OAKVILLE, ON–There’s been less talk about mail order pharmacy in Canada since outspoken former MediTrust Healthcare Services Inc. chairman Norman Paul sold his company to Pharma Plus Drugmarts Ltd. one year ago. But that silence doesn’t indicate inactivity; in fact, mail order pharmacy has been quietly charting its course in the Canadian market.

IMS Canada statistics for 1998 (the latest year for which data are available) estimate that mail order accounts for less than 1% of the $6.3 million in prescription drugs sold through Canadian pharmacies.

Three mail order pharmacies now serve Canadian consumers. MediTrust and Pharmex Direct, both established in 1992, are operating under new ownership. MediTrust, which was acquired by Pharma Plus in January, 1999, is still the country’s only nationally-licensed mail order pharmacy, serving all provinces and territories. Pharmex, bought in late 1998 by two ex-employees of former owner FoxMeyer Canada, serves only the Ontario market. And in the spring of 1999, Wal-Mart Canada added the PriorityScript prescription delivery service to its PartnersPlus program.

None of the three companies would reveal sales figures or prescription volumes.

The situation at MediTrust is basically “status quo,” says Norm Puhl, president and general manager at Pharma Plus. “We are continuing to market MediTrust to corporations, and continuing to service our existing customers,” says Puhl.

He sees the mail order business as “another way in which we can exceed customers’ expectations. It’s an extension of our delivery system,” he says, and a logical next step to follow the delivery services offered by community pharmacists in the past.

At Wal-Mart, mail order is being marketed to corporate plan sponsors as an option for employees in remote locations who are on maintenance medications, says Peter Miceli, manager of pharmacy business development. The company has no intention of promoting mail order service over its in-store pharmacies. “We’re a pharmacy chain, and the ideal is to have the patient come into the store, and purchase the items from a pharmacist,” he says.

Convenience and low cost are the selling points at Oakville, Ontario-based Pharmex Direct, which promotes mail order pharmacy to employers in Ontario and also serves as the dispensary for Wal-Mart’s PriorityScript service. “Employers are reluctant to mandate the use of mail order pharmacy, nor should they,” says president and C.E.O. Thomas Holloway. Still, some companies are capping prescription fee reimbursement at $5, or deciding that they will only pay the ingredient cost of prescriptions. Those policies make both Pharmex Direct’s and PriorityScript’s $5 fee and single fee on 90-day supplies of maintenance medications extremely attractive to employees, says Holloway.

“Where we see mail order pharmacy taking off is for special patient programs, on the maintenance medication side,” says Denise Balch, a consultant with Managed Care Health Group (MCHG) in Burlington, Ontario. She cites a current trial prescription and patient compliance program for patients with benign prostate hyperplasia which MCHG is coordinating for a pharmaceutical company. Patients see their physician for the initial prescription and receive counselling and followup from MCHG’s staff consultant pharmacists. The maintenance portion of the drug therapy is delivered via a mail order pharmacy. The benefit of using mail order in such a program, says Balch, is “consistency. In a national program such as this, we can use a single pharmacy for patients who are geographically distant, and be guaranteed a consistent level of service to each participant.”

Cost is also a consideration, Balch admits. “With mail order, there’s the guarantee of a consistently low markup, and a fair and reasonable fee.”