'Less choice for Canadians': Manulife-Loblaw deal raises access, competition concerns

Insurance company Manulife has announced big changes in how it covers certain prescription drugs, with roughly 260 medications now only available for coverage if dispensed at a Loblaw-owned pharmacy.

The new arrangement is known as a preferred pharmacy network arrangement: insurers get a better price on medication in exchange for giving pharmacies exclusive rights to dispense it. This agreement includes medication used to treat complex, chronic or life-threatening conditions such as rheumatoid arthritis, Crohn's, multiple sclerosis, hypertension, cancer and hepatitis C.

For independent pharmacists like Mohammad Masood, it signals another shift away from personalized patient care

"For every medication, they can come here," he said. “But for their oncology or arthritis medication, they have to go to a completely different pharmacy and pharmacist. They may be well trained, but they don't have the holistic picture that we have.”

Masood says many of the 260 medication included in this agreement were already restricted in terms of where they could be filled under coverage, but he says independent pharmacies should have been brought into this process.

"If they wanted to improve competition and come down on price they could have come to independent pharmacists and said this is the price we are willing to pay for a drug. 'If you want to dispense it, dispense it,'" he suggests. "'If you want to leave it. Leave it.'"

Manulife says the deal will provide "more options" for patients with prescriptions available for pick up in store or by delivery

"At this time, to evolve our program, it's appropriate to select a single service provider to move the program forward for the benefit of our customers and their employees," said Doug Bryce, Manulife vice-president of product and platforms.

Loblaw, which owns Shoppers Drug Mart, insists the patient experience "will remain unchanged, if not better."

"They can pick up their prescriptions from one of more than 1,800 pharmacies across our network, or have them shipped directly to their home," said spokeswoman Catherine Thomas.

But others, aren’t as sure.

"The consolidation of the pharmacy business is less choice for Canadians," says Stephen Morgan, a professor of health policy at the University of British Columbia. "It will start looking a lot like our telecom industry where we have less choice and pay high prices. You don't want to see that in your pharmaceutical sector."

In Quebec, rules prevent preferred pharmacy networks so coverage in that province will remain unchanged. But for those in small and rural communities in other parts of the country, it might mean driving longer distances to a Loblaw-owned pharmacy.

"It's not ideal from a patient care perspective," said Justin Bates, CEO of the Ontario Pharmacists Association. "It introduces an uneven playing field because largely independent pharmacies aren’t able to participate."

At Mohammad Masood’s Scarborough, Ont. pharmacy most patients are long time customers. Masood says he knows their history and understands their medical needs. He thinks deals like the partnership between Manulife and Loblaw doesn’t take that into account.

"There is a discontinuity," he says. "We have a circle of care here in which the patient is taken care of."