Independent pharmacist Ron Yochim, left, and Amy Miller in Pharmasave Waterloo Wellness Pharmacy in Waterloo on June 10.Sarah Palmer/The Globe and Mail
An Ontario teacher is running out of an expensive medication she depends on, as she waits for the province’s pharmacy regulator to investigate her complaint about being forced to transfer her prescription to an in-house pharmacy set up by her insurer.
In a letter sent to the Ontario College of Pharmacists, high-school teacher Amy Miller criticized the regulator’s lack of action against MemberRx, a pharmacy created to exclusively serve the Ontario Teachers Insurance Plan (OTIP).
Ms. Miller filed a complaint with the college in August, saying the exclusive deal harms teachers covered by the plan by taking away their choice of pharmacist. OTIP has told plan members that they must receive certain high-cost specialty medications from MemberRx in order to be covered for those drugs.
Ms. Miller takes Humira to treat her ankylosing spondylitis arthritis, a condition characterized by painful inflammation of the spine. Currently, she has only a two-week supply of the drug from her independent pharmacist. She has objected to switching to MemberRx, saying she has the right to continue to fill her prescription with a pharmacist she trusts.
“Absolutely no action has been taken in Ms. Miller’s case to alleviate the clear pattern of harassment and intimidation forcing her to transfer her prescription to MemberRx,” Ms. Miller’s legal counsel Aly Haji, a lawyer with Ricketts Harris LLP, wrote in a letter to the college late last week.
Mr. Haji said MemberRx and OTIP have sent e-mails and made phone calls to Ms. Miller to pressure her to use MemberRx.
“It is difficult to label MemberRx’s conduct as anything other than extortive,” he added.
Ms. Miller filed a complaint against MemberRx and three of its directors on Aug. 28, about a month after the college invited Ms. Miller to speak publicly at a board meeting about her experience.
She told them she first received a notice from OTIP in March that MemberRx would be the exclusive provider for certain specialty medications. According to OTIP, more than 3,000 patients now receive medications through MemberRx.
The complaint to the college in August argued that OTIP’s arrangement with MemberRx is a “preferred provider network” or PPN, a type of deal that has been subject to growing scrutiny and criticism in recent months. In a PPN, pharmacies often agree to provide drugs at a lower cost to insurers, and then benefit from higher volumes as members of those insurance plans are told to fill prescriptions through that pharmacy.
In the summer, the Ontario college issued a zero-tolerance statement on PPNs, saying exclusive deals and other payer-directed care models pose a “potential risk of harm to patients.”
College spokesperson Dave Bourne said in an e-mail it “empathizes” with Ms. Miller’s situation, and while the college cannot comment on the status of any specific investigation as that process is confidential, it is not uncommon for an investigation to take “several months” before being brought to the complaints committee.
“We do not have authority over insurers and employers; therefore, effectively resolving the concerns associated with such models will require a broader system approach such as government support for legislation or other mechanisms aimed at restricting insurers and employers from entering into such agreements,” he added.
MemberRx was set up for OTIP by Cubic Health, a Toronto-based consultancy. Cubic chief executive officer Michael Sullivan did not respond to a request for comment.
The Ontario Pharmacists Association has been working with Ms. Miller to find alternative options to provide Humira during the investigation. Without an alternative, Ms. Miller could be forced to use MemberRx against her will, or to pay out of pocket for the drug, which costs roughly $30,000 a year.
“We’re looking to support Amy’s system navigation as she looks to maintain the relationship she has with her pharmacy – and avoid establishing a relationship with the pharmacy against whom she has a complaint,” said Jen Belcher, vice-president of strategic initiatives and member relations with the OPA.
OTIP spokesperson Patricia Wilkinson-Bizjak did not comment specifically on Ms. Miller’s claims that the MemberRx deal restricts her autonomy.
“We understand how important it is for patients like Ms. Miller to receive their medication in a safe and timely manner. This is why MemberRx works with patients to ensure their prescription is delivered to a place that is secure and convenient and meets their needs,” she wrote in an e-mail to The Globe and Mail.
But Ms. Miller said she does not feel the delivery options are safe or secure. She lives in a condo building with no way to keep her medication refrigerated when she’s not there to receive delivery. She said MemberRx offered to arrange a courier drop-off at a local craft store, or to deliver to her place of employment, but the options raise privacy concerns.