On Friday, the province announced a 60-day public comment period asking insurance companies, pharmacy operators, consumers and employers to weigh in on the role of preferred pharmacy networks in the group benefits insurance sector
Prescription drugs are seen on shelves at a pharmacy in Montreal on March 11, 2021. The Ontario government said in a consultation paper released Friday that it is considering 'whether policy intervention is needed or appropriate' in relation to preferred provider networks in the province.
The private health insurance industry has been expanding its use of PPNs over the past decade. PPNs are complex agreements that can vary between insurance companies. Insurance companies say these exclusive deals can deliver savings on the premiums group benefits plan members pay for specialized drug care, because the pharmacies are able to supply in bulk. In turn, it can reduce co-pays for consumers or make the continued coverage of these pricier drugs more feasible for employers. However, the paper said that more information is needed to determine whether this is happening.
Patient groups have been advocating for an end to PPNs that they say can limit access to drugs. Independent pharmacists say such deals unfairly lock out thousands of small businesses across the country because they do not have the clout to strike the same kinds of deals with insurers that larger chains are able to negotiate.
If the government does not choose to maintain the status quo, it will consider whether new policies could be introduced, such as an “any willing provider” framework that could require insurers to make participation in their PPN arrangements open to any pharmacies willing to adhere to their terms.
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