Introduction and Summary:
Ontario’s pharmacists are noticing a troubling trend – private health insurers are entering into exclusive relationships with corporate pharmacy groups that restrict a patient’s freedom to choose their pharmacy provider. Patients are neither consulted nor asked about such plan changes and typically, independent pharmacies are not invited to participate.
Some patients, especially those in rural communities, are forced to travel long distances to obtain their medications. Some must break the trusted bond established with their pharmacist over many years.
Representing more than 10,000 pharmacy professionals operating in communities, hospitals, long-term care homes, family health teams and other settings across Ontario, the Ontario Pharmacists Association (OPA) believes that health insurers, manufacturers and wholesalers should not restrict a patient’s freedom to choose a pharmacy if that pharmacy is willing to adhere to the terms and conditions established through an insurance plan. This supports the Ontario government’s strategy – Patients First: Action Plan for Health Care designed to deliver on one clear health promise – to put people and patients first by improving their health care experience and their health outcomes.
This would be achieved through “Any Willing Provider” legislation that levels the playing field, as all pharmacies would have an opportunity to take part in their patient’s drug plan. It should be noted this would not mean a ban on Preferred Provider Networks (PPN).
Legislation in this regard would be good for patients, pharmacists and the healthcare system at no cost to government. With the introduction of OHIP+, it also makes sense to ensure all parents can obtain services at the same pharmacy as their children.
OPA Position Statement:
The Ontario Pharmacists Association (OPA) recommends that the Legislative Assembly of Ontario pass legislation to allow any pharmacy to join a Preferred Provider Network (PPN) created by private health insurance payors if they can provide the benefit at the same price (drug price + mark up + dispensing fee) at which the insurer has agreed to pay and agree to terms that relate to quality outcomes to ensure patients retain their freedom to choose their pharmacy.
To support OPA’s advocacy to the government on Any Willing Provider legislation, OPA retained Aly Haji of Ricketts Harris LLP to assist with the legal strategy associated with advocating against closed PPNs. The following reports were commissioned from leading experts as part of OPA’s study of the impact of PPNs and have contributed to OPA’s overall position on closed PPNs.
