The Globe and Mail reports in its Wednesday, Jan. 1, edition that private health insurance provides 23 million Canadians access to lifesaving medications, but what drugs and pharmacies are available is often determined by secret agreements between insurers, pharmacies and drug makers. The Globe's triple bylined item reports that these deals also impact insurance premiums for employers and employees, yet their details remain undisclosed. Some in the medication ecosystem argue that the lack of transparency is increasing costs and unfairly directing employees to less convenient but more profitable health care providers for insurers. Consulting House adviser Paul Sabat warns that increasing drug benefit costs are jeopardizing the sustainability of some client benefit plans. Getting drugs is only part of the supply chain; dispensing them to patients is equally important. Over a decade ago, insurers started forming preferred provider networks (PPNs) that direct plan members to specific pharmacies for insurance coverage. In closed networks, out-of-network prescriptions may not be reimbursed at all. Pharmacies in PPNs usually offer a small discount in exchange for a higher volume of patients from the insurer.