All posts by pharmacyaccess

California Legislature Should Protect Patients’ Rights to Choose a Pharmacy

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!

Op-Ed: Mail Order Pharmacy Mandates Hurt San Francisco Patients

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.

Pharmacists Can Help Offset Uncertainly in an Expanded Healthcare System

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.  

Lawsuit Alleges Blue Cross Keeping HIV/AIDS Patients Out Of Pharmacies

A new lawsuit filed in California this week alleges that Blue Cross is discriminating against HIV/AIDS patients, among others, forcing patients with certain preexisting conditions to use mail-order only for their pharmacy care.

From the Fox 5 San Diego report:

Under the new program, HIV/AIDS patients’ insurance policies will no longer cover medications at local pharmacies, according to the suit filed Friday by Consumer Watchdog, a nonpartisan consumer advocacy organization with offices in Washington, D.C., and Santa Monica.

HIV/AIDS patients will instead be required to purchase their prescription drugs from a mail order pharmacy, while Blue Cross members who do not suffer from one of the targeted conditions under the same policies will continue to enjoy full access to the pharmacies of their choice, according to the suit.

Health plans and pharmacy benefit managers (PBMs) forcing patients to lose access to their trusted community pharmacist and instead receive medications through the wasteful mail order system deprives these patients of a much needed health care provider.

For patients with chronic illness, their pharmacist is a key player in their ongoing care, and often the provider they speak to the most. For a plan to deny them of that relationship is harmful.

To learn more about how mail-order pharmacies hurt California patients, visit Pharmacy Choice and Access Now today!

Medi-Cal Reimbursement Case Heard By Ninth Circuit Court

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!  

Medi-Cal, California Budget Woes, and the ACA

The unfortunate facts are what they are: California’s fiscal hardships are just as bad as you thought, possibly worse. According to a new report released this week, the cost of Medi-Cal in particular has put a real strain on California’s budget.

From coverage of the report this week:

Tops on the list of concerns in the report is the high cost of Medicaid, the federal program providing health care for the poor or disabled and administered here in California via the state program Medi-Cal. Funding for the health care services, and rules about eligibility and spending, are shared between states and the feds.

“The rapid growth in Medicaid spending has pushed aside other types of state spending,” says the report.  “Both the states and the federal government need to find ways to contain and control Medicaid costs.”

Regarding Medi-Cal, the question remains what will happen to the program–and how it will impact the budge–under the new Affordable Care Act, which a Daily News report indicates will provide health care (in part through Medi-Cal) to over 2 million residents in Los Angeles alone.

One pharmacist argues this week that the ACA will provide more competition to insurance companies, which could benefit health care providers and provide incentives for offering better care–competition could mean higher reimbursements.

From the article:

As a local pharmacy owner, […]the cash price of prescription drugs is not “stunningly less” than the insurance price. Insurance companies have been squeezing reimbursements to ALL healthcare providers (including pharmacies) over many years now, and have funneled money away from providers (who take care of patients) in order to boost corporate profits. […] those who have health insurance are ALREADY paying for the uninsured through the outrageous and ever increasing premiums that we pay. Being a business owner who provides generous benefits to my employees, I can attest to this fact first-hand. And the insurance companies, unchecked by real competition (that a government supported exchange would otherwise provide) keep raising their premiums at will.

California Patients Struggling Under Managed Care

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!

Redondo Beach Pharmacist Urges Support of SB1195

Independent pharmacist Odette Leonelli owns a small pharmacy in Redondo Beach. Like many small businesses, the pharmacy has struggled in recent years due to economic hardship, but they have survived. The bigger threat to small pharmacies, according to Leonelli, is not the economy, but the abusive auditing practices of large pharmacy benefit managers (PBMs), the companies who control a large portion of the prescription drug industry in this country, including pricing and pharmacy reimbursement rates.

According to Leonelli’s opinion piece in the Redondo Beach Patch this week:

Small, independent pharmacies like mine have survived many economic downturns-including the Great Recession-and have adapted to technology and the changing needs of our customers. But we face a formidable foe in the large pharmacy benefit management companies (PBMs) that manage prescription drug benefits for more than 215 million Americans. PBMs manage prescription insurance claims, and pharmacies of all sizes must enter into contracts with them in order to serve patients.

Leonelli goes on to describe the frequently unfair PBM auditing process, which has a direct impact on the pharmacy business, particularly smaller, independent pharmacies. Leonelli argues that PBMs use this process to “bully” smaller pharmacies:

Right now, there are no uniform auditing standards, so pharmacies are subject to whatever “rules” a PBM sets up. Because the PBMs keep the money they recover from a denied claim, they have a strong financial incentive to deny every claim.

As a result of abusive audits, pharmacies are required to spend excessive amounts of time documenting each pharmacy claim and surviving the audits.  This is time that would be much better spent on patient counseling and care.

So, for relief, we are asking our state legislators to support state Sen. Curren Price’s bill to establish fair standards for pharmacy audits and prevent claims from being denied based on minor technicalities. SB1195 maintains the right of a PBM to audit the claims of pharmacies to identify fraud and invalid prescriptions, but takes away the incentive for the PBMs to deny as many claims as possible. It brings fairness to the audit process.

This legislation is pro-small business, pro-patient, and will not cost taxpayers a dime. It deserves the full support of the Legislature.

To learn more about how PBM’s are hurting California’s independent pharmacies, and find out what you can do to help, please visit Pharmacy Choice and Access Now.  

Study: Less is Not More in Medicaid Managed Care

With state budgets in bad shape, many legislatures are turning to cutting state programs in desperate attempt to stem the tide of deficits. Among these plans is the move to shift Medicaid patients to a managed care program, which is happening in states such as Texas and Florida. Many see this as a way to save millions of dollars for state budgets, but this plan will only cost more in the long run.

According to a report from Bloomberg (emphasis ours):

Bloomberg Government health-care policy analyst Christopher Flavelle looked at managed-care plans in the five most populous states, including New York and California. His Bloomberg Government Study found large managed-care plans provided health care that was significantly and consistently worse than the national median.

For patients, the outcome may mean poorer health care. For states, the outcome may be higher costs when patients return to the system with more serious conditions.

Some states are starting to penalize the private managed-care providers because they perform poorly. The managed-care providers face the choice of doing a better job, or betting that states will continue to tolerate poor results.

This is not the first evidence that managed care systems are not a good solution for Medicaid, nor will it be the last. The only question remaining is whether states will listen, and take steps to course correct.

Managed care is bad for patients, and is also bad news for health care providers such as hospitals, doctors, and pharmacies. Many pharmacies under managed care will be forced to make the choice between remaining open and barely turning a profit, turning away longtime Medicaid patients they can no longer afford to service, or shutting their doors altogether. This is unacceptable.

Join Pharmacy Choice and Access Now, and fight back against managed care for Medicaid!

Medi-Cal Cuts Hurt California’s Most Vulnerable

California is in the midst of another budget crisis, and Governor Brown is looking to take $1.8 billion from the state’s Medicaid program, known as Medi-Cal, to help make up the shortfall. As part of the cuts to the Medi-Cal program, the governor’s plan includes cutting funding for hospitals and nursing homes. For many members of California’s most vulnerable and frail populations, this will mean more cuts to health care services that they rely on and loss of access to life-saving medications.

According to a local news report:

For many of those who rely on Medi-Cal to live as normal a life as possible, the proposed cuts will have major consequences.  Eva Crump turns 86 next month and says it’s scary for her to think about more cuts to her Medi-Cal benefits… A diabetic with a recently diagnosed heart condition, Crump relies on Medi-Cal to get the medicine she needs to live an independent life. “There are so many of us that need these facilities to get out and be taken care of without having to go into a bed and care home or something of that type”, Crump says, “its just like a God-send to have it available.”

Medicaid cuts at the state level are hurting seniors nationwide, with many of these types of budget cuts resulting in loss of access to some of their most vital health care services. In additional to hospitals, nursing homes, and senior care centers feeling the impact of state budget slashes, community pharmacies are often forced into an impossible predicament when reimbursement rates are lowered. Do they turn away valued and loyal customers, many of whom rely on their pharmacist as one of their primary health care providers? Or do they shut their doors, unable to stay in business and still service their Medicaid-dependent clientele?

One thing is clear: in situations like the one in California, there are no winners. Medi-Cal recipients like Eva Crump are hurting, health care providers are hurting, and community pharmacies are hurting. Surely there are other ways to solve a state’s budget woes than to cut access to vital services for the most vulnerable populations?

To find out more about Medicaid cuts and how they will impact seniors, community pharmacy access, and more, visit Pharmacy Choice and Access Now.