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Canada Toronto doctor resigns from committee, accuses pharmaceutical company of deliberately creating shortage of drug

Dr. Nav Persaud poses for a photograph in the lobby of St. Michael's in Toronto on Jan. 17, 2018.

Christopher Katsarov/(Christopher Katsarov/The Globe

A prominent Toronto doctor has resigned from the Ontario committee that evaluates requests for public funding of prescription medications over what he alleges is a pharmaceutical company’s attempt to effectively double the price of a drug taken by people with schizophrenia.

Nav Persaud, a staff physician and scientist at St. Michael’s Hospital, quit the expert committee this week after filing separate complaints with the federal Competition Bureau and Health Canada about Pendopharm, a division of Montreal-based generic drug maker Pharmascience Inc.

Dr. Persaud is accusing Pendopharm of deliberately creating a shortage of the two-milligram version of benztropine in order to promote the one-milligram version at a slightly higher price. Both strengths would cost about five cents a pill, but many patients would need twice as many pills.

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Pendopharm is the only company in Canada that makes and sells benztropine, a drug that has been on the market for decades and is primarily used to quell tremors in patients taking antipsychotic medications.

“I think they’re playing games with people’s health,” Dr. Persaud said. “I think this is a way that a company can manipulate people and manipulate a market so that it charges double.”

Steeve Azoulay, a spokesman for Pharmascience, said the company has faced “supply challenges” for both strengths of benztropine, but he declined to say what caused those challenges.

The drug is manufactured in Canada.

“Considering that the 1 mg is the most versatile dose for the patients we have focused our efforts to ensure continuous supply of that strength while we continue to evaluate all supply options,” Mr. Azoulay said via e-mail.

Dr. Persaud dismissed that explanation as “nonsensical.” Asking patients to keep track of more pills is usually considered a disadvantage and the two-milligram version is scored so it can easily be split for patients on low doses, he said.

“If they have enough of the active ingredient to make the one-milligram tablet and people are taking the same number of milligrams per day, then a shortage of the active ingredient could not explain this declared shortage,” Dr. Persaud said.

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After being sent a copy of Dr. Persaud’s complaint, Pharmascience declined to respond directly to his allegations.

“Our focus is always on the health and safety of our patients which in this case is not impacted,” Mr. Azoulay wrote.

Pendopharm and Pharmascience sold more than $5.5-million worth of benztropine in 2017, up about 7 per cent from five years earlier, according to prescription drug tracking company IQVIA.

The benztropine issue came to Dr. Persaud’s attention when Pendopharm asked the Committee to Evaluate Drugs (CED) to make a recommendation on the public funding of the one-milligram pill. Currently, Ontario routinely funds only the two-milligram version.

Most other provinces already cover both strengths for patients who qualify.

A spokesman for the Ontario Ministry of Health and Long-Term Care, which oversees the CED, confirmed the committee is reviewing a submission for the one-milligram benztropine pill.

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Dr. Persaud said he could not speak about the committee’s deliberations because of confidentiality rules.

Still, he said he had no choice but to resign.

“It’s difficult because there are a lot of dedicated people involved in the committee who I respect a lot,” he said. “But ultimately, I don’t want to be part of a process that rewards companies for what I view as abusive behaviour.”

There has been a shortage of the two-milligram pill since September, 2017, according to the federal government’s drug shortages website.

The company also reported a very brief shortage of the one-milligram version in February.

Cynthia Leung, a primary-care pharmacist who works as part of a family health team in Kingston, said it has been difficult managing the shortfall of the two-milligram pill and the lack of public funding for the one-milligram version.

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Patients with schizophrenia, many of whom are on social assistance, often can’t afford even a small out-of-pocket fee for their drugs. “Paying even $2, $3 or $5 – to us, it may not be a big deal,” Ms. Leung said. “To these patients, it’s a huge concern. They sometimes don’t have enough money to eat.”

A spokeswoman for Health Canada said in response to Dr. Persaud’s complaint that the regulator cannot compel a company to market or supply a specific product.

The Competition Bureau, meanwhile, said its policy is to not speak publicly about complaints or even confirm receiving them.

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