This week, seven physician groups began fighting back against forced mail-order pharmacy for specialty medications. They cited many concerns including delays of medications to patients, lack of temperature control, communication issues, and increased costs.
Blue Cross Shield of Tennessee responded that specialty pharmacy (mail-order) wasn’t of any greater risk than getting medications from a wholesaler.
I, along with many other patients, caregivers, physicians, and pharmacists strongly disagree.
Blue Cross Blue Shield of Tennessee, this is not true. When patients must work with a mail-order specialty pharmacy, the issues start with poor communication. Although this is an issue with specialty mail-order pharmacies, I haven’t heard complaints about the communication issues with wholesalers.
Optum RX, CVS Caremark, and Express Scripts are pharmacy benefit managers (PBMs) that own their own mail-order pharmacies. Some PBMs that own mail-order pharmacies outsource their customer service to other countries making simple tasks such as refilling a medication as seen here quite difficult. There are issues with hold times, multiple transfers, and simply acknowledging a prescription. I spoke with a pediatric transplant coordinator that states that they cannot keep up with all of the issues with mail-order pharmacy. The coordinator stated, “This doesn’t make sense. At one time, we could hand the prescription to the patient and they would go to the pharmacy and have the medication in hand in 15 minutes.” Now, the same medication is taking hours of coordination from nurses and 3-7 days for patients to receive. Many other physicians have informed that they have hired additional staff to handle the issues.
Blue Cross Blue Shield of Tennessee stated that they can have medications shipped as soon as the next day. We know that medications can be shipped the next day. Will they be?
Express Scripts has informed some patients to allow 3 weeks for processing a refill request. 3 weeks vs 15 minutes to an hour. Per Kidshealth.org, “If you want to use the mail-order option, plan ahead because it may take up to 2 weeks to get your medicine.”
If medications are lost, damaged, shipped to the wrong address, or stolen, add another 5-7 days. For a patient whose life or ability to function relies on a medication, the toll of a delay can be debilitating and life-threatening. I see and hear these patients' stories daily.
Blue Cross Blue Shield of Tennessee claims that they and employers will save money by forcing patients to mail-order. It’s a common statement from insurance companies and their pharmacy benefit manager. Often, the insurance company and PBMs are affiliated with the mail-order pharmacy that they are forcing patients to use.
Sadly, evidence across our nation proves that PBMs are price-gouging more than saving money as they steer to their affiliated mail-order pharmacy. Many researchers have found that the steering to specialty pharmacies creates a lack of transparency that allows for the price gouging of taxpayers, patients, and employers.
Is it a coincidence that the steering to mail-order pharmacies has strongly increased as our independent pharmacists across our nation have successfully demanded that the gag clauses be removed? The gag clauses kept pharmacists from telling patients that they would be able to afford their medications if they paid cash instead of using their insurance & paying their copay.
Also, many patients currently complete their infusions at a setting in a provider's office. Some physicians have cited that the PBMs and insurance companies are forcing patients to go to the hospital to complete their infusions. Many patients see this as an unnecessary risk.
A press release by the American College of Rheumatology states,
“The predictable result of this policy will be a shift in site of care for your patients’ infusions to a more expensive hospital outpatient setting, which may serve as a significant barrier to their access…” the letter states. “Not only will treatment costs be higher in the hospital setting, but there will be a predictable minority of patients who due to their inconvenience, the higher out-of-pocket cost, or simply fear of the unknown, will drop their treatments when transferred to this setting, and their overall healthcare costs will predictably rise as their diseases flare.”
The letter goes on to share that some patients may lose access altogether, because not all hospital facilities accept medications from outside specialty pharmacies, and that any savings to insurers that were derived from PBMs negotiating drug prices for their specialty pharmacies would likely be offset by drug waste and higher point-of-care costs.
There are costs that are not figured into BCBS of Tennesee’s figures, because no one is regulating the mail-order pharmacies or adequately tracking the costs to the reduced access to pharmaceutical care. The insurance companies and PBMs act as though the pharmacy patient relationship has no value. That’s just not true.
When my son went into transplant rejection after a mail-order pharmacy shipped is liquid oral transplant medication on a 102-degree day, the costs for the hospitalization and testing was over $100,000. Specialty pharmacies fail to tell our employers that most medications will ship in only a bag in all temperature extremes. They fail to admit that no one is tracking the exact temperature of the inside of the mail-box or UPS trucks.
When patients don’t receive their medications on time and they lose their ability to function or work due to a deteriorating condition, this is an additional cost to our employers. The costs are most often just passed onto the employees. The PBMs and insurance companies know that this is not being tracked.
Also, the waste is not being tracked. Several patients have reported receiving thousands of dollars in medications that they didn’t ask for or want but the specialty mail-order pharmacy continued to send medications. Several physicians have stated that this has caused some patients with chronic conditions to become confused about what medications they are supposed to take. Some physicians have cited that patients had overdosed on medications due to the confusion. This shipping of medications is what the PBMs call adherence, meaning that the patients get a green checkmark indicating compliance with their medication schedules. The PBMs will then use this information to tell our employees how wonderful patients adhere to their meds. Again, no one is tracking or penalizing the PBMs and their mail-order pharmacies for the millions of dollars in waste.
Pharmaceutical care from the hands of pharmacists and staff who patients have developed a personal relationship with has a value that the PBMs and insurance companies are not being truthful about as they cut these relationships completely out of patients' healthcare and force patients to an 800#, usually a plastic bag, and a standard delivery service.
It’s time that our employers, government officials, and regulating authorities start acknowledging and safeguarding this value and put a rapid halt to the decline in our pharmaceutical care.
https://www.change.org/p/stop-forcing-mail-order-pharmacy/u/25760196
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Tell your story: loretta@uniteforsafemeds.com