The Bermuda Health Council is investigating Allshores’ exclusive pharmacy deal while parties to that deal are breaching the council’s formulary. If it cannot, or chooses not to, enforce its own pricing rules, how much faith can we place in its review?

The council introduced the national drug formulary to “address affordability and inconsistent pricing”. Ozempic 1mg has a regulated price of $193.45 plus a $35 dispensing fee ($228.45 total). Yet Bermuda General Agency continues to charge $255 at wholesale, and Phoenix Pharmacies are charging patients $290, more than $60 above the regulated price. We have raised the issue repeatedly. No response.

On October 31 last year, the regulated price was set at $148.31 for a December 1 roll-out. On November 28, we were told branded drugs such as Ozempic would be excluded owing to lack of accurate pricing information. On November 29, BGA dropped its price from $255 to $193.45, and then on December 1 reverted to $255. On December 9, we were told Ozempic would be re-included at $193.45, the same price BGA originally published. We raised with the council, pharmacy owners and media why BGA had published the later official price before anyone else. We were immediately locked out of BGA's website and remain so.

When The Royal Gazette reported it, the council denied preferential treatment but gave no explanation. The formulary is published in a public Google spreadsheet. We used its revision history to prove the price changes; the council has since turned that history off. As of late February, BGA was still at $255, past the February 17 import exemption deadline, and we have a Phoenix receipt for $290.

There appears to be a double standard: BGA and Phoenix continue to charge above the regulated price with no apparent consequence, while others are expected to comply. Formulary breaches carry a $50,000 fine per offence, yet none has been imposed. Would an independent get the same leniency?

Kim Wilson, the health minister, directed the council to review the Allshores deal. In its press release, the council was quick to say the review is “not a finding of wrongdoing”, and “not reviewing the concept of preferred networks in principle”.

The council’s CEO wrote in 2020 that adding complex structures to the health system “without regard to adequate accountability and consideration of system ramifications” was “irresponsible”, and that US-style consolidation “limited patient choice”. In 2023, he warned that fewer companies making “significant population health decisions” could “derail” efforts to improve health, and that the council would adjust insurer licence conditions “if necessary”. He has also noted that “this type of change” was criticised as “being out of line with putting patients first” while the Government was proposing the same.

He warned of an “arms race for who can create the largest partnerships” as reforms were being established. He said it needed “evidence-based regulatory rules” and system-wide consideration. The Health Council Act 2004 gives the council the job of licensing insurers. Yet, it has introduced no regulations for insurers. Mergers, exclusivity deals, vertical integration. None of it has prompted the council to act.

In September 2023, we complained with evidence about the conflict of interest between CG Insurance and CG Pharmacy. The CEO responded more than a year later pledging action. Nothing has materialised. He noted that the council does not regulate pharmacies but sidestepped the fact that it has power to regulate insurers; our complaint was about CG Insurance, not CG Pharmacy.

The same asymmetry appears in regulation: the council has introduced no regulations or licensing criteria for insurers, yet extensive new regulations for health providers, with subjective criteria that could target independents. There are no regulations for wholesalers, yet our wholesale registration has been refused since 2020 while others were processed. Ironic that the council laments relying “on a single primary importer”.

The CEO has argued that there is “a strong case for public policy to target oversupply” of “the wrong types of services”. In practice: regulations and refusals for independents, while the largest partnerships go untouched. JJ Soares, who won a case against the council, put it plainly: “The health minister and Bermuda Health Council seem more focused on controlling doctors than on enhancing patient care or the quality of medical services.”

Dr Soares and My Pharmacy have won cases against health regulators. After My Pharmacy’s win in November 2023, the CEO called for a “holistic review” of the Pharmacy Act; extensive new regulations have been promised for pharmacies. When independents win in court, new powers over them are proposed instead of change.

The council talks of fairness but focuses on independents while leaving big players, and the consolidation its own CEO warns about, unchecked. It shows no sign of changing course. In 20 years, its most visible achievement has been a rebrand; staffing and budget have ballooned, and health costs are out of control. Until rules are applied consistently and the council uses its insurer licensing powers, will anything change? Besides, it has already signalled the conclusion of its review before it started.

• Denis Pitcher owns My Pharmacy LLC with his wife and is a former columnist for The Royal Gazette