Ontario's planned crackdown on exclusivity deals could go further, pharmacy regulator says

Globe and Mail

2 days ago

The board of Ontario's pharmacy regulator said on Monday the province's proposed new restrictions on exclusivity deals between insurers and pharmacies were a good step, but should go further to protect patient safety.
Ontario recently began a second public consultation on preferred provider (or pharmacy) networks (PPNs), a type of deal between pharmacies and insurers that can restrict where patients get medication.
The consultation proposes two options for restricting the deals: 'any able and willing provider' legislation that would allow any pharmacy to join an insurer's network if they met the necessary criteria; and 'standardized and mandatory exemptions' that would allow any patient to go outside a network if they met conditions set by a regulator. The province leaves it open to whether it could pursue either, both or neither option.
The board of the Ontario College of Pharmacists has been discussing a potential crackdown on PPNs since early last year, even passing a motion expressing 'zero tolerance' for closed networks last July.
The board discussed the latest consultation at its meeting Monday. A briefing document prepared and distributed by college staff ahead of time suggested the province's proposals could be 'strengthened' to meet the regulator's goals of guaranteeing patient choice, continuity of care and access to care.
Ontario regulator condemns exclusive deals between pharmacies, insurance companies
Board chair Doug Brown, who owns and runs a pharmacy in the town of Port Perry, said he acknowledged that there was frustration in the community 'over what is perceived to be the lack of progress on this issue.'
However, he said the consultation – which is run by Ontario's Ministry of Finance – crosses multiple industries and needs to be done carefully. He said any new actions undertaken by the college could be undone depending on how the legislation is eventually drafted, and so it would be prudent for the regulator to wait for now.
'But let me be absolutely clear, the college is prepared to move quickly and decisively once the government has confirmed what it will or won't do to address the clear concerns that remained unresolved,' he said.
Most board members expressed support for the province's proposed options.
Elnora Magboo, one of the board's public members, asked during the meeting whether PPNs could provide greater access to medication because of savings negotiated between the agreement's participants.
Ontario considers rule to limit exclusivity deals between insurers and pharmacies
Insurers have argued PPNs are useful tools to keep costs down. They say the deals allow them to negotiate discounts from pharmacies that they pass on to plan sponsors.
But some of the board's independent pharmacists, who are often kept out of these networks in favour of large chain pharmacies, pushed back on the idea that there are cost savings, and raised other concerns with the deals.
Siva Sivapalan, a community pharmacist in Beamsville, raised a witness the board heard from last July, whose medication was delivered by a network pharmacy to a non-refrigerated area at the back of a craft store.
That witness – a teacher from Waterloo named Amy Miller – lodged a complaint with the network pharmacy last summer. In the months since, she has expressed frustration at the slow pace of the college's investigation and the difficulty in obtaining her medication from her preferred source.
'Every month that passes without a decision makes my access to care more uncertain,' Ms. Miller wrote in a letter sent to the board in May, which she shared with The Globe and Mail. 'Every delay deepens the harm. And every public statement you make about protecting patients becomes more hollow.'
College spokesperson Dave Bourne said the regulator could not share details about Ms. Miller's case, but continues to investigate concerns about PPNs. Speaking generally, he said some complaints are complex and time-consuming to investigate.
'We understand Ms. Miller's frustration with the time being taken to address her complaint, and we empathize with her situation,' he said in an e-mail.