When Ontario changed the rules for its drug formulary - through the Transparent Drug System for Patients Act in 2006 - it "upset the apple cart for other payers because its drug formulary had previously been used as the price point across the country," says an article in the Canadian Medical Association Journal.

"Private drug plans are administered by insurance companies who use a handful of Pharmacy Benefit Networks (PBNs) for their claims adjudication," states the article. "It is these PBNs who have agreements with pharmacists that set out the maximum allowable ingredient cost for any drug purchases. These price points are specific to the PBN and do not differentiate based on insurer, let alone the plan sponsor. When questioned in the past about price control, the PBNs have strongly defended their price points. But if the government can negotiate much lower prices, why can't the PBN's?" This issue brings to light a growing awareness of private plan sponsors about putting pressure on their providers to implement drug price control.