Statement: CLHIA supports sustainable drug access for Ontarians through Preferred Provider Networks

Communiqué

(Toronto, July 31, 2025) Patients with serious and debilitating conditions such as cancer, rheumatoid arthritis, multiple sclerosis and rare diseases shouldn’t have to worry about how to cover the costs of these life-saving medications. But drug prices are a real concern with some of the most vulnerable patients in Canada requiring medications that cost over $1 million per year per patient. 
 
That’s why ensuring Canadians can access affordable medicines through benefits plans is a priority for the CLHIA and our members. This is especially important as our country faces heightened economic uncertainty and affordability concerns. Polling by the CLHIA shows that nearly 70 per cent of all Canadians, regardless of whether they have health benefits under their employer’s plan, place significant importance on paying the lowest prices for prescription drugs. 
 
One critical tool we have for managing high drug costs and negotiating lower fees with pharmacies is through Preferred Provider Networks (PPNs). Without PPNs, the cost of comprehensive drug coverage may be unsustainable for employers, leading to reduced benefits coverage—shifting the financial burden of high-cost drugs to both individuals and the government. 
 
The Government of Ontario has requested consultation on regulating PPNs. We do not believe that regulating PPNs will improve patient access or experience. However, if the government chooses to regulate, we support a Standardized Mandatory Exemption (SME) model because it focuses on patients, not pharmacies.
 
The SME model ensures that a consistent, transparent exemption criteria is applied, allowing patients to access non-network pharmacies in specific circumstances. The SME model preserves the core benefits of PPNs and will continue to support affordable coverage. It minimizes disruption to patients and does not excessively restrict the flexibility employers need to design benefit plans with PPN options that best meet the needs of Ontario businesses and their employees.
 
We are committed to working with the government to ensure that patient access and affordability of life-saving medications continue to be prioritized.  

Read our full submission to the Government of Ontario: CLHIA - Submission to the Ontario government on Preferred Provider Networks (PPNs) 

About the CLHIA
The CLHIA is a voluntary association whose member companies account for 99 per cent of Canada’s life and health insurance business. These insurers provide a wide range of financial security products including life insurance, annuities (including TFSAs, RRSPs, RRIFs and pensions) and supplementary health insurance to nearly 30 million Canadians. They hold over $1 trillion in assets in Canada and employ almost 180,000 Canadians.