Manulife is steering Wegovy and Mounjaro patients to Shoppers pharmacies

Manulife Financial Group MFC-T is steering patients who take the popular diabetes and weight-loss drugs Wegovy and Mounjaro to Shoppers Drug Mart to fill prescriptions, just a year after cancelling a similar “preferred provider” arrangement that triggered patient and political backlash.

The Globe and Mail has spoken to pharmacists and patients who say Manulife has rejected claims on GLP-1 drugs until patients speak to a Shoppers Drug Mart representative who encourages them to fill their prescriptions at pharmacies owned by grocery giant Loblaw Cos. Ltd. L-T In some cases the patients felt they had no choice but to do so if they wanted Manulife to cover the drugs, or else they faced a lengthy process to continue using a non-Shoppers pharmacy.

Khalid Bhatti, director of pharmacy and diabetes education at Durham Care Clinic and Pharmacy in Oshawa, Ont., said in the last two weeks his pharmacy has seen about 10 patients with Manulife coverage who have been asked to switch to Shoppers. “It’s definitely impacting patient access to care,” he said.

Stephen Sorial, who runs an independent pharmacy in Toronto, said he recently had a patient describe receiving a call in which they were told their GLP-1 drug would only be covered by Manulife if it was bought at a Shoppers pharmacy. “We still manage all their other prescriptions,” Mr. Sorial said. “It’s just that one med they have to go to Shoppers to get.”

Some Wegovy prescriptions redirected to pharmacies that signed exclusive deals with insurers

It is not the first time Manulife and Shoppers have struck this type of arrangement. Deals between insurers and pharmacies, known as preferred provider networks, or PPNs, were thrust into the spotlight in early 2024 when the two companies announced a deal that would have required some Manulife members to get their specialty care drugs from Shoppers pharmacies, in order to receive coverage for those drugs.

The companies soon announced they had cancelled the deal after public outcry, including criticism from a federal cabinet minister.

Since then, preferred provider networks have come under regulatory scrutiny and have been the subject of two public consultations by the Ontario government, which is planning legal changes to restrict the practice.

Manulife’s latest policy is part of a new arrangement it has made with Shoppers to run a specialty drug care plan for these popular drugs, which are among the best-sold in Canada. More than $2.5-billion worth of Ozempic (a sister drug to Wegovy) was sold at retail pharmacies last year, according to IQVIA data, nearly triple the next best-selling drug.

Manulife, Canada’s largest insurer, said in a statement sent by spokesperson Emily Vear that patients on Wegovy or Mounjaro need to “opt in or out” of the program with Shoppers Drug Mart, and insists that buying the medication from Shoppers remains “voluntary.”

Loblaw spokesperson Catherine Thomas wrote in a statement that the arrangement is “not a PPN,” because patients are not required to fill prescriptions at Shoppers.

Preferred provider networks are not always mandatory, but often direct people to use certain pharmacies or health care providers – a concept sometimes referred to as “patient steering,” which has been the subject of criticism from some health care advocates.

Cheaper, generic versions of Ozempic could come to Canada as early as next year

The change in how Manulife started treating claims for what it calls GLP-1 drugs began this summer when it removed Wegovy from its DrugWatch program, a list of drugs that are considered high cost to an insurance plan. Although Wegovy is on the cheaper end of high-revenue blockbuster drugs, at around $5,000 a year per patient, its popularity can mean a high aggregate cost for plans.

Roberta Heiberg got a prescription for Wegovy from her doctor in May. She said when she first tried to put in a claim for the medication, Manulife denied it and said it was not covering the drug.

She tried again weeks later, and Manulife said it would cover the drug if her doctor completed a special authorization form, which the doctor did. But when Ms. Heiberg tried again to fill the prescription at her local pharmacist in Calgary, the claim was again denied. She said she followed up with Manulife’s call centre multiple times in the weeks after.

Finally, on Aug. 27 she received a call from a woman about her Manulife coverage who said the Wegovy prescription would be covered. The woman asked what pharmacy she was going to buy the medication from, and when Ms. Heiberg said it was her regular pharmacist, the woman said the prescription could be filled anywhere, but Shoppers and Real Canadian Superstore were Manulife’s “preferred locations.” Both stores are owned by Loblaw.

The caller said there would be no price differences in buying from Shoppers, but that Shoppers had people who would “deal with Manulife and do the billing for you and answer any questions for you,” said Ms. Heiberg.

That same day, Ms. Heiberg received an e-mail – which she shared with The Globe – from a “patient care specialist” at the “Manulife SDC Program” (which stands for “Specialty Drug Care”), from an e-mail address that ended with “@shoppersdrugmart.ca.”

Ms. Heiberg said her claims for Wegovy have still not gone through with her independent pharmacist, even after the call.

“I haven’t had an experience like this with any other medications,” Ms. Heiberg said. “Just this one has been a bit of a nightmare.”

Manulife said patients should receive a call within 48 hours of receiving prior authorization for the drugs and that following the call they are free to go to a pharmacy of their choice.

“These medications are not part of an exclusive pharmacy partnership, but rather a voluntary one,” the insurer said in a statement.

Manulife would not answer questions about any financial terms of its deal with Shoppers, or what benefit patients might receive from the arrangement.

Loblaw’s Ms. Thomas said the retailer offers a patient support program for people taking some GLP-1 medications. The program includes patient resources such as care co-ordinators who can answer questions and self-injection guides, she said.

“They can fill their prescription at any pharmacy they choose, and this is not exclusive to any one insurer,” Ms. Thomas wrote in a statement.

Some other health insurers have also moved to reimburse Wegovy and similar drugs only if they are bought at in-network pharmacies. GreenShield Canada told The Globe in August it had done so because the popularity of Ozempic and Wegovy was expensive for plans. GreenShield also said it would re-evaluate that decision when cheaper generics come on the market next year.

Ian Patton, director of advocacy and public engagement at Obesity Canada, said preferred provider networks can make it unnecessarily difficult for patients to access the medication they need.

“It’s just hurdles and a lack of clarity for patients,” he said.