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Spilled pills (Andrew Soundarajan/iStockphoto)
Spilled pills (Andrew Soundarajan/iStockphoto)

The battle to bottle up drug costs Add to ...

And it’s expected to cast a wider net. In its U.S. home base, Express Scripts’ pharmacy sells expensive specialty drugs and observers believe it’s just a matter of time before the firm expands to those drugs also in Canada, threatening one of the most lucrative businesses of drugstores.

Canadian Pacific, which partnered with Express Scripts this year for most of its 14,000 Canadian employees, already is enjoying a 7-per-cent saving in Ontario alone, said Judy Au, CP’s human resources director. It no longer provides drug benefit coverage to 6,500 of its unionized plan members if they buy their maintenance prescription drugs elsewhere.

CP estimates that it will save at least $1-million over three years on an annual $5.2-million spending on maintenance drugs from using Express Scripts. Ms. Au has this warning for traditional drugstores, including Rexall, which is CP’s conventional pharmacy partner: “You can either work with us as plan sponsors to provide opportunities or options to save money, or you’re going to face, quite frankly, a loss of market share ... The big drugstores haven’t made any overtures to most plan sponsors to say: ‘Here’s how we can save you money.’ ”

Still, the savings can have their own costs. William Brehl, whose Teamsters union represents about 3,500 CP maintenance employees, said some workers complain of problems getting drugs, including insulin, shipped to them on time, forcing them to pay out of pocket for the prescription at a local pharmacy. The delivery problem is exacerbated by many of the members being on the road a lot, he said.

And getting through to the Express Scripts hotline can be time-consuming, he said. The union doesn’t want to renew the program after it expires on Dec. 31 “unless they fix the problems.” (Ms. Au said employee feedback has been positive; Express Scripts said there have been “isolated incidents” and some delays, but that it has been able to ensure that drugs are delivered when and where needed.)

John Caplice, a senior vice-president of Shoppers, said mail order has been available in Canada for years, but has never been able to replace the personal touch of the pharmacist-customer relationship.

Even so, independent pharmacists are worried about the potential for Express Scripts to drain business from them and limit patient choice. “It’s a concern,” said Adam Silvertown, a Toronto pharmacist. “A lot of pharmacists like myself are seeing this as a trend, and there’s nothing we can do to stop it but find some way to draw attention to it.”

He may hope that added scrutiny will discourage switching to lower-cost rivals, but Toromont executives like what they’re seeing in their new benefit alternatives. More of its staff are choosing Costco for drug purchases.

And Toromont’s Mr. Wetherald is starting to speak to Express Scripts about teaming up with its home delivery pharmacy to try to pare expenses even more. “I like the idea of game changers.”

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