Manulife has said that coverage for certain specialty prescription drugs applies only to Loblaw-owned pharmacies, raising questions about the insurer’s relationship with large pharmacy retailers.
For independent pharmacists like Cairo Mase, who owns Toronto’s Lawlor Pharmasave, the deal signals a new shift away from personalized patient care, which has built long-standing relationships with local pharmacists. .
“At the end of the day, what it means for patients is that they’re going to get their medications from a high-volume pharmacy, or even a mail-order pharmacy, and they’re not going to need any personal care in the hospital. . It’s a process,” Mase told CBC News.
Such exclusive agreements, known as “preferred pharmacy network agreements,” are common in the U.S. and are not new in Canada, but they are gaining attention and worrying pharmacists like Mase.
“We’re gradually moving toward an American model where it’s just a bunch of pill mills,” he said, adding that some patients may have to travel to get to the pharmacy where they can get their drugs. He pointed out that there is a gender.
Manulife and Loblaw’s agreement, the details of which were shared with planholders earlier this month, affects about 260 drugs under the insurer’s specialty drug care programs.
This class of drugs is intended to treat complex chronic and life-threatening diseases such as rheumatoid arthritis, Crohn’s disease, multiple sclerosis, pulmonary arterial hypertension, cancer, osteoporosis, and hepatitis C. .
If you are taking a drug covered by the Specialty Drug Care Program and are concerned about how this change will affect you, please email ask@cbc.ca.
“Very large, very powerful insurance companies are essentially exercising some of their market power in the pharmacy business,” said Stephen Morgan, a professor at the University of British Columbia who specializes in pharmaceutical policy. Stated.
Canada spends approximately $10 billion annually on specialty drugs, which are drugs that cost more than $10,000 per patient per year. Morgan said the price increases for these drugs are about $600 million to $800 million a year, and insurers like Manulife want to get in on the action.
“They want to use their power to essentially direct customers to certain pharmacies in exchange for kickbacks,” he said.
Starting January 22, the specialty drug care program will be implemented “primarily” through Shoppers Drug Mart and other Loblaw-affiliated pharmacies, Manulife said. The company previously also covered specialty pharmaceuticals through Bayshore Healthcare, a national home and community health care provider.
Doug Bryce, Manulife Life’s vice president of products and platforms, said in a statement: “At this time, as we evolve our programs, we are developing a single service offering that advances our programs for the benefit of our customers and their employees. It is appropriate to choose the provider.” .
A “shadowy” agreement
Such arrangements are not new to the Canadian market, but insurer Green Shield introduced a preferred pharmacy network arrangement for specialty drugs through Health Forward in 2015, said Mina Tadros, an assistant professor at the university. He says such arrangements are becoming more common. University of Toronto.
Deals like the one between Manulife and Loblaw could make it even harder for Canadians who rely on specialty medicines to navigate an already difficult health-care environment, Tadros said.
“You might go to your regular pharmacy and find out you have to change pharmacies or go to a different location. So that might be a concern, or if you live in a rural area. “This may be of particular concern to patients,” he said.
Marc-Andre Gagnon, a professor at Carleton University who focuses on social, health and pharmaceutical policy, said pharmacy price increases for specialty drugs, which are inherently expensive, play an important role in “shadow” contracts with insurance companies. He says that there is a possibility that this will be achieved.
“There’s a lot of money for these particular drugs, which means there’s a lot of scope for organizing systems of rebates between drug companies, patient assistance programs, insurance companies and pharmacies,” he said. .
“Basically, you end up with some very shady deals that are done completely under the table in a system that has no transparency and we have no idea what’s going on.”
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Manulife spokeswoman Emily Via told the Canadian Press that the partnership with Loblaw will give group benefit members “more options” to receive specialty medicines, which are owned by Loblaw. You can pick up your medication at the store or have it delivered to you, the statement said. their home.
“We believe in giving our members greater choice in how they access and receive the services they need for their health and wellness,” she said.
“This exciting partnership also gives us access to a dedicated team of experts, including nurses and pharmacists, to help our members manage their medications.”
CBC News has contacted Manulife for further information.
Bayshore Healthcare says on its website that members of its specialty drug care plan can have medications shipped to their home, doctor’s office or physician’s office, but does not mention a pick-up option at a pharmacy. .
Loblaw spokeswoman Katherine Thomas said in a statement to CBC News that the company is confident the patient experience “will remain unchanged, if not improved.”
She said the program’s expansion would affect less than 1 percent of the patient population who require specialized care.
“You can pick up your prescriptions from over 1,800 pharmacies in our network or have them shipped directly to your home,” she said.
“Super profitable medicine”
Other experts dispute the idea that preferred pharmacy network arrangements hurt competition.
“Manulife found that they could essentially get a better deal by going with a single provider,” said Aidan Hollis, an economics professor at the University of Calgary. His research focuses on innovation and competition in the pharmaceutical market.
“The idea is that if they get a better deal, they should pass those savings on to their policyholders,” he said.
“This is just a small part of the deal, the business is much bigger than this. It’s just Manulife, not all the insurance companies. Perhaps these independent pharmacies will work together and form a chain or collaboration. And we’ll be able to find a way to try and get back some of that business.
“There’s no reason for Shoppers Drug Mart and Loblaws to try to have it all. Other chains will try to do the same.”
Manulife says on its website that the exclusive use of specialty drug care plans does not apply in Quebec.
Carleton University’s Gagnon said the lack of such regulations outside of Quebec has created a problem where some pharmacies are attracting “a lot of drug money,” while smaller pharmacies are “struggling to keep up.” He said an equal system was emerging.
“If a pharmacy chain’s super-profitable drugs are all monopolized by a few parties, that’s a problem for the rest of the pharmacies,” he said. “They end up with leftovers, drugs that don’t have much of a profit.”
