The Ontario government is set to launch a second public consultation aimed at restricting exclusive deals between pharmacies and insurers. The load management initiative is a direct response to overwhelming interest from stakeholders expressed during the first consultation. In addition to this, it seeks to increase competition and patient access to medications.
The Ontario College of Pharmacists (OCP) had set an implementation date of October 2023 to raise the alarm to just 5 prescriptions. During that meeting in December 2024, the OCP board discussed a motion regarding pharmacist involvement in payor-directed models of care. Instead, they pushed these conversations to a later date. It’s great to see such enthusiasm on the part of the college ahead of this initial consultation. It touts its move to assuage worries over preferred provider networks (PPNs).
As an Ontario teacher, member Amy Miller’s experience led her to file a complaint, but the pharmacy in question—MemberRx, which serves only OTIP members—wasn’t her employer. She’s publicly expressed her frustrations with the OCP for what she characterizes as a long mishandled case. Miller counts on Humira to control her ankylosing spondylitis arthritis. Since she filed her complaint last summer, she received extreme delays that she specified.
“Without this specialty PPN model, the cost for many employers to cover specialty drugs could be challenging, which could reduce coverage and limit a patient’s ability to access treatment while inadvertently shifting costs back to provincial drug programs,” said a representative from the Canadian Life and Health Insurance Association. This relatively simple statement has serious implications, particularly because the costs of pathologizing PPNs are unclear.
Indeed, last summer, the OCP pledged to act on PPNs. It has now delayed its decisions on these networks until at least June 2025. The board is expected to decide what to do next in June, depending on the direction of the federal government. In the interim, the feds’ investigation into Miller’s complaint has been pushed back until the end of May, heightening her fears even more.
When I launched my complaint last summer, I expected decisive action to protect patient rights and pharmacist choice – not endless delays and empty statements,” Miller stated. Her disappointment is symptomatic of the increasing frustration of patients who just want affordable access to the medications they need without complicated, pharmacy-insurer contracts involving restrictive partnerships.
Yet, OTIP’s chosen specialty pharmacy vendor, MemberRx, is facing criticism for its business model. The pharmacy provided Miller with various options for receiving her medication. She could select from a courier drop-off at a nearby arts-and-crafts supply store or delivery directly to her design studio. This exclusivity in such arrangements compels inquiry into whether comparable services are even made available to the general public.
Quebec is the only province in Canada that prohibits PPNs unconditionally. Some of those discussions have been about what this means for Ontario—and whether Ontario will be next to follow suit. The forthcoming EXR consultation would take an important step in addressing these inequities. Additionally, it will consider how to make any eligible pharmacy be able to participate in PPNs, increasing competition and improving access to critical medications.
The Ontario government’s 2025 budget announcement included plans for this second round of consultations, signifying a commitment to reevaluating the current landscape of pharmacy-insurer relationships. Stakeholders are looking forward to more guidance as the OCP come to its June meeting to discuss and vote on these matters.
