Ont. teacher says she's being forced to switch pharmacies to maintain medication coverage

A Waterloo, Ont. teacher says she’s frustrated after learning the arthritis medication she depends on is no longer covered under her benefits plan.

Amy Miller received a notice from her provider, Ontario Teachers Insurance Plan, indicating in order to maintain her coverage for the drug, she needs to transfer the prescription to MemberRx, a speciality pharmacy.

“There are so many things that are wrong with it,” Miller says.

The medication she takes to treat ankylosing spondylitis, a type of arthritis that causes inflammation in the joints and ligaments of the spine, would cost $1,700 per refill if she had to pay out of pocket.

“The drug I'm on now is a TNF blocker, so you inject it every 10 days and it sucks up all the inflammatory cells, which allows me to move normally,” Miller explains.

The letter goes on to say: “If you do not speak with a member of the MembersRX pharmacy team, you will be responsible for paying for the cost of these high-cost speciality drugs.”

Miller admits she’s known about the coming change since last year, but hasn’t transferred her prescription yet because she doesn’t agree with the options in front of her.

“I’ve been dragging my feet ever since, to be quite honest,” she says.

With MemberRx, Miller will no longer be able to go pick up her prescription when she wants because their physical pharmacy is located in Mississauga. Delivery is her next option.

“But we live in a condo,” she said. “These things need to be refrigerated and I don't necessarily go straight home after work… They said they could deliver it to the school. I also don't want my medication coming to my place of employment.”

Privacy is also a major worry.

“They actually wanted to drop it off at Michael's craft store this week, which to me is odd.”

Miller’s pharmacist Ron Yochim at Pharmasave Waterloo Wellness Pharmacy, echoes her concerns.

“The patient should have the choice to pick up their medication at whatever pharmacy they choose to pick it up,” Yochim said. “And then in terms of safety as well, we have no way of knowing if a patient is on another medication unless they tell us if they're receiving it at a different pharmacy.”

In an email to CTV News, Ontario Teachers Insurance Plan says there is no profit motive or retail element in the MemberRx model.

“All proceeds are returned to the benefit plans that have partnered with MemberRx to support members on complex, chronic therapies,” Ontario Teachers Insurance Plan says in part. “Lower costs mean the benefit plans can continue to provide the best coverage, at the best value, for the medications their plan members need. About 1 per cent of plan members require MemberRx pharmacy support for their specialty drug needs. For the other 99 per cent, plan members continue to fulfill their everyday prescriptions at the pharmacy of their choice.”

Even so, Miller feels a responsibility to speak up for others affected by the change.

“I'm sure people are annoyed and maybe they're not speaking up, but I am going to speak up about this because it's ridiculous,” she says.