A closer look into how CPhA's advocacy spurred the Competition Bureau investigation into Express Scripts Canada
In a landmark development for Canadian pharmacy, the Competition Bureau of Canada recently announced that it has launched an investigation into Express Scripts Canada (ESC), following a formal complaint filed by the Canadian Pharmacists Association (CPhA) last year. This marks a significant victory in CPhA’s ongoing efforts to combat anti-competitive practices in the third-party payer space and defend the interests of pharmacists and patients across the country.
How we got here: Advocating for fairness
The investigation is the culmination of over a year of persistent advocacy work that began in November 2023, when ESC announced a mandatory new service fee for pharmacies. The fee, ranging from $25 to $200 per month, was introduced unilaterally and without consultation. For pharmacies, paying this fee was not optional; without it, they would lose the ability to submit claims directly on behalf of patients, disrupting access to immediate insurance coverage at the pharmacy.
Recognizing the profound impact this would have on pharmacy sustainability, patient access, and competition in the sector, CPhA worked with its members and pharmacy partners to swiftly respond. Through a multi-faceted advocacy campaign, CPhA filed a formal abuse of dominance complaint with the Competition Bureau, engaged in direct dialogue with ESC leadership, and mobilized pharmacy professionals through a national MP engagement initiative. These efforts were supported by public awareness campaigns and collaboration with provincial associations and pharmacy groups.
Competition Bureau investigation: A major milestone
On April 11, 2025, the Competition Bureau announced it had secured a federal court order to investigate ESC's business practices.
Based on the Competition Bureau’s filings and statements, the investigation is focused on several key areas of concern related to ESC’s conduct in the pharmacy sector:
- Patient steering: The Bureau is examining whether ESC is engaging in practices that limit patient choice by directing or incentivizing plan members to use specific pharmacies—particularly those affiliated with ESC.
- Margin squeezing and fee structures: The investigation is also focused on whether ESC’s service fees, clawbacks, and audit practices are having the effect of financially squeezing pharmacies in a way that benefits ESC pharmacies.
- Market power and anti-competitive conduct: More broadly, the Bureau is exploring whether ESC’s conduct could amount to an abuse of dominance under the Competition Act, by leveraging its market power in a way that reduces competition and limits pharmacy and patient choice.
ESC, a subsidiary of U.S.-based Cigna Corp., operates as Canada’s largest pharmacy benefit manager (PBM), managing insurance claims and operating mail-order pharmacies. CPhA's complaint argued that ESC’s service fees and audit practices unfairly burden community pharmacies, while simultaneously benefiting ESC's own retail operations.
“This is a significant step forward. PBMs have operated unchecked for far too long, and this investigation marks an important step toward greater accountability,” said Joelle Walker, CPhA's Vice-President of Public and Professional Affairs.
Why this matters: Protecting competition and patient care
Beyond the immediate impact of ESC’s fees, this investigation underscores broader concerns about payer-directed care. CPhA has consistently warned that unchecked PBM influence threatens the viability of community pharmacies, distorts pharmacist-patient relationships, and risks reducing patient choice.
Through its advocacy, CPhA has worked to educate policymakers, stakeholders, and the public about these systemic issues. The Bureau’s investigation represents a recognition of the need for greater transparency and regulatory oversight.
Key process highlights and next steps
- 60–90 day production timeline: ESC has 60–90 days to produce a comprehensive set of documents identified in the court order, issued under section 11 of the Competition Act. This deadline may be extended by mutual agreement between ESC and the Competition Bureau.
- Executive testimony under oath: Certain ESC executives will be examined under oath as part of the investigation. This is notable, as such examinations are not always required at this stage and signal the seriousness of the inquiry.
CPhA will continue to collaborate with the Competition Bureau, providing information and supporting the investigation as it evolves.
“This is proof that advocacy works. Our collective efforts are making a difference,” said Walker. “We will keep pushing for reforms that protect both providers and the patients we serve.”