have not been very active in reducing the costs associated with expensive therapies, since the higher the costs associated with these therapies, the greater the profits of the insurer.

Reviewing the operating mode surrounding specialty drugs is therefore, in our opinion, the only way forward to make the system fair and equitable for patients and for community pharmacists. The AQPP invites all stakeholders in this file to work together to find a lasting solution to the challenge presented by the growing arrival of these expensive therapies for the treatment of rare diseases.