New Yorkers are being forced to use mail order pharmacies for many medications despite their clear preference to obtain their prescriptions from a local pharmacy.
In 2011 the NYS Anti-Mandatory Mail Order (AMMO) insurance law was passed to guarantee New Yorkers on private health plans the option to obtain prescription medicines through their local pharmacy as well as through mail order. However, language added to the bill after its passage enables insurers to impose “terms and conditions” on member pharmacies that limit their reimbursement. Specifically, medicines categorized as “specialty drugs” are not being reimbursed. These include, but are not limited to, drugs to treat hepatitis, HIV, cancer, mental health conditions, hemophilia, and many others. The loophole is impeding the intended effect of the law: New Yorkers are still essentially being forced to use out-of-state mail order pharmacies for many medications (even when cost is the same).
What is the Anti-Mandatory Mail Order (AMMO) Pharmacy Bill?
The Anti-Mandatory Mail Order (AMMO) Pharmacy Bill will remove language allowing “special terms and conditions” to be imposed on pharmacies, thus restoring consumer access to both options for all covered medications.
Why is it important?
For some patients, mail order pharmacies are a convenient way to get medications. For others, mail order fulfillment results in negative consequences ranging from inconvenience and loss of privacy to health-threatening treatment barriers. Among issues consumers have had with mail order pharmacies:
• Delays – Mail fulfillment can cause dangerous treatment delays due to medication being lost or stolen or spoiled from being left outside. Patients have a right to receive their medicine intact and on time.
• Cost – The patient may be required to pay full cost for replacement medicine. Patients have a right to pick up their prescription locally to avoid this cost.
• Loss of Privacy – Sending medicine via mail exposes it to any number of people en route as well as family members or neighbors who may receive it in error. Residents of apartments and rural areas, as well as those without a full-time address, often lack a secure place to receive deliveries. Patients have a right to privacy regarding their illness and medications, especially if they are more sensitive to discrimination, like people affected by Hepatitis C and HIV.
• Lack of State Oversight and Protection – Patients do not have recourse to deal with problems encountered through out-of-state mail order pharmacies. In-state pharmacies are staffed with NY licensed pharmacists and regulated by the NYS Board of Pharmacies. Patients have a right to recourse with their state officials if they feel standards are not being followed.
In addition, mail order fulfillment may deprive patients of personal, trusted and culturally or linguistically competent counsel and service from their local pharmacist. People with complex medical conditions are more likely to ask for and follow medical advice from someone they know and trust. Treatments for diseases like hepatitis C and HIV may require multiple medications that need to be prepared or specially administered. Community pharmacists develop relationships with local residents and know their medical histories and help with medication adherence and prevention of dangerous drug interactions. Consumers have a right to these benefits.
The Bill was passed by the NYS Assembly on June 9, 2015, passed to the Senate and referred to the Insurance Committee. In the Senate the bill is directly sponsored by a bi-partisan group of 27 Senators not including leadership (32 are needed for the bill to pass). It must however pass out of committee before it can be considered for a full Senate vote
What Can you Do?
1. Contact members of the Insurance Committee and your Senator to remind them that they should take action to bring Bill S.2530 (Golden) / A.6194 (Joyner), the “Anti-Mandatory Mail Order” fix bill, to a vote so that consumers, not insurance companies, may exercise their right to choose whether to receive medications by mail or from a local pharmacy.
2. Stay tuned to this page for updates.