The Ontario College of Pharmacists (OCP) is deliberating a motion that could impose penalties on pharmacies forming exclusive agreements with insurance companies, restricting patient access to medications. This proposal, introduced at the OCP's latest meeting in December, mandates that accredited individuals or entities must terminate such agreements within a year. A legal review is currently underway, with the board set to deliberate on March 24. Meanwhile, the Ontario government evaluates public feedback on whether policy interventions are necessary concerning Preferred Provider Networks (PPNs).
The OCP's initiative responds to growing concerns over PPNs, which gained significant attention following an exclusive deal between Manulife, Canada's largest insurer, and Loblaw, the country's foremost grocery and pharmacy retailer. The college released a position statement on PPNs and similar payer-directed care models last summer, aiming to clarify its stance and guide future actions.
Michael Nashat commented on the complexities surrounding such motions, emphasizing the independent nature of the accreditation committee:
“The college council can’t direct the accreditation committee to do something, because the accreditation committee by statute is an independent committee,” – Michael Nashat
This motion aligns with the Ontario Pharmacists Association's (OPA) efforts to curtail payer-directed care through legislative changes and ethical enforcement. Justin Bates, OPA's CEO, expressed support for the motion:
“The spirit of the motion is what we have been advocating for,” – Justin Bates
The OCP's policy framework already includes guidelines delineating acceptable pharmacy conduct, such as provisions related to loyalty points. Nashat highlighted how these policies inform the behavior of accredited pharmacies:
“It gives you clear examples of when certain behaviour is allowed, and when it’s not allowed,” – Michael Nashat
In recent years, the OCP disciplined pharmacists for ethical violations, notably a senior director at Innomar in 2023. These actions underscore the college's commitment to maintaining professional standards within the industry.
Todd Leach from the OCP noted ongoing efforts to develop policy solutions addressing concerns about payer-directed models:
“Staff are also continuing to work on other policy options to address the Board’s concerns related to payer directed models and PPNs and an update on that work will also be discussed at the Board meeting,” – Todd Leach
Despite these developments, some stakeholders remain reticent. Specialty-care pharmacies such as Express Scripts Canada and Innomar Strategies declined to comment on the OCP motion. BioScript Solutions, involved in a PPN arrangement with Sun Life, did not respond to requests for comment. Similarly, the Canadian Life and Health Insurance Association (CLHIA) chose not to comment.
The motion seeks to establish a definitive direction for the college regarding PPNs. This move comes amid heightened scrutiny of exclusive pharmacy-insurer deals that potentially limit patient choice and access to medications. Aly Haji emphasized the importance of effective implementation:
“It just needs to be operationalized properly,” – Aly Haji
