Manulife drug plan members continue to face barriers when trying to fill prescriptions at pharmacies of their choice

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A month after Manulife Financial Corp. MFC-T announced it would allow group benefit plan members to use any pharmacy of their choice for certain specialty drug prescriptions – backing down from an exclusive pharmacy deal with Loblaw Cos. Ltd. L-T – plan members say they are continuing to face barriers to switching providers.

Michael Nashat, a director of OnPharm-United – a network of more than 600 independent pharmacies – said members of his network have reported having about 100 specialty drug claims that Manulife has denied for customers, some of whom are trying to switch prescriptions from Manulife’s previous preferred providers Bayshore HealthCare and Shoppers Drug Mart.

“Obviously, we weren’t expecting Manulife to make that change happen right away,” Mr. Nashat said in an interview. “For a lot of these patients who have been getting their drugs through Bayshore for three to four years – and are looking to continue with Bayshore – there is no problem. But when people began switching pharmacies – even weeks after the announcement – or for those new Manulife clients coming in, it has become a major issue.”

Known as preferred pharmacy networks, or PPNs, these agreements are typically set up between insurance companies and one or several groups of pharmacies to help reduce claim costs for expensive specialty drugs.

Earlier this year, Manulife found itself in the hot seat after it announced a plan to change its PPN for all 260 specialty medications to be “primarily” fulfilled by Shoppers Drug Mart and other Loblaw-owned pharmacies. That exclusive agreement meant Manulife would end its arrangement with Bayshore, which has about 300 affiliate pharmacies across Canada, as of Jan. 22. Both agreements allowed Manulife policyholders to pick up prescriptions in-store or through home delivery.

However, after the deal sparked competition concerns and negative feedback from some customers, Manulife reversed its decision and announced on Feb. 5 that its plan members who take specialty medications will now be able to fill their prescriptions at any pharmacy of their choice.

Now, more than a month later, Mr. Nashat – who is also a pharmacist himself in Mississauga – says pharmacies continue to see reimbursement requests denied on a daily basis with pop-up alerts on their work terminals pushing patients back to Manulife’s preferred pharmacies, which are Shoppers Drug Mart and Bayshore. When pharmacists tried to contact Manulife, he said they were told the delay was because of a technology change that needed to occur in the system and was in the hands of Manulife’s pharmacy benefit manager.

One of those patients is Michael Lund, a 32-year-old resident of Ridgeway, Ont. Last November, Mr. Lund began to suffer from chronic hives and was put on several different oral medications before he was referred to a specialist in January.

Mr. Lund was then referred to RX Connect, a specialty pharmacy that can administer an injectable medication called Xolair. In early February, after Manulife reversed its decision, RX Connect submitted Mr. Lund’s paperwork for approval to receive two injections of Xolair a month. But Mr. Lund says his bill was rejected by Manulife with a notice saying he must join Bayshore in order to receive the drug.

“They were dictating where I should get my drugs from,” Mr. Lund said.

While the Feb. 5 announcement said the changes would be done “swiftly,” the insurer did not provide a timeline.

Now, Manulife Canada president and chief executive officer Naveed Irshad said in an interview with The Globe and Mail that the technology requirements to automate the process are expected to be “fully operational by the end of April.”

“This is a complex process that typically a project of this nature would take up to a year to implement,” Mr. Irshad said. “But this is a top priority for Manulife so we’ll get it done in less than three months.”

Until then, Manulife group benefits plan members can request a change in pharmacy by speaking directly with a customer service representative. The company has set up a dedicated number to assist specialty care drug clients with this change. For privacy reasons, he says, it has to be the member making the request and not the pharmacist.

For Mr. Lund – who contacted the Manulife call centre before the dedicated telephone line was set up – the ordeal took more than 3½ hours on the phone between multiple parties. At times, Bayshore was referring him back to Manulife to make the change, while Manulife was referring him to Bayshore. In the end, after a two-week delay, he was forced to receive his first dose of medication through Bayshore. Last Thursday, almost a month after he first began paperwork, Mr. Lund was notified he was approved to continue his medication regime with RX Connect.

“I was running around in circles trying to put through an exception,” Mr. Lund said.

Manulife said the number of customers in the program is “less than 1 per cent” of its total group plan members and customers in other prescription drug programs have the option to choose their pharmacies.

Prior to Feb. 5, Manulife offered two different PPN options for employers to choose when selecting specialty care drug plans for their employees. In an open or voluntary PPN, plan members are given an approved list of pharmacies to access certain specialty drugs. They can still fill a prescription at an out-of-network pharmacy, but it may be more expensive. In a closed or mandatory PPN, insurers restrict plan members to using the approved pharmacies, and they cannot fill their prescriptions elsewhere.

Mr. Irshad said that as of Feb. 5, Manulife has been operating a voluntary PPN for 100 per cent of its specialty care drug plan clients. Since then, he added, Manulife’s group benefit clients have had the choice to continue to use Bayshore or Shoppers Drug Mart, or they can opt out to use a pharmacy of their choice, as long as they call Manulife directly to make the change.

However, he added, the company is still in the process of confirming which pharmacy providers will be in the voluntary PPN but declined to comment on anything “related to current and/or future providers.”

Both Bayshore and Loblaw did not respond to The Globe’s request for comment on whether they are currently in discussions with Manulife regarding their PPN agreements.