CPhA calls for regulation of insurer practices straining pharmacies and threatening patient choice
National survey of more than 1,100 pharmacists shows administrative red tape from insurers is disrupting care and limiting patient choice
September 4, 2025 (Ottawa): The Canadian Pharmacists Association (CPhA) is calling on governments to take action to regulate the practices of pharmacy benefit managers (PBMs) and insurers that are placing unnecessary strain on pharmacies and undermining patients’ ability to choose where they receive care. To support its call, CPhA is releasing template legislation designed to improve transparency, safeguard patient choice, and reduce administrative burdens for pharmacists.
“Pharmacies play a critical role in patient care, yet they are increasingly weighed down by administrative requirements that pull them away from their primary responsibilities,” said Annette Robinson, Chair of the Canadian Pharmacists Association. “Our proposed legislation offers a blueprint for policymakers to ensure pharmacists can focus on patients, not paperwork.”
Survey data reveals heavy administrative burden on pharmacies
Findings from a national pharmacist survey illustrate the significant impact of insurer practices:
- Over a third (36%) of pharmacists face multiple patient conflicts daily due to managing third-party payer claims.
- 75% of pharmacists spend 5 hours or more per week managing third-party payer claims, with nearly 20% dedicating over 15 hours weekly.
- 81% of pharmacies report moderate to significant disruptions to workflow and patient care due to these administrative tasks.
- While 71% of pharmacies do not participate in preferred provider networks (PPNs), 75% report being required by third-party payers to direct patients to other pharmacies in these networks.
While pharmacists report rising administrative strain, Canadians are also experiencing the effects of insurer practices — and overwhelmingly support the right to choose their pharmacy:
- 8% of Canadians — nearly 3 million people — report having switched pharmacies because it was recommended by their insurance company.
- 86% of Canadians believe they should be able to fill their prescriptions at any licensed pharmacy, regardless of their insurance provider.
“These findings make clear that insurer-driven red tape is not a minor inconvenience,” Robinson added. “Our data shows the urgency: when pharmacists spend hours on paperwork instead of with patients, and Canadians are being steered away from their pharmacy of choice, it’s clear intervention is required — and that’s where our draft legislation comes in.”
Framework to regulate insurer and PBM practices
The template legislation proposes concrete measures to address insurer and PBM practices that negatively impact patients and pharmacies, including:
- Protecting patient choice by preventing insurers and PBMs from requiring patients to use specific pharmacies.
- Ensuring fair, unbiased audits by preventing conflicts of interest, limiting audit frequency and timing, requiring advance notice, restricting recoupment practices, and establishing clear appeal processes.
- Banning administrative fees charged by PBMs for electronic claims submissions, adjustments, or related transactions.
The message from Canada’s pharmacists is clear: insurer practices must not stand between patients and the care they deserve. Protecting patient choice and reducing the unnecessary administrative burdens will ensure that pharmacists can focus on what matters most—providing timely, patient-centred care.
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
tgogo@pharmacists.ca
613-293-7223