Through its legal counsel McMillan, Beneva has filed a complaint with Competition Bureau Canada over what it describes as anti-competitive practices by certain pharmacists in Quebec. Insurance Portal obtained a copy of the 17-page letter sent on May 15 on behalf of the insurer.
In the letter, addressed to Competition Commissioner Matthew Boswell, Beneva denounces what it calls unreasonable professional fees charged by pharmacists as part of specialized patient support programs. These programs include supervised injection sites for patients using specialty drugs, which are known for their high cost.
“This situation artificially inflates the cost of essential treatments and causes serious harm to the Quebec population,” the letter states.
Artificially inflated fees
The letter opens by noting the rapid growth of the specialty drug market. According to TELUS Health’s 2024 Canadian Drug Data Trends and National Benchmarks report, specialty drugs represented 35.1 per cent of eligible drug spending in Quebec in 2023. The insurer’s research suggests that number climbed to 36.8 per cent in 2024, based on TELUS Health’s 2025 Canadian Drug Data Trends and National Benchmarks report.
The letter goes on to state that specialty drugs generated nearly $700 million in total claims costs in Canada in 2023 for a single insurer. Beneva refers here to GreenShield, which disclosed this figure in its 2024 Drug Trends Report. The report shows that GreenShield saw lower costs in 2022 for specialty drugs, at $630 million.
Beneva argues that the market is being deliberately restricted by widespread anti-competitive practices, orchestrated by companies and professionals with privileged access to specialty drug distribution.
The complaint points to six pharmacies that have allegedly entered into preferred or even exclusive agreements with patient support program (PSP) operators. These PSPs, says Beneva, grant the pharmacists in question direct and priority access to distribute specialty medications.
This arrangement, according to the letter, forms a coalition that “significantly restricts access for other Quebec pharmacists to these drugs, thereby limiting or severely reducing competition.”
The pharmacists involved have attempted to give their arrangement a veneer of legitimacy by forming an association called the Regroupement des pharmacies de médicaments de spécialité du Québec, the letter claims. This group has just five members: Gabriel Torani & Habib Haddad Pharmaciens inc., Larivière et Massicotte, Pharmaciennes inc., Marc Chabot et Daniel Vermette, Pharmaciens inc., Martin Gilbert Pharmacien inc., and Pharmacie Michael Assaraf, Pharmacien inc.
The Beneva complaint states that in recent years, the Ordre des pharmaciens du Québec has initiated several disciplinary proceedings against pharmacists named in the letter, all of which have resulted in guilty pleas or findings of guilt. Among the examples provided is a decision concerning Marc Chabot, who pleaded guilty to soliciting clients through an intermediary—a PSP administrator—and to illegally sharing his professional fees with a third party that is not a pharmacist (entities affiliated with PSP administrators). Chabot and his co-owner, Daniel Vermette, were found to have paid fees to Innomar Strategies Inc., through related companies, amounting to between 2.4 and 2.6 per cent of the gross volume of certain sales.
The letter also references a class action lawsuit filed in June 2024 by the Association québécoise des pharmaciens propriétaires (AQPP) against pharmacists, including those mentioned earlier.
Not so specialized after all
The letter further challenges the notion that handling specialty drugs constitutes a distinct professional specialization. It argues that, contrary to what the pharmacists involved might suggest, the task does not require unique expertise or infrastructure.
“The primary tool required for managing specialty drugs is essentially a refrigerator—equipment that almost all community pharmacists already have,” the complaint states.
Beneva contends that what truly limits access is the set of preferential and exclusive agreements between PSP administrators and the selected pharmacists. These arrangements allow the pharmacists to inflate their fees in exchange for “lucrative kickbacks” to the PSP operators.
According to the accompanying press file, some specialty drug treatments can cost several hundred thousand dollars per year, and pharmacists involved in these programs may be paying up to $500,000 in monthly rebates per pharmacist to PSP managers.
Monopoly with no caps
Insurance Portal spoke with Éric Trudel, Executive Vice-President and Leader, Group Insurance, at Beneva, who described the situation as “very specific” to Quebec. Unlike other provinces, Quebec law does not require pharmacists to disclose their professional fees in invoices.
This lack of transparency exacerbates the issue, making it more difficult to scrutinize agreements between pharmaceutical companies that manage PSPs and the pharmacists. Despite several disciplinary actions launched by the Ordre des pharmaciens du Québec, the practice persists, the letter adds.
“These pharmacists are operating a kind of monopoly and billing excessive professional fees,” says Trudel. “We often hear that pharmacy fees average around 10 per cent. But in Quebec, there's no fixed dollar cap. Some specialty drugs can cost up to $2 million a year. So, we’re seeing fees of $200,000 per patient annually for a single drug.”
Trudel warns that this situation creates pressure on the cost structure of private insurance plans. “When a pharmacist bills $200,000 instead of a more reasonable $50,000, it results in additional costs to the plan. Ultimately, insured members are the ones footing the bill,” he says.
Public plan holds an advantage
Quebec residents are either covered by the public drug plan managed by the Régie de l’assurance maladie du Québec (RAMQ) or by a private insurer. While both must cover drugs listed under the public formulary, private plans may cover additional medications.
In the letter, Beneva breaks down the pricing structure of prescription drugs as follows:
- Manufacturer’s cost, as paid by the pharmacist
- Wholesaler’s cost, as paid by the pharmacist
- Pharmacist’s professional fee
These professional fees vary depending on whether the drug is covered under the public or private system. For public plan drugs, fees are set by agreement between the AQPP and the Ministry of Health and Social Services.
No such agreements apply to private insurers. According to Beneva, the professional fees it is billed under private plans average more than double the public plan rate.
“For specialty drugs, the average is 40 times higher,” the letter states. For example, for the drug Vimizim, pharmacists bill $127.70 per vial to private group plans, compared to just $10.82 per prescription, regardless of the number of vials, under the public plan. An average prescription includes dozens of vials, the letter notes.
Overall, the total cost of medications is on average 18.8 per cent higher for private plans, which equates to a $650 million annual gap in Quebec, Beneva claims. “A large portion of this cost difference between the public and private systems is due to the situation involving specialty drugs,” the letter concludes.
Wider scrutiny in the pharmacy sector
Concerns about pharmacy practices appear to be part of a broader trend. In a separate case, on April 11, 2025, the Competition Bureau announced that it had secured a Federal Court order to advance an investigation into Express Scripts Canada (ESI Canada), a drug claims processing platform.
The Bureau is examining potentially anti-competitive conduct by four mail-order pharmacies owned by ESI Canada that operate across the country—excluding Quebec. It is investigating whether patients’ choices are being steered and whether retail pharmacists are being squeezed through imposed fees and procedures.
