Telus Health limits prescription reimbursements to virtual pharmacy

Employees must use the company's virtual pharmacy for certain drug reimbursements, sparking concerns

Telus Health limits prescription reimbursements to virtual pharmacy

Telus Health, an offshoot of Telus Communications, has mandated that its employees will only receive reimbursement for certain prescription drugs if these are obtained through the company's virtual pharmacy, as revealed by CBC News.

This policy, effective from March 1, designates Telus Health's virtual pharmacy as the “preferred provider” for its group prescription drug plan, highlighting the virtual pharmacy's “lower markups and dispensing fees than the industry average.”

This move has sparked frustration among Telus Health employees, three of whom spoke to CBC News and shared screenshots showing policy details. They voiced concerns over the restriction of their ability to choose where to fill their prescriptions unless they are willing to pay out of pocket.

Additionally, worries were raised about the potential for missed deliveries of critical medications through the virtual pharmacy system. This problem could disproportionately affect those in rural areas.

The policy explicitly targets two categories of medications: maintenance drugs, which are required on a recurring basis to manage conditions like asthma or diabetes, and specialty drugs, which are used to treat complex or life-threatening diseases such as cancer or Crohn's Disease.

Telus Health is self-insured, meaning both the company and its employees contribute to a benefits package, with the company covering the costs of claims. Enrollment in the plan is described as optional.

A spokesperson from Desjardins, which processes claims for Telus Health, stated that their role is limited to claims processing. At the same time, Telus Health distributes some benefits through its virtual pharmacy.

The issue of steering patients to specific pharmacies, especially those owned by their employer or insurer, is highlighted as a growing trend. The Canadian Pharmacists Association (CPhA) has stated it opposes such practices, advocating for regulations to ensure competitive fairness among pharmacies.

Despite these concerns, Telus Health claims its policy aligns with standard practices in the pharmacy sector, arguing it offers “a range of advantages, including enhanced coinsurance and reduced dispensing fees.”

Critics argue that this policy is part of a broader strategy by employers to control drug costs, potentially prioritizing cost-saving measures over patient care and choice. The restriction on where employees can fill their prescriptions is seen as limiting, particularly for those who prefer to use pharmacies close to their healthcare providers.

This development reflects the growing influence and market dominance of pharmacy benefits managers (PBMs) and preferred pharmacy networks (PPNs) in Canada. This trend has been more pronounced and scrutinized in the US.

Concerns revolve around the erosion of competition in the pharmacy sector and the potential creation of ‘pharmacy deserts,’ areas with limited access to independent pharmacies driven by the growing power of conglomerates in the pharmaceutical industry.