Industry Divided on Bill To Let Patients Opt Out of Mail-Order Rx

While provider and patient advocacy groups are throwing their support behind a bill (AB 2418) that would allow patients to opt out of insurers' mail-order prescription requirements, insurers and some pharmacies oppose the measure, Payers & Providers reports.

Background on Bill

This week, the Senate Health Committee is considering the Assembly-passed bill.

The measure would give about one million Californians whose health plans require them to order prescriptions through the mail an option to waive that requirement.

Data from the Pharmacy Benefit Management Institute show that about 25% of large employer health plans require drugs to be dispensed by mail. About one million California residents currently are enrolled in such plans, according to Payers & Providers.

Support for Bill

According to Payers & Providers, the bill is supported by:

• Drug and grocery retailers;
• The California Association of Physician Groups;
• The California Pharmacists Association;
• Labor unions; and
• Senior advocacy groups.

Assembly member Susan Bonilla (D-Concord), the bill's sponsor, said it "creates processes that improve patients' access to medications and encourages interaction between patients, pharmacists and doctors to ensure patients receive their medications in a timely, convenient manner."

Insurers, Some Pharmacies Oppose Bill

However, the measure is opposed by:

• Anthem Blue Cross;
• Blue Shield of California;
• The California Association of Health Plans;
• CVS Caremark; and
• Express Scripts.

The Pharmaceutical Care Management Association this week launched a campaign against the bill that includes the release of a study finding that mail-order pharmacies save about 16% more than brick-and-mortar pharmacies, including $500 million in savings next year on regular prescription medications. However, the study also noted that standalone prescription drugs often were more costly through mail-order pharmacies.

PCMA CEO Mark Merritt said the bill "profits the drugstore lobby by eliminating a safer, more affordable pharmacy option that many employers have embraced."

He added, "Automatic home delivery of refills is among the easiest, most popular ways to reduce pharmacy costs. Many employers and patients see it as a much better option than cutting benefits or raising premiums," and "AB 2418 could compromise this cost-saving tool" (Shinkman, Payers & Providers, 6/26).