What do you think? Ontario government wants opinions around preferred provider networks

Should Ontario have new regulations or legislation around preferred provider networks (PPNs)?That’s the question the Ministry of Finance is asking consumers, insurers, pharmacy operators, employers and other stakeholders over a 60-day public consultation. The time for input began on Aug. 23 and will end on Oct. 22. “For insurers and employers designing employee benefits plans, PPNs may be seen as a tool to contain rising costs for specialty medicine . . .. However, these potential savings may come at the cost of consumer choice and the potential for more competition in the pharmacy sector,” the government said in an overview of PPNs. Right now, there are no regulations around PPNs in Ontario.Read: Payer-directed care and closed PPNs ‘pose potential risk of harm’: OCPThe government is discussing both open PPNs—where an insurer sets terms and any pharmacy that is willing to meet them can join—and closed PPNs, which are more opaque deals with specific pharmacies or pharmacy groups. It also encompasses both mandatory PPNs, which means patients won’t be covered at pharmacies that aren’t covered by the PPN, and voluntary ones, where their medicines are covered outside of the network, but they may require higher co-pays. The government overview said PPNs can affect cost, accessibility, consumer choice, quality of care and accessibility, especially around specialty medications, which is where they are most often used. It offered up three potential policy options: keeping things as they are; creating “any willing provider” legislation, which would mandate PPNs be open, voluntary, or both; and having the Ontario College of Pharmacists (OCP) restrict closed PPNs through its power over pharmacists and pharmacies. The OCP came out against closed PPNs in a position statement in July. “Closed PPNs (and other payer-directed care models) pose potential risk of harm to patients, contravene established ethical principles guiding the profession and conflict with standards of quality patient care,” it said. “As Ontario’s pharmacy regulator, OCP has zero tolerance for any payment or reimbursement models involving pharmacies and pharmacy professionals that put patients at risk, disregard patient autonomy, or that get in the way of a pharmacy professional’s duty to put patient interests first.” Comments should be sent to FIPUConsultations@ontario.ca, and more details are available on the ministry’s website. Read: Alarming growth in ‘patient steering’: CPhA calls on Canada to regulate PPN arrangements

What do you think? Ontario government wants opinions around preferred provider networks

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