The Competition Bureau announced on April 11, 2025 that it had obtained a court order from the Federal Court “to advance an investigation into Express Scripts Canada.”

This order will allow the Competition Bureau to require Express Scripts Canada to produce records and written information, and provide oral testimony in connection with its investigation.

A subsidiary of Express Scripts, a U.S. company owned by Cigna Group, Express Scripts Canada is known for its electronic payment services for group drug claims. The company offers these services to insurers, third-party payers and pharmacies. 

Express Scripts Canada is also known for its annual Prescription Drug Trends Report, which examines the evolution of costs absorbed by private group plans.

In its press release, the Competition Bureau points out that Express Scripts Canada also operates four mail-order pharmacies across Canada, with the exception of Quebec.

Pharmacy network under the microscope  

The Competition Bureau wants to examine “alleged anti-competitive conduct that can prevent or limit competition in the pharmacy retail market.”

Patient steering is one of the behaviors under the microscope of the independent agency charged with enforcing the federal Competition Act. It wants to verify whether such steering could occur through preferred provider networks that force or induce patients to “to use Express Scripts Canada owned or associated pharmacies instead of their pharmacy of choice.” 

The Competition Bureau also wants to investigate what it calls “margin squeezing” behavior. Under this practice, the payment service provider reduces the profit margin of its retail pharmacy competitors by increasing its service fee, “and by requiring a costly and burdensome audit process.”

The Competition Bureau says “there is no conclusion of wrongdoing at this time.” 

A controversial practice  

Preferred provider networks have been the subject of much debate for some years now. On Aug. 23, 2024, the Ontario Ministry of Finance launched a consultation on the role of preferred provider networks in the province's employer-sponsored drug insurance sector, reported an Insurance Portal article published on Sept. 4, 2024.

In early 2024, Manulife had announced an agreement with Loblaw that would allow coverage of 260 specialty drugs to be offered only in 300 Loblaw-owned pharmacies across the country, reported a Feb. 25 article published by the Portail de l’assurance (Insurance Portal’s French-language sister publication). Faced with negative reactions from the public and the media, Manulife backtracked shortly afterwards, announcing that its policyholders would be able to obtain these drugs at the pharmacy of their choice.

Banned in Quebec 

The practice of preferred provider networks is prohibited in Quebec. Section 2 of the Health Insurance Act stipulates that nothing may limit a person's freedom to choose a healthcare professional.

Private plans are no exception. Section 42.2.1 of the Act respecting prescription drug insurance states that no group insurance contract or benefit plan may restrict a beneficiary's freedom to choose a pharmacist.

Finally, article 50 of the Pharmacists' Code of Ethics states, among other things, that a pharmacist must not accept any benefit relating to the practice of his or her profession, over and above the remuneration to which he is entitled, except a thank-you or a gift of modest value. Nor must he or she pay anyone a benefit related to the practice of his or her profession. 

However, on June 12, 2024, the Association québécoise des pharmaciens propriétaires (AQPP) asked the Superior Court to authorize a class action against ten of its members who own six pharmacies, three patient support program managers and three infusion clinic networks. “At present, all pharmacist-owners are being deprived of significant revenues as a result of prohibited and wrongful business practices perpetrated by a few of their colleagues,” the AQPP alleged.

The AQPP's class action suit “is ongoing and has not yet been accepted,” AQPP spokesperson Marilie Beaulieu-Gravel told Insurance Portal in response to this article.