Concerned for patients’ privacy and pocketbooks, Ontario’s health minister says he will tackle a new Big Pharma marketing scheme that uses electronic medical records to sell drugs.

Minister Eric Hoskins said he will ask Ontario’s College of Physicians and Surgeons to investigate how electronic vouchers that steer patients to brand name drugs over cheaper generics “may be impacting privacy, accessibility and affordability.”

He said he also plans to “express my concerns” with Telus Health, which inserts the electronic vouchers into its popular electronic medical record software (EMR) used by thousands of doctors across Canada.

“Our government remains steadfast in our commitment to put patients at the centre of our health-care system,” Hoskins said in a statement.

To drive business their way, brand-name drug companies have paid Telus to digitally insert vouchers so that the prescription is filled with their product instead of the lower-cost generic competitor that pharmacists normally reach for, a recent Star investigation found.

The voucher works like a coupon: If a patient’s insurance does not cover the full cost of the pricier brand name drug, the drug’s manufacturer will cover part or all of the cost difference from its generic equivalent.

Thousands of doctors across Canada use electronic medical records to take notes during patient visits and to create a prescription to be filled by the patient’s pharmacy. Telus Health, a subsidiary of the telecom giant, is a dominant player in the electronic medical records field. Following publication of the Star story, one major Toronto hospital has suggested that its doctors opt out of the voucher feature.

By including the vouchers in electronic medical records, concerned physicians say a clinical tool they use to prescribe drugs and care for patients is being co-opted so drug companies can increase profits. Industry experts say the vouchers can add unnecessary costs to private drug plans, which may be passed on to the patient through higher premiums.

Doctors had to agree to the voucher feature in the Telus software before it was enabled on their systems, and physicians can opt out at any time.

Telus Health said the feature has been positively received by the majority of doctors using the software. The voucher is offered only after a physician chooses a drug by its brand name to prescribe “so there is no influence on what drug the physician selects,” a spokesperson said.

Telus has been a significant beneficiary of a provincial government-funded program that saw more than $340 million distributed to doctors to adopt electronic medical records in their practices. Roughly half of the doctors who received funding went with a Telus-owned EMR that now includes the voucher feature.

OntarioMD, a subsidiary of the Ontario Medical Association, managed the funding program, which ran from 2005 to 2015. Its role included determining if EMR software met certain specifications to be certified. The organization’s CEO, Sarah Hutchison, said the use of brand drug vouchers in EMR is not considered as part of the certification process.

But some doctors think it should be.

“Electronic health records are publicly funded for the benefit of patients,” said Toronto physician Nav Persaud, who complained about the voucher feature to Telus.

“Electronic health records that are used to market products for the pharmaceutical industry or to share information for marketing purposes should definitely not be publicly funded — they could be banned entirely.”

In his statement, Hoskins said he will be writing to Telus and OntarioMD “to express my concerns about these practices and start a dialogue on how we can best move forward with the management of our patients’ electronic health records to ensure transparency and openness.”

Hoskins, a doctor, will also request Ontario’s College of Physicians and Surgeons look into the matter to see “how we can establish a stronger, clearer guideline moving forward.”

The head of the doctor regulator has already said, in general, vouchers being included on a prescription is “not appropriate” as they may lead patients to think their physicians favour brand drugs over generics.

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In an internal obtained by the Star, Dr. Rocco Gerace, registrar of Ontario’s College of Physicians and Surgeons, said the inclusion of vouchers on prescriptions may also “lead some patients to perceive that the physician is in a conflict of interest, or that they are recommending or endorsing the name-brand formulation of a drug instead of a generic or other alternative.”

Gerace said in his letter that the regulator’s policy recommends physicians generally use the generic name of a drug to make sure the prescription is clear.

Generics contain the same pharmaceutical ingredients and can cost as little as one-fifth of the brand price.

To keep costs down, many drug plans encourage pharmacists to substitute a cheaper generic drug when filling a prescription for a brand drug, unless the prescribing doctor specifically requests otherwise. Without a voucher, even if a doctor uses the brand name on a prescription, pharmacists may substitute the cheaper generic.

The voucher feature is offered in a number of electronic medical record systems, a Telus spokesperson said, adding that its system, introduced in August 2016, follows ethical principles not necessarily present other software.

Ontario’s health minister committed to raising the issue at the next meeting with his federal, provincial and territorial counterparts.

“I believe we need a pan-Canadian approach to addressing this and ensuring consistency across the country,” Hoskins said.

For now, it will remain up to individual doctors to decide whether to use the voucher feature.

At St. Michael’s Hospital in Toronto, about 100 physicians and nurse practitioners in the family medicine and pediatrics units use a Telus EMR to write prescriptions for their patients.

The hospital is “strongly” encouraging its doctors opt out of the voucher feature, said chief medical officer Dr. Doug Sinclair, adding that the vast majority have already disabled the function.

“We do not see that it benefits them or the patient population we serve,” Sinclair said.