Prescription drugs on a Montreal pharmacy's shelves. The Ontario government has launched another consultation into whether to restrict exclusivity deals between health insurers and pharmacies.Ryan Remiorz/The Canadian Press
The Ontario government plans to launch its second public consultation in a year on whether to restrict exclusivity deals between pharmacies and insurers after some health advocates and industry voices said these arrangements hurt patient choice and access to medications.
The second round of consultations was announced in the province’s 2025 budget tabled Thursday.
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The continuing consultations have stalled work by the Ontario College of Pharmacists, which first pledged last summer to crack down on these deals, called preferred provider networks (PPNs). Meanwhile, the investigation of a complaint from an Ontario teacher who risked losing access to her medication because of her insurer’s involvement in a closed network has not moved forward.
In the budget, the Ontario government said its first consultation, which began last year, “sparked tremendous interest” from stakeholders – which included insurers, pharmacies and patient advocates – and the second consultation would be to solicit feedback on potential policy options.
One option it cites is to introduce “any-willing-provider” legislation that would “enable any eligible pharmacy to join PPNs.”
That measure would essentially end what are called “closed” PPNs, in which patients can only get medication reimbursed if it comes from specific pharmacies that have deals with their insurance company. An “open” PPN allows more pharmacies to join these networks if they can show they can meet certain quality and pricing standards.
Quebec is currently the only province that bans PPNs.
The networks came into the spotlight in early 2024 after Manulife Financial Corp. and Loblaw Cos. Ltd.-owned pharmacies, such as Shoppers Drug Mart, announced that patients taking certain specialty drugs would have to buy their medication only from Loblaw-owned pharmacies.
The companies cancelled the deal after public outcry but, as The Globe and Mail reported at the time, different kinds of such networks are widespread in the industry.
Access to medication is increasingly being dictated by preferred pharmacy networks
Insurers have argued PPN arrangements can result in reduced premiums for employers, and are used mostly for the small number of people with chronic diseases whose medication can be very expensive.
“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,” the Canadian Life and Health Insurance Association wrote in its submission to Ontario’s first consultation.
The Ontario College of Pharmacists, which is the province’s professional regulator, adopted a position last July saying it was against closed PPNs because of the potential risk to patients’ health.
However, the college has yet to develop a policy around professional expectations and PPNs.
In December, 2024, the college’s board debated a motion to hold any pharmacist who participated in a payor-directed care model – including a PPN – in violation of the college’s ethical principles. The motion did not receive a vote.
High school teacher Amy Miller, pictured in 2024, is waiting on the results of her complaint against the MemberRx pharmacy created to serve Ontario Teachers Insurance Plan members. She objected to switching a drug prescription to the plan.Sarah Palmer/The Globe and Mail
In March, the board voted to defer all decisions related to PPNs until at least June to allow the provincial government to provide clarity on any actions they would take on the issue.
Spokesperson Dave Bourne said Thursday the college welcomed news of the second consultation. He said the college’s board would determine its next steps at its June board meeting based on the direction the government outlines when it launches the consultation.
Meanwhile, throughout the college’s discussion, a complaint was lodged by Amy Miller, a high-school teacher from Waterloo, Ont., has been delayed until the end of May. Ms. Miller takes Humira to treat her ankylosing spondylitis arthritis, a condition characterized by painful inflammation of the spine.
Last summer, after meeting with the college, Ms. Miller filed a complaint against MemberRx - a pharmacy created to exclusively serve members of the Ontario Teachers Insurance Plan (OTIP). Ms. Miller said OTIP’s decision eliminates a patient’s choice on where they can go to fill their prescriptions.
Ms. Miller objected to switching to MemberRx. She lives in a condo building with no way to keep her medication refrigerated when she’s not there to receive delivery. MemberRx offered to arrange a courier drop-off at a local craft store, or to deliver to her place of employment, she said, but the options raise questions around whether retailers having adequate storage for deliveries and privacy concerns for employees who don’t want to disclose medical conditions
She was hoping for a resolution from the college last October – the same month her insurance plan ended coverage for Humira unless she transferred to MemberRx. She has been able to temporarily get access to Humira independently as she waits for the investigation of her complaint to conclude. Last week, she was told it would be pushed back until the end of May.
“When I launched my complaint last summer, I expected decisive action to protect patient rights and pharmacist choice – not endless delays and empty statements," Ms. Miller said in an interview.
“They asked me to step forward publicly, assured me they cared, and then left me in the dust.”