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:

Patients “should have the right to choose where they collect their prescriptions”.

This is the response from an independent pharmacy, following a move by Allshores to narrow distribution of certain drugs to the Phoenix network.

Sheryl Martins of Caesar’s Pharmacy said, “this directive may penalize the patient who would prefer to collect these prescriptions from their independent pharmacy of choice”.

She is one of a handful of independent pharmacists who are pushing back, arguing that relying on a single pharmacy group and its parent wholesaler creates a fragile supply chain, and may drive up costs over time. (SCROLL down for their statement)

The eight pharmacies have written to Health Minister Kim Wilson with their concerns.

Speaking to Bermuda Broadcasting, Lindo’s CEO Wes Toavs cited problems that could arise if a patient on several medications is forced to pick up one of their drugs at somewhere other than their usual pharmacy.

“Sometimes, patients aren’t fully aware of all the medications they’re on,” Mr Toavs said.

“They may not give the Phoenix pharmacists the full picture of the medications that they’re on, and there might be a contraindication.”

Bermuda Broadcasting broke the story on Monday that Allshores, the amalgamation of health insurers Argus and BF&M, had made Phoenix their designated provider for certain drugs.

Allshores said consolidating distribution will secure better pricing, and assured customers that “this initiative does not reduce pharmacy benefits”.

“For most plans, eligible medications continue to be covered at 100% with no copay or deductible when dispensed through the designated pharmacy partner.”

All of the independent pharmacists we have spoken to have highlighted the connection between patients and pharmacists.

“We’re not just glorified shopkeepers”, said Jennifer Lightbourne of Northshore Medical Pharmacy, “we have very personal relationships with our customers.”

Mr Toavs says, “it’s not simply a matter of moving a prescription from one place to another. It’s that trusted relationship and the knowledge that a pharmacist has developed with a patient over a period of time, that I think is at jeopardy here.”

Jonathan Lightbourne, co-owner of Northshore Pharmacy with his wife Jennifer, also affirmed other pharmacist’s comments about maintaining the supply chain.

He says, “there’s an element of resilience that you get with lots of little players taking up a position in the market. When you start to consolidate supply chains and you start to consolidate all the services into one or two players, actually there’s less resilience and more risk.”

Allshores alerted pharmacies to the “critical change” last week, stating that a list of 46 prescription medications – including Ozempic, Adderall and Eliquis – “must be directed to Phoenix Pharmacies for dispensing”, beginning March 1st.

The eight Phoenix locations represent less than a third of pharmacies in Bermuda, half of them within the City of Hamilton.

“They’re not in St David’s. They’re not in St George’s. They’re not in Somerset”, Jennifer Lightbourne says, “so it’s very inconvenient for people who live in extremities of the island.”

Disquiet spread among other pharmacies after the announcement, a disquiet reflected by the community since Bermuda Broadcasting first reported the story on Monday.

The webpage containing the Phoenix Pharmacy prescription list originallly stated that certain prescriptions “must be filled exclusively through Phoenix Pharmacies in Bermuda”.

The language was subsequently changed to “new prescriptions for these medications filled at other pharmacies in Bermuda will be subject to coverage in accordance with the terms of individual health plans.” The effective date is now listed as April 1st.

Pharmacy operators have acknowledged the need to address rising health insurance costs, and Wes Toavs of Lindo’s commended the efforts of Allshores in this area.

“They are providing annual physicals with no co-pay”, he said. “They’re coordinating with health care providers abroad in order to negotiate good rates for people to still have excellent care, but at a reduced cost.”

Northshore’s Jennifer Lightbourne added that, if the list of Phoenix prescriptions was more targeted, what Allshores is doing could actually be beneficial for the independent operators.

“We often felt that the centralization of high cost medications was probably a good idea”, she says.

“For a small pharmacy like ours, if we have to order in a $10,000 drug for a cancer patient, and that patient unfortunately dies, then we’re left with $10,000 sitting on ourselves that we can’t dispense. ”

“So having a centralized process for that … I would welcome that.”

However, the inclusion of more common drugs that are not as expensive is problematic, she says…

“When a company starts to include other medications that are not high cost, for example Eliquis which is an anticoagulant, and all of the GLP-1 medications which are used for your diabetes… it’s quite concerning driving all of those people, because those people tend to be on a lot of other medications.”

“They’re going to want to get all of their medications from one pharmacy, and they’re going to lose out on that relationship that they’ve developed over the years with their pharmacist.”

Wes Toavs suggested an ‘in-network’ and ‘outside-network’ approach to pricing, as opposed to network exclusivity …

“Where they’ll say, if you go to one of our Allshores healthcare providers, we won’t charge you a copay, but if you go to your own, we’ll reimburse you up to, say, $120 or $130.”

“I know that probably gets a little bit messy from how to design a model… But I do think that, given some of the other risks that I discussed, that would probably be a prudent way of maybe managing this process.”

We have reached out to Allshores about the concerns raised, and await their response.