The Ontario government is now considering a new regulatory proposal that would significantly change the way patients are able to access community pharmacies. This proposed regulation will give patients the ability to choose which pharmacy they want to use. To facilitate this choice the bill introduces a mandatory shelter exemption. This initiative forms part of a broader examination of exclusivity arrangements between insurance providers and pharmacies, which is undergoing a second public consultation.
The administration is debating two proposals on PPNs. These networks are critical to ensuring that Canadians can continue to access the specialty and other medications that they cannot access through other pharmacy models. PPNs are designed to help insurers manage costs while maintaining quality standards for medication distribution. The Ontario government has discovered that these networks can improve access to costly specialty medications with adequate coverage for the patient.
Additionally, PPNs have been found to save 20 percent more in pharmacy mark-ups. Like for example, the mark-up rate has gone all the way down from 15 percent to 10 percent. Per the Canadian Life and Health Insurance Association, these networks are critical to the insurance industry’s interest. Perhaps most importantly, they highlight the essential role these networks play in keeping healthcare costs under control.
The idea of PPNs has already created controversy among stakeholders. Chris Bonnett, a private health insurance and drug policy consultant, echoed the need for equitable benefits across the board. He argues that this fairness is crucial to the long-term viability of PPNs.
“That means the terms have to ensure a viable market, be clear and transparent, and be monitored so that overall, everyone is better off.” – Chris Bonnett
The chief executive officer of the Ontario Pharmacists Association, Justin Bates, expressed optimism about the potential introduction of “any-willing-provider” legislation. He thinks this would lead to a more inclusive approach to pharmacy provision.
Advocates worry about the use of the word “able” in “any-able-and-willing-provider.” Quinn Grundy, an assistant professor at the University of Toronto, criticized this usage. He insisted that it distracts from the real problem they really should be focusing on.
“I actually don’t think that is the issue at all.” – Quinn Grundy
Grundy went on to say that any pharmacist can fill whatever medications are within their scope of professional practice. The real question is whether they, themselves, can afford to provide these services at the reimbursement rates insurers have established.
“Everyone can get a fridge. These drugs are within any pharmacist’s scope of practice to dispense. I think the question around able is whether they can afford to provide those services at the price that the insurer is willing to reimburse.” – Quinn Grundy
Pharmacist and director of OnPharm-United Mike Nashat proclaimed his disappointment with the use of the term “able.” He cautioned that such language could codify a loophole, allowing unqualified pharmacies to be excluded from networks based on business interests instead of clinical qualifications.
“We’re increasingly concerned that the word ‘able’ will be used as a loophole to justify excluding qualified pharmacies from networks for commercial, not clinical or competency, reasons.” – Mike Nashat
The office of the Minister of Finance has decided to not explain their decision to do consultation in the first place. This consultation is due to close on July 28. The first stage of consultations held last year included 11 stakeholder roundtables and produced 178 separate submissions.
PPNs are supposed to work in the daylight. Lurking is the fear that insurers will create networks that look okay on the surface but do not provide adequate access due to stringent cost-cutting requirements, narrowing pharmacies’ ability to participate. We should be asking some hard questions about the pharmacy landscape, and about transparency and fairness.
Karen Leiva emphasized the importance of PPNs in helping patients receive the medications they need.
“PPNs help to ensure that Canadians who need life-saving medication and other supports can receive them.” – Karen Leiva
Conversations about the future of pharmacy access to Ontario are far from over. Stakeholders across all sectors are being extremely vigilant regarding the effects of any new rule may have. The outcome of this consultation could significantly influence how patients interact with their healthcare providers and the medications they require.
