State officials and the courts should act to prevent California’s most vulnerable patients from losing their freedom to obtain their prescription medications from their local community pharmacists.
Last December, the media reported that Anthem Blue Cross had planned for a single mail-order pharmacy, CuraScript, to be responsible for filling all prescriptions for patients who require drug treatment to treat complex illnesses as a result of HIV/AIDS.
By March 1st, these patients would have no longer be able to visit their local pharmacy for these medications, but would have been forced into the mandatory mail-order program had it not been for the public outcry and inquiries into Anthem’s plans by state officials. Anthem has since reversed it’s decision.
As a community pharmacist, the health and wellbeing of my patients is very important to me. Along with a patient’s physician and other health providers, I play a critical role in helping people get well, or manage their conditions if a full recovery is not possible. Today’s prescription drugs offer great promise for treatment of HIV+ patients. They are also very powerful, and must be taken exactly as directed, with a sharp eye toward avoiding harmful interactions and adverse side effects.
My role is to educate patients about the medications they are taking, and to counsel them to ensure they get the most benefit from their medications. My patients benefit tremendously from this relationship. They find comfort in knowing that I am monitoring their health needs and advising them about this important aspect of their care. I am also able to offer them other opportunities to improve their health, such as getting a flu shot onsite, or notifying their physician if their medication needs to be adjusted. But this type of face-to-face, one-on-one contact will be lost under a mandatory mail-order scheme.
What Anthem was proposing is also a fundamentally unfair business practice that is, unfortunately, growing more common in the health-care world. A health plan, in this case, Anthem, hires a pharmacy benefits manager (PBM), in this case, Express Scripts, to administer its pharmacy program. The plan then requires that beneficiaries obtain their prescription medications exclusively from a mail-order facility, in this case CuraScript, which (surprise!) is owned by Express Scripts.
Patients have no choice in the matter and other pharmacies, including chain and independent drug stores, cannot compete for their business. Patients cannot “vote with their feet” if they are getting poor service from the mail-order company by choosing another pharmacy.
I’d like to thank Attorney General Kamala Harris for looking into the matter to see if Anthem’s policy would have been a violation of California law banning discrimination on the basis of one’s medical condition.
For the benefit of chronic care patients, and for the pharmacy community that serves them, it is important that the state now act to prevent other companies from considering policies similar to what Anthem nearly implemented and prevent more patients from being subject to mandatory mail-order requirements. If Anthem or other companies were to be successful in mandating the use of mail-order pharmacies, the end result will be patients having fewer choices about their care and their health could suffer if they lose access to their local pharmacy.
Curt Emick is the Mayor of Apple Valley and has more than three decades of experience as a Pharmacist in the Inland Empire.