Manulife has announced that its coverage of 260 specialty prescription drugs will apply only at Loblaw-owned pharmacies, a deal that was first reported by The Canadian Press on Tuesday.
Experts who spoke with CBC News said the deal could hurt independent pharmacies and degrade the quality of pharmaceutical care that patients receive, while others said the arrangement is good for Canada's competition landscape and that patients will benefit from lower costs.
CBC News answers your questions about the Manulife-Loblaw deal.
How do I know if I will be affected?
The deal will impact only people whose specialty drug prescriptions are covered by Manulife. If you have a prescription that's not for a specialty drug, the arrangement won't affect you.
According to Manulife's website, the change will take place in phases. New claimants will have to go through Loblaw-owned pharmacies, which include Shoppers Drug Mart, as of Jan. 22. It is unclear what the timeline is for recurring claimants.
CBC News reached out to Manulife with a detailed list of questions. Manulife spokesperson Luke Shane wrote in response that the deal "does not impact the vast majority of our members who have not been prescribed Specialty Drugs."
Is my prescription included?
If your medication is covered under Manulife's Specialty Drug Care program, you will have to confirm with your insurance provider that your prescription drug is part of the group of 260 medications included in the exclusivity deal.
At this time, there is no publicly available list of medications included in the Specialty Drug Care program. Manulife did not provide a list of these medications as requested by CBC News.
The drugs included under Manulife's program are used to treat a number of conditions, including rheumatoid arthritis, Crohn's disease, multiple sclerosis, pulmonary arterial hypertension, cancer, osteoporosis and hepatitis C. They might be difficult for patients to store or administer by themselves.
What is a preferred pharmacy network?
This type of arrangement, called a preferred pharmacy network, is common in the United States and gaining traction in Canada. The idea is that an insurance company deals exclusively with one or several pharmacies in exchange for lower costs.
Steve Morgan, a professor at the University of British Columbia in Vancouver and an expert on pharmacare systems, said that "we don't know exactly how much of the savings that are generated get passed on to the consumer at the end of the day."
Sun Life offers a voluntary preferred pharmacy network with several specialty pharmacies. Green Shield has offered a preferred pharmacy network arrangement for specialty drugs through HealthForward since 2015.
CBC News reached out to Canada Life to ask whether the insurance company has exclusivity deals with pharmacies, but a spokesperson did not respond before deadline.
How will co-pay be impacted?
According to Manulife, there will be no change in cost to members who require specialty drugs.
"Manulife has identified that they're basically able to get a better deal by just going to a single provider. That's why they're doing it," said Aidan Hollis, an economics professor at the University of Calgary whose research focuses on innovation and competition in pharmaceutical markets.
"When they get that better deal, the idea is that they should be passing on the savings to their insured customers."
As for the co-pay — which is the standard rate that a person pays for their prescriptions and other pharmaceutical care — Mina Tadrous, an assistant professor at the University of Toronto's faculty of pharmacy, said it depends on an individual's specific insurance plan.
If you're insured through your employer, speak to a human resources employee or your benefits provider to understand how it might impact your coverage plan, Tadrous said.
"The co-pay piece can really vary depending on [a person's] specific plans and arrangements. Insurance companies have many different coverage programs," he said.
Does Canada regulate these deals?
Some provinces have regulations that require a person's written consent if an insurance agreement restricts access to their pharmacy of choice, including Ontario. But according to the Ontario College of Pharmacists, when it comes to preferred provider contracts, "consent is given by the [patient] when they opt-in or enrol for benefits."
The only province in Canada where these kinds of exclusivity deals are illegal is in Quebec. The province's Bill 92 prohibits preferred pharmacy arrangements between pharmacies and insurance providers.
"We have regulatory bodies that look at the profession of pharmacy, and this is not in their mandate because ... they don't look at business deals," Tadrous said, adding that there is no single regulator whose mandate would be to uphold standards and ensure patients aren't being left behind.
He said the Ministry of Health is most concerned about drugs that it pays for, noting that the federal government doesn't interfere in the distribution of medications — just the approval of medication access.
Can I still fill my prescriptions through Bayshore?
Manulife previously had a relationship with Bayshore HealthCare to administer its Specialty Drug Care program. "Our previous provider had a small network of retail pharmacies," Shane wrote in his response to CBC News.
You might still be able to fill your prescriptions through Bayshore, but it depends on whether your insurance group plan is mandatory or voluntary.
People under a voluntary group plan will still have the option of getting their medication from Bayshore or another pharmacy of their choice. But they won't get special pricing, according to Manulife's initial announcement. Those under a mandatory group plan will have to make the switch to Loblaw.
Manulife told CBC News that it will be offering delivery for customers with specialty drug prescriptions who do not live close to a Shoppers Drug Mart and to those who want to keep having their prescriptions delivered.
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2024-01-31 22:45:01Z
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