Toronto's auditor general raises 'red flags' in city employees' health and drug plan

Toronto's auditor general will discuss how to better manage city employees' health and dental benefits at a committee meeting Friday morning — including a suggestion to put an annual cap on reimbursements for erectile dysfunction drugs.

This week, Beverly Romeo-Beehler released a report highlighting how much the city is paying for prescription drugs as well as several so-called "red flags," like cases where excessive quantities of drugs like oxycodone and fentanyl were reimbursed.

Among those findings:

• 16 claimants received an equivalent of two to five years' supply of oxycodone in one year.
• 32 claimants received up to almost seven years' supply of fentanyl patches in one year.
• 27 claimants received the same prescription opioid at different pharmacies on the same day.
• Five claimants were each reimbursed more than $5,000 for erectile dysfunction drugs in 2015.

The city spent $60 million on drug benefits in 2015 — including nearly $2 million for erectile dysfunction drugs. The report indicates $180,000 could be recovered if council follows up on its recommendations, and an annual savings of some $750,000 could be achieved by implementing a $500 cap on erectile dysfunction pills.

Toronto mayor John Tory said if there is any evidence of fraud by claimants, the city should consider punitive measures including termination.

"We cannot, in a circumstance where we're the trustees of the public's money, allow it to be abused, whether it's for Viagra or any other drug," Tory said.

Dr. Peter Selby, a clinician-scientist with Toronto's Centre for Addiction and Mental Health, says while controlling excessive quantities of drugs is a good thing, it's important to not leave potential addicts behind.

"I know it may be embarrassing for some," Selby told CBC News.

"What I don't want people to do is take a punitive approach to the people who they're investigating. Find out if these people are actually addicted and need help, as opposed to simply just cutting them off."

Manulife is the city's current benefits administrator, but its contract expires at the end of December. City staff are working on developing a new five-year contract with Green Shield Canada.