Independent pharmacist Ron Yochim and Amy Miller and Pharmasave Waterloo Wellness Pharmacy in Waterloo on June 10.Sarah Palmer/The Globe and Mail
Ontario teachers with certain chronic conditions are being told that they can only get their medications from their insurance plan’s in-house pharmacy – a move the plan says saves money, but some pharmacists say inappropriately restricts patient choice.
The arrangement from the Ontario Teachers Insurance Plan (OTIP) is an example of patient steering, which has drawn renewed attention since an exclusivity deal between Manulife and Shoppers Drug Mart brought the practice into the spotlight earlier this year.
The Ontario College of Pharmacists, which is the provincial regulator for pharmacies, is set to discuss the OTIP deal at its July 8 board meeting as part of an effort to push back on patient restrictions and what are known as preferred pharmacy networks (PPNs).
The meeting was originally scheduled for June 10, but was delayed because of a controversy involving a board member’s participation in a lawsuit against Shoppers.
OTIP worked with a private company called Cubic Health to set up the in-house pharmacy, called MemberRx, last May. It has a physical location in a Mississauga industrial park from which it mails out medications.
Teachers who get their drug coverage through OTIP can get most of their prescriptions filled at the pharmacy of their choice – unless they have certain chronic conditions that require taking expensive specialty drugs.
Educators who require medications such as Copaxone, used to treat multiple sclerosis, will only have their prescriptions covered by insurance if they are filled by MemberRx. OTIP’s website lists 46 medications that fall in this category.
Amy Miller, a high-school teacher in Waterloo, said she was shocked to receive an e-mail from OTIP last year telling her that she would need to go to MemberRx to fill her prescriptions for Humira to treat her ankylosing spondylitis arthritis.
She said she wants to continue to work with her pharmacist, Ron Yochim, at the Pharmasave Waterloo Wellness Pharmacy.
Mr. Yochim, who will attend the board meeting in July with Ms. Miller, says patient steering is a growing problem within Canada that is being imposed upon people under the guise of cost savings.
“While there may be cost savings associated with the buying power of specialty pharmacies, it raises concerns about anti-competitive practices if only certain pharmacies are permitted to dispense specific medications to patients,” Mr. Yochim said.
In addition to her concerns about restricting her choices, she said she’s also concerned that MemberRx told her it would have to mail out her prescriptions in cooler boxes that she would have to pick up at a courier drop-off in a local craft store.
“So I’ll just get these beads and yarn and my $2,000 worth of drugs?” Ms. Miller said. “It doesn’t even make sense to me.”
OTIP said it set up the in-house pharmacy as a way to save plan members money, with all proceeds generated by the plan directed back to the plan’s sponsors.
“Lower costs mean the benefit plans can continue to provide the best coverage, at the best value, for the medications their plan members need,” Patricia Wilkinson-Bizjak, OTIP’s vice-president of corporate affairs and communications, said in an e-mail.
Ms. Wilkinson-Bizjak declined to provide any comment on the Ontario College of Pharmacists’ plan to hear from Ms. Miller, or on concerns that this model could reduce patient choice.
Marc-André Gagnon, a professor at Carleton University who studies pharmaceutical policy, said as more PPNs emerge, he is seeing more plan sponsors imposing online pharmacies on their members – particularly when it comes to specialty-care drugs. But it is still rare for private plans to create their own in-house pharmacies.
He said that on the plus side, the in-house pharmacies may be able to focus on service because they would receive predictable sales volumes. But “the con is, you end up with the same logic of steering patients to specific pharmacies.”
As of April 4, OTIP no longer approved members to use their pharmacy of choice for specialty-care drugs. In an e-mail memo sent to plan members, teachers were notified that if they choose to continue to use a pharmacy other than MemberRx, they are responsible to pay the cost of the drugs out of pocket.
Ms. Miller, who first spoke publicly on the issue to CTV Kitchener, was able to extend the OTIP deadline until September as her local pharmacy had already ordered several boxes of her prescription, Humira.
It was a small win, she said, but only buys her limited time before she will be forced to move over to MemberRx. During that time, Ms. Miller has sent e-mails to her union, the Ontario English Catholic Teachers’ Association (OECTA), in hopes that she can get answers to why the change was made and if OTIP will reconsider its decision. She said OECTA, which along with the other three teachers’ unions in the province runs the OTIP, has not yet responded to her e-mails.
OECTA spokesperson Michelle Despault directed all questions asked by The Globe and Mail to OTIP. Ms. Despault did not respond to a follow-up e-mail on why OECTA had not responded to concerns from one of its members.
Ms. Miller is concerned that what she is going through with her drug plan is part of a larger trend in Canada to adopt patient-steering tactics used by health care companies in the United States.
“I think it’s a very slippery slope to the next thing, which is gonna be ‘You have to go see this doctor, you have to go see this rheumatologist,’ which sounds very American to me.”