A postponed prescription coverage deal between Allshores and Phoenix came into effect yesterday, with the insurer lauding that some high-cost drugs will now have no co-pay
A list of 46 high-cost drugs will now have zero co-pay in most circumstances for some Allshores members – if they fulfill those prescriptions at one of the eight Phoenix Pharmacies.
If members choose to fulfill elsewhere, however, the most Allshores will cover is 50%.
The 46 prescriptions include diabetes and weight-loss drugs Ozempic, Mounjaro and Waygovy; blood-thinner Eliquis; and specialized cancer drugs such as Lenalidomide.
Allshores, the amalgamation of health insurers Argus and BF&M, previously stated that these medications only represent about 3% of prescriptions, but account for more than 30% of total prescription spend among their members.
The deal was supposed to come into effect in April, but Health Minister Kim Wilson had the Bermuda Health Council request a delay to implementation, after independent pharmacies and doctors cited concerns over the deal.
The online list states that fulfilling prescriptions at other pharmacies will be considered out-of-network, and “coverage will be 50% or per the member’s Schedule of Benefits”.
The website also states that prior to June 1st, Allshores coverage for many of these drugs was 80%, whereas the new deal puts that up to 100% with no co-pay at Phoenix Pharmacies.
An Allshores spokesperson told the Royal Gazette that “at the heart of this initiative is a commitment to ensure members receive the care they need without financial hardship.”
Independent pharmacists previously voiced their concerns when it appeared the Allshores deal may restrict certain prescriptions to one network, citing the loss of established relationships with long-term patients, limited choice for customers, and the fact that Phoenix Pharmacies are in only eight locations – not including St David’s, St. George’s and Somerset.
In February, when Health Minister Kim Wilson sought a delay to the Allshores/Phoenix deal, she also reiterated that Government is committed to introducing anti-monopoly legislation.
“Competition law is not about punishing success,” the Minister said, “it is about protecting the public interest. It ensures that innovation thrives, that consumer choice is preserved, and that market power is not exercised in ways that undermine affordability, fairness, or access.”
Responding to our questions as to whether all Allshores plans will include coverage of specialist drugs, an Allshores spokesperson said that benefits can vary depending on the plan, and members should refer to the latest schedule of benefits.
The spokesperson added that the new Allshores-Phoenix deal has removed significant out-of-pocket costs that many patients previously faced, and that “some of our cancer patients currently pay thousands of dollars per month even with just a 20% copay, for example. These patients will now have no copay.” (Full response from an Allshores Spokesperson below)
The full list of medications affected by the Allshores/Phoenix deal can be found at allshores.com/pharmacy.
Response from an Allshores Spokesperson:
“People with Allshores health plans should refer to their latest Schedule of Benefits for the information about their plans. Benefits can vary depending on the plan. If there are any questions about their benefits, people can reach out to our teams at pharmacy@allshores.com who are ready to assist them. At the heart of this initiative is a commitment to ensure members receive the care they need without financial hardship. By reducing the acquisition cost of these specialist medications, we have been able to expand coverage to 100% for most eligible members—removing significant out-of-pocket costs that many patients previously faced. Some of our cancer patients currently pay thousands of dollars per month even with just a 20% copay, for example. These patients will now have no copay.”
