PHARMACY ACCESS REFORM
OUR POSITION
Action is long overdue to ensure all patients have equal access to local and mail order pharmacies to meet their individual care needs.
THE ISSUE
Under current New York State law, health insurance plans and Pharmacy Benefit Managers (PBMs) can impose extra terms and conditions on already in network local pharmacies in order to dispense certain high-cost medications. These extra terms and conditions are outside the already strict New York State regulations for local pharmacies. Because of this, some local pharmacies aren’t able to serve some patients, meaning the patients are forced to rely on a mail order pharmacy for their medication.
Patients might need to use a local pharmacy for several reasons:
They don’t have a safe, private place to receive deliveries
They have trouble communicating because of cognitive impairment or language barriers and need in person help
Their medication may require special handling (like refrigeration)
Patients who need a local pharmacy and are forced to use mail order may have a hard time getting medication deliveries, maintaining their privacy, and keeping the medication from being lost/damaged. Lost/damaged medication can delay their treatment and make them sick, or they may be forced to pay for replacement medications. In addition, if you have a problem with a local pharmacy you can report it to New York State for help; you can’t do that with an out of state mail order pharmacy.
Delayed, lost & damaged medications are a serious problem for people with serious medical conditions who take special medications. Many people with bleeding disorders use clotting medication; the medication is temperature sensitive, and a one-month refill can cost over $50,000. A delayed, lost or damaged delivery may leave them without medication, leading to serious complications.
PROPOSED SOLUTION
Bill A.5854a (Joyner) / S.3566 (Breslin) prevents extra terms and conditions from being imposed on already in network local pharmacies while limiting the local pharmacy from charing more than a mail order pharmacy.
Payers should not be allowed to impose additional certification requirements on pharmacies already regulated, inspected, and licensed by New York State
If a local pharmacy is already in network with a health plan, is willing to accept the same reimbursement and charge the same price as a mail order pharmacy, they should be able to serve patients
Out of state pharmacies should be required to meet New York State standards
A.5854a/S.3566 doesn’t limit plans from offering a mail order pharmacy option, nor does it limit patients from using a mail order pharmacy.
An important part of helping people stay healthy is for them to get the medication they need, when they need it, whether it’s from a local or mail order pharmacy. Some patients do better with mail order. Other patients need a local pharmacy. All patients should have equal access to the pharmacy option which best meets their individual care needs.