Manulife announced that its coverage of 260 specialty prescription drugs would apply only to Loblaw-owned pharmacies, a deal that was first reported by The Canadian Press on Tuesday.
Experts who spoke to CBC News said the deal could hurt independent pharmacies and degrade the quality of pharmaceutical care patients receive, while others said the deal is good for Canada’s competitive 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 agreement will only affect people whose specialty drug prescriptions are covered by Manulife. If you have a prescription that is not for a specialty medication, this arrangement will not affect you.
According to the Manulife website, the change will happen in stages. New applicants will have to go through Loblaw-owned pharmacies starting January 22. It is unclear what the deadline is for repeat applicants.
CBC News contacted Manulife with a detailed list of questions but did not receive a response before deadline.
Is my prescription included?
If your medications are covered by Manulife’s specialty drug plan, you will need to confirm with your insurer that your prescription medication is part of the group of 260 medications included in the exclusivity agreement.
Currently, there is no public list of medications included in the Specialty Drug Care Program. CBC News asked Manulife what drugs were included.
Drugs included in Manulife’s program are used to treat a number of conditions, including rheumatoid arthritis, Crohn’s disease, multiple sclerosis, pulmonary hypertension, cancer, osteoporosis and hepatitis C. It may be difficult for patients to store them or administer them themselves.
What is a preferred pharmacy network?
This type of arrangement, called a preferred pharmacy network, is common in the United States and is gaining ground in Canada. The idea is that an insurance company deals exclusively with one or more pharmacies in exchange for lower costs.
Steve Morgan, a professor at the University of British Columbia in Vancouver and an expert on drug benefit systems, said that “we don’t know exactly how much of the savings generated is ultimately passed on to the consumer.” “
Sun Life offers a voluntary network of preferred pharmacies including several specialty pharmacies. Since 2015, Green Shield has offered a network of preferred pharmacies for specialty medications via HealthForward.
CBC News contacted Canada Life to ask if the insurance company had exclusivity agreements with pharmacies, but a spokesperson did not respond by deadline.
What will be the impact of the co-payment?
“Manulife realized they could get a better deal by just going with one supplier. That’s why they do 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 they should pass the savings on to their insured customers.”
As for the co-pay — which is the standard rate 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 the drug plan. specific insurance for each individual.
If you’re insured through your employer, talk to a human resources employee to understand how this could impact your coverage plan, Tadrous said.
“The co-pay 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 transactions?
Some provinces, including Ontario, have regulations that require a person’s written consent if an insurance contract restricts access to the pharmacy of their choice. But according to the Ontario College of Pharmacists, when it comes to contracts with preferred providers, “consent is given by the (patient) when choosing or registering for benefits.”
The only province in Canada where this type of exclusivity agreement is illegal is Quebec. The province’s Bill 92 prohibits sweetheart deals between pharmacies and insurers.
“We have regulatory bodies that look at the pharmacy profession, and that’s not part of their mandate because … they don’t look at trade agreements,” Tadrous said, adding that he doesn’t There is no regulatory body whose mandate would be to enforce respect for the profession. standards and ensure patients are not left behind.
He said the Health Ministry was more concerned about the drugs it paid for, emphasizing that the federal government did not intervene in the distribution of drugs, but simply in approving access to drugs.
Can I still fill my prescriptions through Bayshore?
Manulife previously had a relationship with Bayshore HealthCare to administer its specialty drug care program.
You may still be able to fill your prescriptions through Bayshore, but this depends on whether your group insurance plan is mandatory or voluntary.
People benefiting from a voluntary group plan will still have the option of obtaining their medications from Bayshore or another pharmacy of their choice. But they will not benefit from special prices, according to Manulife’s announcement. People with a mandatory group plan will have to switch to Loblaw.