Bermuda’s medical doctors cite concerns medicine becoming increasingly corporate; Health Council suggests “trade-offs” are needed in the face of our shrinking population
Doctors and the Health Council have weighed in on Allshores making Phoenix its sole provider for certain medications. (SCROLL down for press releases)
The Bermuda Medical Doctors Association has expressed serious concern over the move towards “pharmacy exclusivity”, citing the risk of a fragmented system in which a patient may need to shop at different pharmacies, increasing the possibility of duplicate therapies and delays in identifying adverse medication combinations.
The BMDA is also concerned about medicine becoming increasingly corporate in structure, where “financial and contractual arrangements may influence care pathways.”
“Healthcare decisions should remain grounded in physician clinical judgment and individualized patient needs — not corporate consolidation strategies.”
Meanwhile, the Bermuda Health Council suggests there may need to be “trade-offs” in the face of our shrinking population.
A spokesperson says they understand that “issues of patient choice, safety, affordability, and fairness matter deeply to our community”.
BHeC does not regulate private contracts between insurers and pharmacies, but the public reaction “reflects something bigger than one contracting decision”.
“Bermuda currently has more than 30 pharmacies serving a population that has been gradually declining. In a small country, when the number of providers grows while the population shrinks, margins tighten.”
“We value patient choice and physician independence. But in a small, high-cost system, access, competition, infrastructure, and affordability must be carefully balanced. These trade-offs are real.”
The BheC spokesperson said that, given the level of concern, they will “engage constructively with the insurer and other stakeholders as implementation progresses to better understand impacts on patients and providers.”
The spokesperson added that BHeC is implementing the national drug formulary to introduce clearer pricing discipline.
Bermuda Medical Doctors Association Press Release:
The Bermuda Medical Doctors Association (BMDA) is expressing serious concern regarding the recent policy announcement by Allshores that, effective March 1 [editor’s note: effective date is now April 1st] , 2026, GLP-1 medications and other designated high-cost prescription drugs must be dispensed exclusively through Phoenix Pharmacies for affected members.
While the BMDA recognizes the need for responsible cost management in Bermuda’s healthcare system, we believe this policy raises significant concerns regarding patient choice, medication safety, administrative burden, and the increasing corporatization of medical care.
Medication Safety Concerns
The BMDA is particularly concerned about the potential risks associated with fragmented prescription dispensing.
If patients are required to obtain certain medications from one pharmacy while continuing to fill other prescriptions elsewhere, complete medication profiles may not be visible in a single system. Without seamless integration across pharmacies, this fragmentation could increase the risk of:
- Incomplete drug-to-drug interaction screening
- Duplicate therapies
- Missed contraindications
- Delays in identifying adverse medication combinations
Medication safety depends on comprehensive oversight. Any system that separates prescription records must ensure that patient safety remains the top priority.
Increased Administrative Burden and Cost to Patients
The BMDA is also concerned about the expanded pre-authorization requirements and additional paperwork that will likely result from this change.
Redirecting prescriptions to a designated pharmacy requires additional coordination between physicians, medical practices, pharmacies, and insurers. This includes:
- Completing and resubmitting prior authorizations
- Managing redirected prescriptions
- Clarifying coverage limitations
- Increased staff time handling insurer requirements
These administrative processes carry real costs. Medical practices may be forced to absorb this burden or pass the cost on to patients through administrative fees. Ultimately, patients are likely to bear the financial impact of increased paperwork and insurer-driven processes.
Growing Corporate Consolidation in Medicine
The BMDA is increasingly concerned about the broader structural implications of this decision.
It is publicly known that Allshores has acquired medical practices in Bermuda. When an insurer both owns medical practices and directs patients to a single designated pharmacy provider, the healthcare landscape shifts toward vertical integration.
Medicine risks becoming increasingly corporate in structure, where financial and contractual arrangements may influence care pathways. Healthcare decisions should remain grounded in physician clinical judgment and individualized patient needs — not corporate consolidation strategies.
Protecting Patient Choice
Patient choice is a fundamental pillar of a balanced healthcare system. Restricting pharmacy access for certain medications reduces flexibility and may create unintended barriers to care.
If trends toward insurer-directed care continue, patients may find their healthcare options increasingly determined by insurance policy structures rather than by shared decision-making with their physician.
Call for Transparency and Oversight
The BMDA calls upon regulators and policymakers to examine:
- The safety implications of pharmacy exclusivity
- The financial impact of increased administrative requirements
- The competitive effects of market consolidation
- The long-term impact of vertical integration on Bermuda’s healthcare system
Healthcare is not simply a financial transaction. It is a public trust that requires transparency, accountability, and patient-centered safeguards.
A Message to Patients
Patients are encouraged to engage in this conversation. If you believe that your healthcare decisions should be guided by you and your physician — and that your medication access should prioritize safety, choice, and fairness — your voice matters.
The BMDA remains committed to advocating for patients and supporting physicians in protecting the integrity, safety, and independence of Bermuda’s healthcare system.
About the Bermuda Medical Doctors Association
The BMDA represents physicians across Bermuda and advocates for high standards of patient care, professional integrity, and policies that safeguard access, safety, and fairness within the healthcare system.
Statement from a Bermuda Health Council spokesperson:
Many people have raised concerns about Allshores’ decision to create a preferred pharmacy network for certain high-cost medications. We understand why. Issues of patient choice, safety, affordability, and fairness matter deeply to our community.
Under the Bermuda Health Council Act 2004, the Health Council does not regulate private contracting arrangements between insurers and pharmacies. Our role is to oversee the health financing system, monitor performance, and protect equitable access and long-term sustainability.
We were aware that an RFP relating to certain high-cost medications was being issued to the industry. However, we were not involved in setting the selection criteria, determining the list of medications, deciding the timing, or approving the final contract. Consultation with the Council was not required under the law.
That said, the public reaction reflects something bigger than one contracting decision.
Bermuda currently has more than 30 pharmacies serving a population that has been gradually declining. In a small country, when the number of providers grows while the population shrinks, margins tighten. Even relatively small changes in how medicines are distributed can have significant ripple effects for small businesses and for patients.
We also rely heavily on a single primary importer to negotiate and manage national pharmaceutical supply. That provides stability, but it limits our leverage in global pricing negotiations. At the same time, Bermuda frequently sources medicines from some of the highest-priced markets in the world. By the time importation, distribution, and retail margins are added, costs compound quickly.
Meanwhile, medical science is advancing at remarkable speed. Biologics, GLP-1 therapies, oncology drugs, and increasingly personalized treatments are changing lives. But they are also extremely expensive. A small number of high-cost medications now account for a disproportionate share of total drug spending. In a system committed to Universal Health Coverage, that creates difficult choices.
We value patient choice and physician independence. But in a small, high-cost system, access, competition, infrastructure, and affordability must be carefully balanced. These trade-offs are real.
Cost containment must never come at the expense of safety. Concerns about medication visibility, coordination of care, and administrative burden are valid and must be addressed through strong safeguards and monitoring.
As Bermuda advances Universal Health Coverage, we are implementing the national drug formulary to introduce clearer pricing discipline. We are also strengthening procurement and importation frameworks so that Bermuda is not unnecessarily tied to the highest-cost supply chains when safe, quality alternatives exist.
Given the level of concern, the Health Council will engage constructively with the insurer and other stakeholders as implementation progresses to better understand impacts on patients and providers. We will continue to monitor access, continuity of care, and market dynamics, and incorporate lessons learned into ongoing reform.
This situation is part of a broader pattern of consolidation and structural change in our healthcare system. We intend to facilitate open dialogue about where the system is heading and how to balance affordability, competition, innovation, and access in a way that works for Bermuda.
We will also examine whether additional measures are needed to strengthen transparency and support fair competition within the pharmaceutical supply chain.
This is about more than one company or one contract. It is about ensuring that Bermuda’s healthcare system remains sustainable, equitable, and centered on patients as we navigate real economic and scientific pressures.
The Health Council remains committed to guiding that balance responsibly and transparently.
