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Manulife-Loblaw deal to deliver specialty drugs sparks access, competition concerns

In a move that has sparked concerns among pharmacare policy experts, Manulife Financial Corp. recently announced changes to its drug coverage that will exclusively apply at Loblaw Cos. Ltd. pharmacies. This shift, affecting around 260 medications under Manulife's Specialty Drug Care program, has raised questions about competition and patient access to vital medications.

The affected drugs, categorized as specialty drugs, are crucial for treating complex, chronic, or life-threatening conditions like rheumatoid arthritis, Crohn’s disease, multiple sclerosis, pulmonary arterial hypertension, cancer, osteoporosis, and hepatitis C. The new arrangement, effective from January 22, designates Loblaw-owned pharmacies, primarily Shoppers Drug Mart, as the preferred providers for these specialized medications.

Manulife's decision to opt for a single service provider has drawn attention from experts like Steve Morgan, a health policy professor at the University of British Columbia. Morgan points out that such exclusive arrangements, known as preferred pharmacy network agreements, are common in the U.S. and are gaining traction in Canada. He sees this as a way for insurers to exert market power in the pharmacy sector.

Concerns are particularly raised for smaller pharmacies, as these exclusive deals may lead to a squeeze on their business. Marc-André Gagnon, a professor at Carleton University focusing on pharmaceutical policy, emphasizes the potential negative impact on patient access, especially in rural or remote areas where pharmacy options are limited.

Gagnon also sheds light on the financial dynamics of specialty drugs, which often involve significant markups. He warns about the opacity of agreements between drug manufacturers, patient support programs, insurers, and pharmacies, leading to what he describes as "shady deals" that lack transparency.

Manulife, however, argues that the deal with Loblaw will offer more options for its members, allowing them to receive specialty medications either by picking them up at Loblaw-owned stores or having them delivered to their homes. The company emphasizes providing greater choice for health and wellness services through this partnership.

While some experts like Aidan Hollis from the University of Calgary view Manulife's strategy as a means to drive down costs through competition, others express concerns about the potential impact on smaller pharmacies and the overall transparency of the system.

The debate also touches on the role of competition in the pharmaceutical market. University of Toronto pharmaceutical economics professor Paul Grootendorst sees Manulife's strategy as a form of healthy competition but acknowledges the pushback from those advocating for free choice of pharmacy, leading to legislative differences, as seen in Quebec's prohibition of preferred pharmacy network arrangements.

As the situation unfolds, the industry continues to grapple with balancing the goals of cost reduction, accessibility, and fair competition within the complex landscape of specialty drug coverage in Canada.