Many third-party payers have either switched to or are considering moving to a mail-order requirement for long-term prescriptions that would prevent patients from choosing to purchase medications through retail pharmacies. Pharmacists and patients are pushing back.
"What we are concerned about is a trend developing, where more and more employers are going to this type of a system. People should have a right to choose," said Beraldi, a pharmacist at Oard and Ross Drug Inc.
Many health-insurance providers and employer health plans have either switched to or are considering moving to a mail-order requirement for long-term prescriptions, rather than allowing patients the choice to purchase the drugs through retail pharmacies or mail order.
"We worked with the Iowa folks and have a nationwide petition drive. We hope to have some federal legislation introduced in the coming weeks and months," said Mark Hendrickson, NCPA manager of public affairs and grassroots advocacy.
The drive is part of NCPA's grassroots campaign to urge healthcare plans to eliminate mandatory mail-order purchasing of long-term medications. In one initiative, NCPA is urging legislators to support and co-sponsor H.R. 5234, the PBM Audit and Transparency Act, which was introduced last May and is being considered again this session. The act states that pharmacy benefit managers (PBMs) cannot require patients to use a specific type of pharmacy and that their annual reports must disclose the number and total cost of prescriptions filled at retail outlets and through mail order.
Beraldi's involvement in the petition drive began after a patient brought him a letter from her employer, Nebraska Furniture Mart, a large local employer. The letter stated that full-time staffers would have to begin filling their long-term prescriptions through CVS Caremark's mail-order system or at CVS stores.
Some employers are taking a different approach. After NCPA executives contacted BB&T Corporation, it reversed its decision to include mandatory mail order in its healthcare plan.
"The executives at BB&T went away from mandatory mail order and looked at more cost-effective strategies. We showed them the benefits and cost savings that could be generated," said Zach French, vice president of PBM transparency initiatives for NCPA.
According to NCPA, community pharmacies generate savings for health plans by dispensing generic drugs at rates that are 10% to 13% higher than those of the largest mail-order facilities. "Community pharmacy has a higher rate of generic dispensing (71%) than any other practice setting, including mail-order pharmacy," stated a joint NCPA and NACDS letter to the governors and state medical directors of all 50 states.
As they did with BB&T, NCPA representatives provide data on community pharmacy to many corporate health-plan sponsors. "We also do this proactively and influence decisions before they are made. In most cases, we get a very warm reception. No one wants to go to mandatory mail order, but they want to restrict the costs of pharmacy management from going up," French said.