Canada's largest insurer, Manulife, first set up a deal with independent provider Bayshore in 2014 to provide a specialty drug care program to its group benefit customers.Cole Burston/The Canadian Press
Manulife Financial Corp. has renewed a deal with drug provider Bayshore HealthCare that is part of a plan to open up the insurer’s pharmacy network after it cancelled a controversial exclusive arrangement with Loblaw Cos. Ltd. earlier this year.
Canada’s largest insurer has renegotiated a preferred pharmacy agreement with Bayshore, an independent provider with 300 affiliate pharmacies across Canada that was to be dropped from Manulife’s MFC-T specialty care drug program in early January.
The insurer also retained a contract with Loblaw Cos. L-T to include Shoppers Drug Mart in its specialty care drug program after having to break the exclusive deal with the country’s largest retailer in early February. That deal was cancelled after it sparked competition concerns and a backlash from customers who were already accessing specialty drugs through the Bayshore network.
Specialty care drugs are medications used to treat serious, chronic, and often life-threatening conditions, and are typically distributed through what are known as preferred pharmacy networks, or PPNs. These agreements are routinely set up between insurance companies and one or several groups of pharmacies to help reduce claim costs for expensive specialty drugs.
Manulife spokesperson Emily Vear said in an e-mail to The Globe that in January, the majority of participants in the Manulife Specialty Drug Program accessed their medications through Bayshore.
Now, Ms. Vear says, both Bayshore and Shoppers Drug Mart are providers of the new specialty drug program, which since February had been “completely voluntary.”
“Manulife group benefits members can choose to participate in our specialty care drug program,” Ms. Vear said. “Through this option, members get access to negotiated pricing (which most often results in cost savings), a dedicated nurse case manager, and additional program supports, like help with managing potential side effects, health coaching and medication management. ”
Exclusive deals between insurance companies and pharmacies becoming more prevalent in Canada
Vass Bednar: Manulife reversed its pharmacy deal with Loblaw’s Shoppers Drug Mart – so what?
Manulife first set up a deal with Bayshore in 2014 to provide a specialty drug care program to its group benefit customers.
Then in October, 2022, Manulife added Shoppers Drug Mart to its specialty care drug preferred pharmacy network. Both the Bayshore and Shoppers agreements allowed Manulife customers to pick up prescriptions in-store or through home delivery with either pharmacy provider.
That deal was set to expire earlier this year when Manulife announced it was dropping Bayshore for an exclusive agreement for all specialty medications to be fulfilled by Shoppers Drug Mart and other Loblaw-owned pharmacies as of Jan. 22. But the response to the agreement with Loblaw led the insurer to backtrack on its decision.
The company quickly reversed the exclusive arrangement on Feb. 5, and switched to an open pharmacy provider network for 100 per cent of its specialty care drug plan clients. In the meantime, Manulife’s specialty drug clients could continue to use Bayshore or Shoppers Drug Mart for the benefits of a PPN, such as cost savings. Manulife then began to explore setting up new contracts with a list of undisclosed pharmacy providers.
In an open or voluntary PPN, plan members are given an approved list of pharmacies to access certain specialty drugs. They can still fill a prescription at an out-of-network pharmacy, but it may be more expensive. In a closed or mandatory PPN, insurers restrict plan members to using the approved pharmacies, and they cannot fill their prescriptions elsewhere. Manulife customers can also opt out to use a pharmacy of their choice.
The transition period was cumbersome for certain customers as technology upgrades were required by Manulife’s systems to process specialty care drug claims, particularly when trying to switch prescriptions from Bayshore and Shoppers Drug Mart. Group benefit members were required to call in to a 1-800 number in order to fill their prescriptions outside the network.
As of May. 1, Manulife completed the back-end technology upgrade so that members who are looking to change their pharmacy for their specialty care drugs can do so directly at the pharmacist’s counter.
“As promised earlier this year, the new, automated process means there’s no need for specialty drug care customers to call Manulife before changing pharmacies,” Manulife posted on its company website.