Ontario pharmacists question OTIP's MemberRx pharmacy for patient steering and lack of financial transparency
Justin Bates, CEO of the Ontario Pharmacists Association (OPA), raised concerns about the Ontario Teachers Insurance Plan’s (OTIP) in-house pharmacy, MemberRx.
He highlighted issues of patient steering and financial transparency, as reported by The Globe and Mail.
OTIP, with help from Cubic Health, established MemberRx as the exclusive supplier of high-cost drugs for its members. The Ontario College of Pharmacists (OCP) will discuss MemberRx in an upcoming board meeting, where a teacher will contest the transfer of her prescriptions to the pharmacy.
Bates criticized the restrictive nature of MemberRx, stating it limits patients' choices regarding their healthcare providers. He emphasised that patients should choose their pharmacists based on comfort and expertise.
“We believe it’s not in the patient’s best interests,” said Bates.
OTIP and Cubic Health defended the MemberRx model, claiming it operates with “no profit motive,” returning funds to plan sponsors for cost savings. Cubic budgets zero earnings before interest, taxes, depreciation, and amortization (EBITDA) and argues the restrictions ensure necessary patient volumes.
However, Bates and other pharmacists questioned the financial transparency and benefits of the model. Cubic Health, which has a pre-authorization contract with OTIP, now holds a stake in MemberRx and fills three of its five board seats.
“I don’t think there’s transparency there in that financial flow of money,” said Bates.
Cubic Health president Mike Sullivan countered that MemberRx’s zero EBITDA model eliminates “profit-driven interests,” focusing solely on member health optimization. He described the model as innovative and faced opposition from “traditional for-profit pharmacies.”
MemberRx's plan-sponsor pharmacy model is rare in Canada, with another similar pharmacy in Alberta not restricting its members. Jessica Adams, OTIP’s director of communications, expressed confidence in the partnership with Cubic Health.
Preferred provider networks (PPNs), like the OTIP-MemberRx arrangement, have sparked intense debate in the pharmacy profession. Independent pharmacists fear these deals favour large corporations, sidelining smaller competitors.
The OCP voted to seek restrictions on PPNs, and other provinces, including Alberta and Manitoba, are exploring their options. Quebec remains the only province legally prohibiting such deals.
Concerns over PPNs tie into broader debates on how corporate decisions impact healthcare services provided by pharmacists.
A survey of 4,289 pharmacy professionals revealed that 70 percent felt pressured to speed up activities or increase their workload to meet revenue targets.
This pressure was notably higher at large corporate operations, with pharmacists at Loblaw, Rexall, Wal-Mart, and Shoppers (also owned by Loblaw) experiencing it at rates of 80 percent or more. In contrast, only 18 percent of respondents at independently owned pharmacies reported similar concerns.
The Ontario College of Pharmacists' (OCP) board plans to vote on a position statement that expresses “zero tolerance” for business practices interfering with patient health care. They will also explore various solutions to address the issue.
Additionally, the board will vote on appointing a special committee to manage a governance crisis caused by a director being pressured to resign from the board due to their participation in a lawsuit against Shoppers Drug Mart.
