Canadian Pharmacists Association
Canadian Pharmacists Association

Canadian Pharmacists Association calls for regulation of payer-directed care

February 26, 2024 (Ottawa): The Canadian Pharmacists Association (CPhA) today announced a firm stance against payer-directed care. The new position statement results from the increasing trend of private insurers and pharmacy benefit managers (PBMs) directing patient care, ultimately compromising the quality and accessibility of health care for people in Canada.

CPhA’s position underscores the importance of patient choice and access to a full range of medications and treatments from the pharmacy team they choose. Health-care decisions should be made based on individual health needs and the best available evidence, not influenced by payer directives or incentives.

What Canadians are saying

Payer-directed care is already having a widespread and concerning impact across Canada but it’s clear that patients value choice and the trusted relationships they have with their pharmacy teams. According to a recent national survey conducted by Abacus Data:

  • 8% of Canadians (nearly 3 million individuals) report that they have switched pharmacies because it was recommended by their insurance company.
  • 86% of Canadians think they should be able to get prescriptions filled at any licensed pharmacy, regardless of their insurance provider.

Call for regulatory action

CPhA is calling on governments across Canada to restrict payer-directed care and protect the integrity of the patient-pharmacy relationship. Proposed regulations include:  

  • Ensuring patient-centered care by prohibiting PBMs from directing where patients can fill their prescriptions and mandating that medication coverage and dispensing be based on clinical best practices.
  • Restricting the formation of preferred provider networks (PPNs) to allow fair competition among pharmacies and prevent discrimination.
  • Establishing transparent audit practices with clear guidelines to ensure audits are conducted fairly, free from conflicts of interest.

A united stand for patient-centred care

“The growing practice of ‘patient steering’ by private insurers and PBMs is alarming. The choice of pharmacy must remain with the patient, ensuring they can access their medications from any pharmacy without undue influence from payers," said Shawn Bugden, CPhA Chair. "We urge all Canadian governments to take immediate action to protect the rights of patients and ensure the sustainability of quality pharmacy care across the country.”

The Canadian Pharmacists Association is committed to working with all stakeholders and governments to implement these necessary regulations and uphold the highest standards of patient-centred care in Canada.

About the Canadian Pharmacists Association

The Canadian Pharmacists Association (CPhA) is the uniting national voice of pharmacy and the pharmacist profession in Canada. As pharmacists undertake an enhanced role in the delivery of health care services, CPhA ensures that the profession is recognized as a national leader in health care, influencing the policies, programs, budgets and initiatives affecting the profession and the health of Canadians. 

For more information, please contact:

Tyler Gogo
Senior Manager, Communications
Canadian Pharmacists Association