By Janice Harvey, RPh, CDE<\/p>\n
A little over three years ago, I opened our pharmacy with the idealistic goal of being able to provide an exceptional, personalized, clinical pharmacy experience within a community pharmacy setting. I am so proud of what we have achieved! We have a great team of pharmacists and staff, and we provide services that we simply could not offer in a high-volume retail pharmacy environment.<\/p>\n
There are many challenges in operating an independent pharmacy, some of which affect our very survival. A recent Manulife\u2013Loblaw deal made headlines across the country, as it could threaten the sustainability of independent and rural pharmacies. Some see it as a major step towards a more American-style healthcare system, where there are only a few very large pharmacy chains, insurance companies directing patients to those pharmacies, and pharmacy benefit managers (PBMs) processing the prescription claims.<\/p>\n
After significant backlash, the deal has been cancelled as of February 5. Hooray! But let\u2019s look at the deal and why it had us (and other pharmacies) so concerned.<\/p>\n
Benefit plans offered by Manulife include a \u201cSpecialty Drug Care\u201d program<\/strong>, which allows for coverage of specific specialty medications that are used to treat complex conditions such as Crohn\u2019s disease, rheumatoid arthritis, and multiple sclerosis. (1<\/a>) According to Manulife, fewer than 1% of their benefit plan members receive these medications. (2<\/a>) It\u2019s critical that people have access to these specialty medications, but also that they can choose how they receive them. And therein lies the issue.<\/p>\n Manulife had joined forces with Loblaw Companies Ltd. and Shoppers Drug Mart Inc. (Loblaw owns Shoppers). These pharmacies are what are then referred to as a \u201cpreferred provider network\u201d (PPN)<\/strong>. In these types of agreements, the insurer would agree to pay for the drugs only<\/u> if they were picked up from a one of the PPN pharmacies. Individuals who did not live near a Shoppers\/Loblaw pharmacy could have the medications shipped to their home. As these medications are usually refrigerated, people would need to be home to receive them.<\/p>\n PPNs are not new to Canada. Manulife already had a PPN agreement with Bayshore HealthCare, which had very few retail locations, so patients were used to having their specialty medications shipped out and expressed a desire to be able to pick them up from a pharmacy. Manulife felt that this deal would give their patients many options, as they could choose from the roughly 1,800 Shoppers\/Loblaw locations across Canada. However, we could just as easily argue that there are many more other pharmacies across Canada, and telling patients that they cannot get their medications from their usual pharmacy actually limits patient choice. This is absolutely the case in Labrador, where there are no Shoppers\/Loblaw pharmacies, yet patients have previously been able to go to their local, independent pharmacies for these medications. (3<\/a>) And in Quebec, PPNs are not legal, so patients there would not have been subject to this agreement.<\/p>\n In a CTV news report on January 30, Stephen Morgan, a UBC professor of health policy, is quoted as saying, \u201cThe consolidation of the pharmacy business means less choice for Canadians. It will start looking a lot like our telecom industry where we have less choice and pay high prices. You don\u2019t want to see that in your pharmaceutical sector.\u201d (4<\/a>) That same day, Don Davies, MP Vancouver-Kingsway and NDP Health Critic, along with Brian Masse, MP Windsor West and NDP Innovation, Science and Economic Development Critic, requested that the Competition Bureau of Canada conduct an investigation into the Manulife\u2013Loblaw arrangement and determine whether PPNs constitute an anti-competitive practice under Canada\u2019s competition laws. (5<\/a>) As a pharmacy, the loss of one medication out of many isn\u2019t a concern, but if many prescriptions are lost to the PPN pharmacies, it can have a big effect on the bottom line.<\/p>\n Looking beyond the competition concerns, many patients have been frustrated by not being able to choose their own pharmacy. Some companies have forced employees to switch to Express Scripts, Canada\u2019s largest mail-order pharmacy. As Express Scripts is both a PPN and a pharmacy benefits manager, it is able to cut costs by reducing dispensing fees. Unfortunately, it can also result in reduced services and safety concerns for patients.<\/p>\n In a CBC investigation, Jamie Mueller, a Labatt employee, talked about missing prescriptions, medication errors, deliveries left outside for hours, and the challenges of trying to resolve problems over the phone. Canadian Pacific Railway employees, many of whom work away from home on production crews, found it difficult to be home to receive deliveries. Other companies such as Home Depot and Canada Post have allowed their employees to use the service on a voluntary basis, recognizing that, \u201c\u2026 people are attached to their pharmacy and pharmacist.\u201d (6<\/a>)<\/p>\n There are many reasons for people to be loyal to their pharmacy. For us, we value the relationships we build with our patients. We know them, their families, and what\u2019s happening in their lives. When they get a new diagnosis or have a health concern, our patients can feel comfortable talking with us and trust that we are looking out for them. It takes time to develop these relationships \u2014 we have known some of our patients for decades \u2014 and the new pharmacist doesn\u2019t have this history. It\u2019s also unlikely that the new PPN pharmacy will know our patient\u2019s medical history or have access to their health records and lab results, which help to guide our decisions about drug interactions and appropriate treatment. When medication changes need to be made, we can act on them right away. PPN pharmacies simply cannot match the level of service and support that we provide.<\/p>\n As Manulife found out this past week, Canadians feel strongly about changes to the healthcare system, especially when those changes affect their ability to make their own choices about their healthcare needs. We\u2019re not na\u00efve. We know that PPNs and PBMs aren\u2019t going away, that the cost of healthcare will continue to rise, and that insurers will continue to try to cut costs to keep more profits for shareholders. But for now, we are happy that Manulife listened to patients\u2019 concerns and will allow patients to fill ALL of their prescriptions at their pharmacy of choice. (7<\/a>)<\/p>\n We love what we do. Thank you for choosing us as your pharmacy.<\/p>\n <\/p>\n References<\/u><\/p>\n The recent Manulife-Loblaw deal made headlines, as it raised questions about patient choice for accessing specialty medications, as well as the future of independent pharmacies in Canada.<\/p>\n","protected":false},"author":1,"featured_media":2479,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"default","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[20,2],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/posts\/2478"}],"collection":[{"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/comments?post=2478"}],"version-history":[{"count":3,"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/posts\/2478\/revisions"}],"predecessor-version":[{"id":2482,"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/posts\/2478\/revisions\/2482"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/media\/2479"}],"wp:attachment":[{"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/media?parent=2478"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/categories?post=2478"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineshoppecourtenay.ca\/wp-json\/wp\/v2\/tags?post=2478"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}PPNs take away patient choice<\/h4>\n
PPNs limit competition<\/h4>\n
PPNs compromise patient care<\/h4>\n
\u201cYour health. Our priority.\u201d<\/h4>\n
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