ANDRÉ PICARD, Globe and Mail, Jan. 24 2011

Quebec pharmacists are refusing to supply prescription drugs to thousands of refugees and asylum-seekers in the province without being paid up front, in spite of a federal program that is supposed to reimburse them for the cost.

The move is the latest salvo in a long-simmering dispute between Citizenship and Immigration Canada and the association representing Quebec pharmacists.
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Public health officials fear the consequences could be grave and costly, especially if patients cannot afford to continue treatment for infectious diseases like tuberculosis and HIV.

“We are taking this action reluctantly, but pharmacists are just fed-up with Ottawa’s attitude,” Vincent Forcier, director of public affairs at the Association québécoise des pharmaciens-propriétaires, said in an interview.

He said Immigration takes up to three years to pay, and some pharmacists are owed tens of thousands of dollars. Further, there is no agreement on the formulary to be used to determine which drugs are covered and at what price, so sometimes only partial payment is made, or none at all.

“This is clearly not acceptable,” Mr. Forcier said.

Canada takes in about 27,000 refugees and asylum seekers each year, about one-third of whom are in Quebec. Immigration Canada pays their prescription drug costs across the country through the Interim Federal Health Program.

The program covers 125,000 refugees and asylum seekers across the country. However, in other provinces, deals are in place with large pharmacy chains and the slow payments are not as big a problem. Quebec requires individual pharmacists to own their pharmacies, even if they are within chains, and as small business owners, they are less able to carry debt.

Mr. Forcier said Quebec pharmacists who refuse to supply medications urge patients to go to an emergency room, where drugs will be supplied free, although they may not always be available and waits are lengthy.

On Monday evening, a notice was posted on Citizenship and Immigration Canada’s web site saying that, on Jan. 17, it replaced the insurance company administering the drug program with Medavie Blue Cross, and urged pharmacists to send claims there. A spokesman said the change would speed payments and that, under the deal with Medavie, electronically-submitted claims should be processed in 14 days. Those submitted by mail, he said, would take 21 days.

It was not immediately clear if the changes would address the lack of a formulary.

“CIC is hopeful that the majority of Quebec pharmacists would ignore the AQPP’s directives on this issue and continue to serve their patients, including IFHP recipients, as per usual,” said Douglas Kellam. “In the interim, CIC is working on arrangements to provide an alternate service for IFHP recipients in Quebec.”

Norbert Gilmore, a professor emeritus of medicine at McGill University who specializes in the treatment of infectious diseases, pleaded with Immigration Minister Jason Kenney to intervene personally.

“This is a disaster for the personal health of Canadian refugees and asylum-seekers and for public health in Canada,” he said. “This is an impoverished population and few, if any, of these individuals can afford to pay for medication.”

Dr. Gilmore said numerous patients have already stopped their treatment and, without it, their health will deteriorate quickly. “The end result – all too avoidable, but seemingly inevitable – will be greater morbidity, mortality, suffering and costs,” he said.

Mr. Forcier of the AQPP, which represents Quebec’s 1,734 pharmacist-owners, said the fundamental problem is that Immigration Canada refuses to sign a formal agreement with pharmacists to supply services to refugees and asylum-seekers.

Long-standing contracts are in place to provide services to other federal departments such as Health Canada, Veterans Affairs, Indian Affairs and the RCMP that could serve as templates.

“For us, the solution is very simple. If CIC would sit down and negotiate, this could be resolved in a couple of hours,” Mr. Forcier said.

There are 125,000 refugees and asylum-seekers covered by the IFHP, and 18,000 providers Canada-wide such as pharmacists, dentists and optometrists. Patients benefit from the program for one year after arriving in Canada, but they can apply to renew their status.

It is not clear exactly how many patients are affected by the dispute. Dr. Gilmore said clinics do not track patients based on their citizenship status and Mr. Forcier said “when you don’t have a deal you don’t have data.”

With a report from Adrian Morrow