Apply Valley Mayor and pharmacist Curt Emick commented on Anthem Blue Cross’ recent attempt to force patients who were being treated for HIV/AIDs to fill their prescriptions via mail order in a recent article that appeared in Fox & Hounds. Anthem’s mandatory mail order decision was only reversed after much public outcry and inquiries into their plans by California state officials.

Emick discussed his role as a critical aspect of ensuring that these high-risk patients manage their conditions: “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.”

He goes on to point out that Anthem’s mandatory mail order scheme was at it’s heart, a fundamentally unfair business practice. “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.”

In his conclusion, Curick urges the California state legislature to act now to prevent companies like Anthem from forcing patients into using mandatory mail order services. “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.”

For more information about the importance of pharmacy choice, visit Pharmacy Choice and Access Now today!

The Bay Area Reporter recently featured an op-ed by Chip Supanich, a member of the San Francisco HIV Health Services Planning Council and the Mayor’s Disability Council, arguing that mandatory mail order for pharmacy patients is a bad idea.

Supinach is concerned that patients fighting diseases (like HIV/AIDS) that require treatment with specialty drugs have something new to worry about: “whether their health insurance carrier will limit their ability to obtain prescription drugs from the pharmacy of their choice.”

Supinach points out that “mail order and community-based pharmacies are not interchangeable.” He argues that even though they both dispense prescriptions, patients can only get face-to-face counseling, monitoring, and other onsite health services from their community-based pharmacies. Supinach goes on to point out that adhering to prescription drug regimens can be a challenge to patients and the additional support from a pharmacist is essential to ensuring that patients take their meds as prescribed in order to help them live longer and have a better quality of life.

Anthem is arguing that the push for mandatory mail order is nothing more than a cost-cutting measure, but the fact that Anthem’s PBM and its mail order service offers another explanation (namely by forcing patients to use their mail order services, they’ll see increased profits while cutting down on the competition).

For patients in California, there might be some good news: California Assemblyman Chris Holden recently introduced legislation that would prevent insurance companies from partnering with in-state mail-order pharmacies to force patients to get their meds via mail-order.

And for those who believe that it won’t impact them, Supinach offers one final word of warning: “If Anthem Blue Cross succeeds in restricting patients’ rights and freedom of choice by implementing a mandatory mail order for its most vulnerable, chronically ill patients, isn’t it likely they have the same thing in mind for the rest of us?”

For more information on how mail order pharmacy can hurt patients in California, visit Pharmacy Choice And Access Now.

Eight million Americans are expected to gain health insurance through Medicaid next year under the Patient Protection and Affordable Care Act. But there is a lot of uncertainty as to whether states will cooperate and if there are enough providers to make the new system work.

An article in the Sacramento Bee this week discusses the concerns many have over an expanded health care system:

“Questions about the cost of the expansion, whether states will cooperate and a potential shortage of care providers has cast a cloud of uncertainty over the move as the nation’s rapidly evolving health care system readies for this rare jolt of newly insured patients – and whatever surprises come with them.

“The challenge is you don’t know who will show up until they show up,” said Matt Salo, executive director of the National Association of Medicaid Directors.

He said that nearly every state that has undergone a large expansion of its Medicaid eligibility has seen two things: “More people show up than you think will show up, and the people that show up are sicker than you expected.”

Our take on this is that pharmacists, in their evolving role, are here to help. While it’s true that pharmacies are the primary provider of prescription medications Americans rely on, the role of today’s pharmacies and pharmacists goes well beyond dispensing medications. Many now offer health products and services and play a critical role in delivering quality health care to people of all income levels and at all stages of life. As highly accessible-and trusted-health providers, today’s pharmacist assists patients with their health and wellness through counseling, medication therapy management, immunizations and testing, and more.

They are well-equipped and perfectly-positioned to help serve this growing group.

Please visit Pharmacy Choice and Access Now for more information on the role of pharmacists in health care.  

Last week, Drug Store News reported that Ninth Circuit Court of Appeals will hear a case that is critical to California pharmacies struggling under the reimbursement rate cuts put in place by the massive Medi-Cal budget cuts implemented this year.

A coalition of pharmacy and health care advocates filed suit following passage of the 10 percent cuts to Medi-Cal, and a California judge agreed with them, ruling to block the cuts. The case has since been appealed to the higher circuit court, which now holds the future of California’s community pharmacies in its hands.

As the Drug Store News article reports:

Because California Medi-Cal rates are already extremely low and many prescription medications are reimbursed at breakeven rates, many providers cannot afford to participate. Kaiser State Health Facts lists California as the lowest reimbursed state in the nation.

“We expect the appeal to be met with the same verdict Judge Snyder handed down in January, which is to block the Medi-Cal reimbursement cuts,” stated Jon Roth, CPhA CEO. “It’s very clear that if the state moves forward with Medi-Cal payment cuts, access to care for patients is sure to worsen. Many pharmacists throughout the state will have no choice but to turn away new Medi-Cal patients or be forced to stop accepting Medi-Cal all together, which will end up sending California’s poorest, most vulnerable citizens to the hospital or emergency room for care. In the end, California will lose far more many than the projected savings from the cuts.”

Pharmacy Choice and Access Now joins other pharmacy and health care advocacy groups in hopes that the Ninth Circuit will uphold the earlier ruling, and block these disastrous cuts, preserving patient access to critical pharmacy care.

Click here to visit PCAN online and find out what you can do to help fight back against Medi-Cal cuts!  

California approved moving patients enrolled in Medi-Cal, the state’s Medicaid program, to a managed care system last year, and the transition has been a rocky one for many California patients, according to an article in the LA Times. The purpose of the transition is to cut millions from the Medi-Cal budget to help the state’s rocky economy. A noble pursuit to be sure, but at what cost? If reforming Medi-Cal causes patients with disabilities, the elderly, and the chronically ill to lose access to the medical care they so desperately need, is it worth it?

According to the article:

But for some of these low-income seniors and disabled patients, the transition has been anything but smooth, forcing severely ill patients to give up their doctors, delay treatment and travel long distances for specialty care.

As of this month, the state has transitioned 333,000 people, many with diseases such as multiple sclerosis, lupus and metastatic cancer. State health officials said managed care oversees all of the patients’ treatment and guides them through the healthcare system, helping prevent unnecessary procedures and hospital visits.

Patients could apply for temporary exemptions if they wanted to stay on a fee-for-service plan, where the state pays doctors based on the specific treatment provided instead of a managed care general rate that is usually less. But the patients had to meet a high bar: They had to be in ongoing care for a serious illness and any change could cause their condition to deteriorate.

“The criteria is met by very few people,” said Susan McClair, senior medical consultant with the state Medi-Cal Managed Care Division.

One of the biggest issues with managed care continues to be access, as there simply aren’t enough providers that service managed care patients. The article goes on to report:

Shifting patients into managed care has been a “disruption” for many, in part because there simply aren’t enough specialists who will accept patients on Medi-Cal managed care, said Liz Forer, executive director of Venice Family Clinic. The patients’ complicated illnesses overwhelmed family practice providers at Venice Family Clinic, Forer said. They weren’t equipped to treat patients with end-stage organ disease, multiple types of cancer or Parkinson’s disease.

Managed care is not the solution for California. To find out how you can help fight back against this broken system, please visit Pharmacy Choice and Access Now today!