A business partnership forcing patients insured by Manulife to fill their prescriptions at Shoppers Drug Mart if they want coverage is a violation of patient ethics, according to a doctor.
When Amy was prescribed medical cannabis to treat chronic neuropathic pain, she was told her health insurance — provided through her work by Manulife — would only cover prescriptions filled through Shoppers Drug Mart, a wholly owned subsidiary of Loblaw Companies Ltd.
The patient has asked Mugglehead to withhold her real name, exact prescription and LP of choice to protect her identity.
This is deeply troubling and violates the ethics around a patient’s right to choose their own pharmacy, Aleafia Health Inc.’s (TSE: ALEF) chief medical officer Dr. Michael Verbora said.
It’s also an example of one of the many policy barriers which push medical cannabis patients to self-medicate through the easier-accessible recreational market, he said.
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Verbora works at Aleafia’s Canabo Medica Clinic and first met Amy as a patient in November, 2019. She had limited experience using cannabis, but wanted to try it to treat her pain before trying available opioid treatments. So, Verbora prescribed her CBD tablets.
In Canada, medical cannabis patients are prescribed a dosage by a doctor and then can choose which licensed producer they want to fill the prescription, according to Verbora.
Having limited coverage and needing 60 to 120 CBD tablets per month, Amy chose a LP with tablets that fit her budget.
But by January 2020, her prescription still hadn’t been filled. She was then told by Manulife it had blocked her prescription and she had to have it filled through Shoppers, which sold CBD tablets for twice the price of her chosen LP.
This shocked Verbora, who said he’d written thousands of prescriptions for pharmaceuticals and cannabis, and has “never seen an insurance company force a patient to go to a specific pharmacy or, in this instance, a specific licensed producer.”
To allow her to access her medicine, Verbora helped Amy register with Shoppers — though her prescription still hadn’t been filled by the time this article was published.
Attendees at Vancouver’s 2020 Lift & Co. cannabis expo are offered bonus points for registration. Photo by Michelle Gamage
A fentanyl prescription could be filled by tonight, but medical cannabis can take more than three months
Three months to access medical cannabis is completely unacceptable, Verbora said.
“I could give this patient a fentanyl prescription and she could get it filled this evening,” he said. “I write her a prescription for cannabis and it’s been three months and she can’t get it. And she has chronic pain — and I don’t want her on opioids. So why is it harder to get cannabis than it is to get an opioid?”
On Wednesday, Verbora took to Twitter to call out Manulife and Shoppers for leaving Amy in the lurch for three months.
Had a patient today who has @Manulife health insurance and qualifies for medical cannabis coverage. Unfortunately, she is being force to chose @ShopprsDrugMart and Manulife is refusing to reimburse her for her cannabis unless she orders from Shoppers. This seems offside…
— Dr. Michael Verbora (@mverbora) March 11, 2020
Manulife’s partnership with Shoppers offers members consultation with pharmacists knowledgeable about cannabis to help guide patients to medications best suited for them.
That streamlined process can be hugely beneficial for some patients, but it shouldn’t mean Manulife members can only access medical cannabis through Shoppers, Verbora said.
The insurer’s website did not say what happens if a patient wants to access medical cannabis through a different LP or pharmacy. Both Manulife and Loblaw did not respond to multiple requests for comment.
In a response tweeted to Verbora, Manulife said, “Any exemption requests must be approved by Drug Tech,” without specifying what that was.
Hi Michael. All coverage depends on plan specifics. However, Manulife does have a program with Shopper's Drugmart regarding medical cannabis. Any exception requests must be approved by Drug Tech. Hope that answers your questions. Best ^CS
— Manulife (@Manulife) March 11, 2020
“Main thing is: Don’t interfere with patients’ access to medicine, period,” Verbora said. He’s often frustrated by the barriers put between patients and medical cannabis in Canada.
‘It should not be easier to get high than to reduce your pain’
“It should not be easier to get high than to reduce your pain. That’s just a simple philosophy I believe in.”
According to Verbora, patients still face huge hurtles to access medical cannabis. Medical cannabis is still regulated like a narcotic and controlled by a doctor’s prescription. Few insurance companies cover costs and many patients have to pay out of pocket. Doctors, who lack a formal cannabis education, are hesitant to prescribe cannabis.
So patients get frustrated and end up self-medicating through the recreational market, Verbora said.
If Manulife is controlling where its members fill their prescriptions is just adding another barrier, he said.
“The policy needs to be in such a way that you can’t put extra barriers on patients if they don’t choose your so-called streamlined process.”
Insurance companies should have to walk the same line doctors do, he said.
“We don’t dictate where patients get their cannabis or where they fill their prescriptions. There needs to be separation there.”
Top image by GTD Aquitane via Wikimedia Commons
michelle@mugglehead.com
@missmishelle
