The owners of an independent pharmacy have called the roll out of the Bermuda Health Council’s new formulary a disaster and have questioned the fairness of the process.

After struggling to get their concerns heard, My Pharmacy operators Olivia Benyak-Pitcher and her husband, Denis Pitcher, have sent a letter to industry stakeholders and the media outlining their complaints about the formulary — an approved list of medications and prices meant to guide prescribing and managing stock.

They state there were problems with the consultation process, bureaucratic requirements and information sharing. They also claim that importers were confused and not being treated fairly.

They accused the BHC of doubling back on itself on whether branded drugs would be included in the formulary, particularly Ozempic, a drug used by diabetics and people who want to lose weight.

On September 19, the BHC sent an update on formulary drug pricing regulations.

He said in the case of the 0.25mg Ozempic, the pharmacy price was lower than the wholesaler price and left nothing in the margin for pharmacies.

There are exemptions for pharmacies that need to sell certain medications for higher than the BHC’s recommended price but the application process is cumbersome, he said.

“There is a risk upfront in importing,” Mr Pitcher said.

The pharmacy owner said it took two months for their shipper to send an invoice with the final cost of the medication, which made it hard to claim exemptions because often the medication had already been sent.

On October 31, another drug formulary pricing was sent out, Mr Pitcher said.

“BHC proposed wholesale prices with a maximum dispensing fee,” Mr Pitcher said.

On December 9, there were additional updates saying that the formulary applied to generic drug forms only, except when applied to Ozempic and insulins such as Tresiba, Fiasp, Levemir and another diabetes medication, Tradjenta.

“In the meantime the Bermuda General Agency had reduced the price for branded formulary medication, a few days earlier,” Ms Benyak-Pitcher said.

“For example, Ozempic 1mg changed from $255 to $193.45 then reverted to $255 on December 1,” she said. “Tresiba 200 unit went from $168 to $155.88 then reverted back to $168. These figures precisely matched the regulated prices shared (by the Bermuda Health Council) on December 9 and updated in the formulary spreadsheet on December 2.”

Mr Pitcher questioned the reasoning behind this.

He said: “I thought the point is to set prices that they will determine fair and equal for all,” he said. “Instead they have created a complex bureaucracy behind getting exemptions.”

“We were told a price a month before launch of the formulary, which impacted our ordering decisions,” he said. “Then days before we were told that some medicines for which prices were set very low would be excluded because of lack of pricing information. Then we were told on the 9th that those medicines were reincluded retroactively but at a different higher price.”

He said the timing of BGA’s price changes did not match the information they were being provided.

Ms Benyak-Pitcher said this sequence raised serious questions about how pricing information was handled and disseminated in advance of official guidance.

She said the December 9 e-mail from the BHC outlined a “burdensome” transition process for selling above regulated prices, requiring extensive documentation.

The pharmacist said: “Yet BGA has maintained $255 Ozempic pricing since December 9 (with stock increasing from 427 to 561 units by December 22), while smaller independent pharmacies face extensive bureaucracy dependent on waiting at least a month for correct import costing data to seek exemptions based on actual costs.”

The Pitchers submitted feedback on November 28, questioning fairness among pharmacies and the practical challenges of overseas ordering under rapid price changes.

“These points were ignored, with no response or proposed remedies,” she said.

Ricky Brathwaite, chief executive of the BHC denied bias in the formulary process.

“The Health Council is an independent regulator and is not partnering with any supplier or sharing preferential information,” Mr Brathwaite said. “Feedback from multiple stakeholders was considered ahead of the December 1 phase 1 publication, which covers a defined set of high-impact medicines.”

Dr Brathwaite said initial prices were set using available market information, reference pricing and a consistent methodology with validation and refinement continuing through subsequent phases.

“The Health Council introduced medicine price regulation to address affordability, inconsistent pricing and access to essential medicines,” he said. “Bermudians have historically paid widely different prices for the same drugs, which is not sustainable or fair. ”

Referring to a Royal Gazette poll on how to improve healthcare in Bermuda, Mr Pitcher said that the answer was not about increasing government control but about cutting bureaucracy.

He said with more government regulation came more administration and compliance costs.

“Small providers like us will really struggle to manage while the rewards go to big players who can afford full-time staff to map out and checklist all of these policies, most of which have no real justification or necessity,” Mr Pitcher said.

Mr Pitcher said after he and his wife complained publicly, the BGA closed their online account.

“They locked us out and deleted our access to their online ordering platform and have said we can only order by phone or e-mail, which is slower and more challenging,” he said.

The couple did get a response from the BGA suggesting it was going to restore My Pharmacy’s access after they had made changes to their system. It said that their pricing and stock level data was proprietary and not to be shared publicly.

The BGA told The Royal Gazette: “The BGA values and respects the valuable business relationships it has with all its clients. BGA strives to conduct its business in accordance with the highest standards in a way which delivers value for money for the Bermuda public. However, as you will appreciate, BGA is unable to comment publicly on its confidential client relationships.”