Pharmacists Hoping for the Best
By Michael Kaufman
News that Gov. Cuomo has finally signed into law a bill that prohibits insurers from requiring patients to get prescriptions through the mail was greeted with guarded optimism by owners of independent hometown pharmacies. The law, which passed overwhelmingly in both houses of the state legislature earlier this year, will allow people to fill any prescription covered by mail order at an independent retail pharmacy. But there’s a catch.
The governor said the law will only go into effect after state legislators approve an amendment requiring retail pharmacists to agree in advance to accept the same reimbursement rate as mail-order pharmacies. Just how this will work remains to be seen. Will local pharmacists be able to obtain prescription drugs from pharmaceutical companies at prices similar to those negotiated by health insurers with big mail-order companies such as Medco? If not, neighborhood pharmacies will continue to be squeezed as they’ve become accustomed to in recent years with competition from chains such as CVS and Drug Fair, big-box stores such as Walmart and Costco, and from supermarkets that offer pharmacy services in addition to groceries.
The stark fact is that about 375 independent pharmacies in New York have closed since 2008, according to the Pharmacists Society of the State of New York. The group estimates that between $4 billion and $5 billion for prescriptions leaves the state each year because of mail orders. The organization hailed the Dec. 13 signing by Cuomo as “a tremendous victory for all pharmacies in New York State and the millions of New Yorkers they serve.”
“We are hoping for the best,” said pharmacist Jean Murphy, co-owner of Akin’s pharmacy in Warwick. “We don’t know yet how it is going to work.” The governor provided no date as to when the measures would take effect.
Meanwhile, the Pharmaceutical Care Management Association (PCMA), which opposed the bill, welcomed Cuomo’s insistence on the amendment. “Employers, taxpayers and consumers appreciate Governor Cuomo’s admonition to the legislature to improve this costly, anti-consumer bill,” said Mark Merritt, CEO of the Washington-based lobbying group. “In this economy, employers need every cost-saving tool they can get and mail-service pharmacy is at the top of the list.”
The PCMA casts local pharmacists as anti-consumer villains, as does the New York Health Plan Association (NYHPA), which lobbies on behalf of 25 managed health care plans in the state. In opposing the original bill, the NYHPA declared, “This proposal enriches community pharmacists at the expense of patients and will result in increased pharmaceutical costs.”
As noted previously, the original bill was also opposed by the Business Council of New York State (BCNYS), which condemned it as a “state-imposed coverage mandate [that] will increase overall costs to the health care system, limiting one very real opportunity and option to bend the cost curve in health care without any decrease in access or quality to care.”
This statement is belied daily by the real-life experiences of the supposed beneficiaries of this largesse. After our previous post on this topic last month, Peter B. of Warwick wrote, “I HATE Express Scripts, but have to use them. ALWAYS, ALWAYS late, and when I call, which is every time, I get the same bland crap; nothing even remotely helpful or actionable.”
Consumers forced to use Medco, the largest of the mail-order firms and a spinoff of pharmaceutical giant Merck, regularly voice their complaints via the internet at consumeraffairs.com. Here is a sampling of recent comments:
Heather of Ladson, SC, wrote, “I have had nothing but headaches and issues with Medco from the beginning….You receive different information from each representative you speak with….First, they tried to deny medications that my doctor specifically requested (with prescription and official letter) for me because they were supposedly ‘not covered’ under my plan.”
Susan of Drums, Pa., wrote, “I was never notified I would be forced to use the mail order program. And now I am without my medication because I am required to go back to my doctor and spend money I don’t have to get a new prescription….”
Michelle, of Phoenix, Ariz., wrote, “I called to place an order on a prescription and the prescription was never filled. I called back and was told the request was never made, yet I have my confirmation email. The rep then placed another refill request and I was assured it would ship by a certain date as I was almost out of medication. To no surprise the medication did not ship on the date I was advised. I have spent several hours on the phone over the past week with no resolution. I was told I could transfer it to a local pharmacy to be filled immediately.
“I later received a call from Medco stating they tried to transfer it but the local pharmacy didn’t have it in stock….I decided to call the pharmacy myself and found out they do have the medication in stock…. I asked to speak with a [Medco] manager and was advised there was no manager available. I am now left without my medication and have no idea when or if I will actually receive it.”
But the lobbyists at the BCNYS keep spinning: “Typically, mail order pharmacies are an option to employees, not a mandate, and the option usually is accompanied by passing along the savings to the insured in terms of lower out-of-pocket co-pays. If an insured prefers to use a non-mail order pharmacy, it is the informed choice of that consumer to fill the prescription knowing that the co-pay will be higher.” Big Brother would be proud.
Companies that offer mail-order pharmacy as an “option” make it clear they want employees to use mail order. Nonunionized workers in the private sector, fearful of losing their jobs, are likely to comply, like it or not.
Those who don’t are badgered by robot phone calls and mailings from Medco. These start out cordially enough: gentle reminders that you are missing out on a wonderful healthcare benefit and an opportunity to save money. After a while they become more ominous and take on an unmistakingly threatening, invasive tone. They remind you that the cost of your prescription for a specific drug will soon go up if you don’t switch now. They are Big Brother. They’re watching you. And they got to the governor.
Hometown pharmacists are hoping for the best, but the worst would be no surprise.
Michael can be reached at email@example.com.
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