Pharmacy choice battle raging in Colorado

April 26, 2016

Pharmacy benefit managers (PBMs) such as Express Scripts are aggressively opposing the legislation, saying it will increase overall healthcare costs.

The legislator behind Colorado’s “Pharmacy Choice Act”, which specifies that state residents eligible for prescription drug benefits be allowed to fill the scripts at any pharmacy, says he is not opposed to mail order pharmacy.

Rep. Jon BeckerBut pharmacy benefit managers (PBMs) such as Express Scripts are aggressively opposing the legislation, saying it will increase overall healthcare costs.

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Rep. Jon Becker (R-Fort Morgan) and Rep. Dianne Primavera (D-Broomfield) introduced House Bill 16-1361 earlier this year. It recently passed the house and will now go to the senate for consideration.

The bill would allow patients, rather than PBMs or insurance companies, to choose where they fill their prescription. If a pharmacy falls outside of an insurance company’s network, patients would be able to fill their scripts at the pharmacy of their choice at no extra charge.

Surprisingly, independent and chain pharmacies thus far have been quiet on the legislation. “The chains all stayed out of it. They understood the argument when I spoke with them, but didn’t want [to get involved],” Becker told Drug Topics.

In addition, the Colorado Pharmacists Society refused to issue a public statement on the legislation to Drug Topics.

 

Twenty-seven states have similar laws, according to Becker. “This wasn’t against mail order,” he said. “It is just allowing you, if you wanted, to keep dealing with the local pharmacy that you have been dealing with for years.”

However, Express Scripts is opposing the legislation because: “These laws further increase overall healthcare costs by prohibiting plan sponsors from establishing copay incentives for patients to choose higher quality or more affordable pharmacies,” David M. Whitrap, senior director of corporate communications for Express Scripts, told Drug Topics.

In addition, 16-1361 and similar bills “limit the ability of the organizations that hire us, employers, unions, government agencies and health plans, to create their own pharmacy networks and negotiate more affordable pricing,” Whitrap said.

Whitrap said these types of laws require plan sponsors to contract with pharmacies that, because of concerns around fraud and abuse, the plan sponsor would not on its own choose to include in their networks.

Becker insists that Express Scripts is simply “fighting for their monopoly.” He expects an uphill battle in the Republication-controlled Senate.

“Our largest hurdle is [a legislator] thinking we are getting in the middle of contract negotiations between insurance companies and pharmacies. We want to make people realize that, you are mandated to have insurance and you should be able to have a choice about where you are able to use that insurance,” Becker said.