Province reopens review of insurer-pharmacy deals while regulator holds off on decision
Ontario will launch a second public consultation on exclusivity deals between pharmacies and insurers, known as preferred provider networks (PPNs), as announced in the province’s 2025 budget.
According to The Globe and Mail, this comes less than a year after the first consultation, which, according to the government, “sparked tremendous interest” from insurers, pharmacies and patient advocates.
This second round aims to collect feedback on potential policy directions. One proposal includes introducing “any-willing-provider” legislation that would “enable any eligible pharmacy to join PPNs.”
That policy would end closed PPNs, which limit drug reimbursement to patients using select pharmacies contracted by their insurance providers.
An open model would allow more pharmacies to join if they meet pricing and quality standards.
Ontario’s renewed consultation has stalled efforts by the Ontario College of Pharmacists (OCP) to regulate PPNs. The college first declared its opposition to closed PPNs last July, citing patient safety concerns.
However, it has not introduced any policy outlining expectations for pharmacists involved in PPNs.
In December 2024, the OCP board debated a motion that would hold pharmacists who participate in payor-directed care models, including PPNs, in breach of ethical principles.
The board did not vote on the motion.
In March, it voted to defer all decisions regarding PPNs until at least June, allowing time for the government to clarify its position.
College spokesperson Dave Bourne said on Thursday that the regulator welcomed the launch of the new consultation.
He confirmed that the board would determine next steps during its June meeting after the government sets out its direction.
The discussion around PPNs intensified in early 2024, when Manulife Financial Corp. and Loblaw Cos. Ltd.-owned pharmacies, including Shoppers Drug Mart, implemented a PPN model requiring patients prescribed certain specialty drugs to use only Loblaw-owned pharmacies.
The companies withdrew the arrangement following public backlash.
The Globe and Mail reported at the time that such arrangements remain widespread.
Insurers have defended PPNs, saying they reduce employer premiums and focus on a small group of patients who require high-cost medications for chronic conditions.
In its submission to Ontario’s first consultation, the Canadian Life and Health Insurance Association wrote: “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.”
Ontario is considering options as Quebec remains the only province to ban PPNs.
Amid the regulatory delays, the OCP has also not advanced an individual complaint tied to these networks.
Amy Miller, a Waterloo high-school teacher, filed a complaint last summer after her insurer, the Ontario Teachers Insurance Plan (OTIP), required her to fill prescriptions at MemberRx—a pharmacy created solely to serve OTIP members.
Miller, who takes Humira to treat ankylosing spondylitis arthritis, opposed the switch, citing issues with drug storage.
She lives in a condo without secure refrigeration for deliveries and said MemberRx offered drop-offs at a local craft store or her workplace.
Miller raised concerns over whether those locations could ensure safe storage and protect employee privacy.
She said she expected a resolution last October—the same month her coverage for Humira ended unless she moved to MemberRx.
Since then, she has obtained the drug independently while awaiting a decision.
Last week, the college informed her that the investigation would be postponed 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,” Miller said in an interview.
He added that officials had asked him to speak out publicly and assured him they cared, but then “left me in the dust.”
