Health plans should let customers fill specialty prescriptions at retail, N.Y. attorney general says
NEW YORK — The state attorney general of New York is urging health insurers to let patients buy specialty drugs through retail pharmacies instead of having to use mail-order.
In a letter sent to 15 New York-based health insurance plans, Eric Schneiderman said they should adopt "specialty prescription drug fulfillment hardship exception criteria" similar to the one the office helped negotiate earlier this year with Empire BlueCross BlueShield. The letters were sent to Aetna, AXA Equitable Life Insurance Co., CDPHP, Cigna, EmblemHealth, Excellus BlueCross BlueShield, Fidelis Care New York, Healthfirst, Healthnow New York, Independent Health, MVP Health Care, Oxford Health Plans, The Guardian Life Insurance Company of America, UnitedHealth Care and WellPoint.
"Every New Yorker deserves easy access to the benefits they pay for," Schneiderman said. "Those suffering from debilitating diseases like cancer, rheumatoid arthritis and HIV should not be made to suffer further hardship to get prescription drugs that are critical to their care. Exempting beneficiaries with qualifying hardships from mandatory mail-order requirements will allow plan members to continue to get the drugs they need for their local pharmacies."
Following dozens of complaints to its helpline when Empire members received notification that they would have to obtain their drugs through mail-order via Express Scripts' CuraScript specialty pharmacy starting on Jan. 1 in order to obtain coverage, the office's healthcare bureau negotiated with the insurer, leading it to allow exemptions from the mandate. Under New York state law, a commercial health plan member can obtain any covered prescription at a retail pharmacy as long as the retail pharmacy agrees by contract to accept the same reimbursement terms as the mail-order or other non-retail pharmacy.
Last week, Anthem Blue Cross settled a lawsuit filed by an advocacy group representing several specialty pharmacies and their patients in California who had sued after receiving a similar notification in mid-November.
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