Shoppers Drug Mart pharmacy in Etobicoke, Ont., on Jan. 11, 2023. Ontario Pharmacists Association says Ontario teachers with some chronic conditions should not be restricted to buying only from their insurance plan's in-house pharmacy.Tijana Martin/The Canadian Press
The head of the Ontario Pharmacists Association says teachers with some chronic conditions should not be restricted to buying only from their insurance plan’s in-house pharmacy, raising concerns about patient steering and the arrangement’s lack of financial transparency.
The Ontario Teachers Insurance Plan (OTIP) last year set up the pharmacy, MemberRx, with help from health care company Cubic Health, to be the exclusive supplier of some high-cost drugs to its members. The Ontario College of Pharmacists (OCP), which is the provincial regulator for pharmacies, is set to discuss MemberRx in a board meeting Monday and hear from a teacher who is fighting an attempt to transfer her prescriptions to the pharmacy.
Justin Bates, the chief executive officer of the OPA, said his association is deeply concerned with MemberRx and similar restrictive arrangements because they force patients to work with specific health care providers. Patients in that situation can’t make choices based on which pharmacists they feel most comfortable with, or which services or expertise they offer.
“We believe it’s not in the patient’s best interests,” Mr. Bates said in an interview.
OTIP’s arrangement is an example of patient steering, which has received renewed attention since Manulife and Shoppers Drug Mart signed – and then scrapped – an exclusivity deal earlier this year.
OTIP and Cubic said the benefit of the MemberRx model was that it was set up with “no profit motive” and that funds could be returned to the plan sponsors, resulting in cost savings. Cubic said it budgets zero earnings before interest, taxes, depreciation and amortization (EBITDA), and that the restrictions are necessary to ensure patient volumes are high enough to make the model work.
But Mr. Bates, and pharmacists who have been critical of MemberRx, raised concerns about financial transparency and the supposed benefits.
Cubic Health has long had a contract with OTIP to do pre-authorization of high-cost prescription drugs. Cubic now has an ownership stake in MemberRx and fills three of the company’s five board seats, as well as earning management fees for its part in running the pharmacy.
Mr. Bates said he thought the pharmacists involved in setting up MemberRx appeared to be in a conflict of interest because they financially benefited from the patient restrictions, but that much about the arrangement remains unclear.
“I don’t think there’s transparency there in that financial flow of money.”
Cubic Health president Mike Sullivan said that, on the contrary, he believed MemberRx’s model of zero EBITDA removed any “profit-driven interests,” as “this ensures the only incentive driving the organization and the people who work in it, is the optimization of member health.” In an e-mail, he also argued that the business model was innovative and it was facing opposition by “traditional for-profit pharmacies.”
MemberRx’s model, called a plan-sponsor pharmacy, is rare in Canada. One other plan-sponsor pharmacy, owned by the Alberta Retired Teachers’ Association, was also set up by Cubic, but does not restrict its members to buying from it.
Jessica Adams, OTIP’s director of communications, said in an e-mail that the insurance plan was confident that the partnership with Cubic was delivering value to its members.
Restrictive agreements between insurance plans and pharmacies, which are called preferred provider (or pharmacy) networks (PPNs), have become a topic of intense discussion in the pharmacy profession. Independent pharmacists in particular fear that such deals favour large corporations who can shut out smaller rivals.
The OCP voted at its last board meeting in March to seek restrictions on PPNs, and other provinces – including Alberta and Manitoba – recently told The Globe and Mail that they were also concerned and exploring their options. Quebec is the only province that legally prohibits such deals.
The concern over PPNs is also part of a broader debate about how corporate decision-making may affect the health care services that pharmacists provide.
This spring, the OCP conducted a survey of thousands of pharmacists that showed most felt pressure to do unnecessary billing. The college provided a summary of the survey at its March board meeting, but last week released a fuller report on the findings so they could be discussed at the Monday board meeting.
The survey of 4,289 pharmacy professionals found 70 per cent felt pushed to speed up activities or do more to hit revenue targets. The pressure was particularly pronounced at large corporate operations, with pharmacists currently working at Loblaw, Rexall, Wal-Mart and Shoppers (also owned by Loblaw) reporting pressure at rates of 80 per cent or more.
By comparison, only 18 per cent of respondents at independently owned pharmacies reported the same concerns.
The OCP’s board is set to vote on a position statement expressing “zero tolerance” for business practices that interfere with patients’ health care, and explore various options to combat the problem.
The board will also vote on appointing a special committee to handle a governance crisis that stems from a director being pressured to resign from the board because they are participating in a lawsuit against Shoppers Drug Mart.