Recently, Anthem Blue Cross announced that it would require some of its plan subscribers to use a mail order pharmacy to obtain their medications. Specifically, those who depend on what Anthem has termed as “specialty drugs”, including HIV treatments. Such individuals will now have to obtain them through CuraScript, a mail-order pharmacy owned by Express Scripts, the carrier’s pharmacy benefit manager (PBM).
In some states, some HIV-positive beneficiaries are already experiencing problems with this type of change. In California, people who need to or would prefer to get their medications from their local pharmacies would no longer have had that option on March 1st. Luckily, in California, Anthem Blue Cross backed down and its beneficiaries who use “specialty drugs” can continue to get them from their local pharmacies. We’re concerned, however, that while this battle has been won there will be others to come.
Project Inform remains concerned that Anthem’s attempt to limit beneficiary choice could resurface or may signal attempts by other plans to limit choice. Taking away an individual’s choice of pharmacy provider could result in negative health outcomes and potential barriers to care for some living with HIV and other high-cost conditions.
While mail order is a good option for some with HIV, for others it is not. Medical literature consistently acknowledges the critical role pharmacists play in the delivery of an effective drug treatment regimen, especially for persons with chronic life-threatening conditions like HIV and cancer. Mail order pharmacy for these patients can interrupt and inhibit the patient-centered approach to care and lead to fragmented management of the essential elements utilized to ensure persons with HIV’s adherence success and positive clinical outcome. Additionally, a mail order pharmacist does not have consultative relationships with the prescribing providers.
Pharmacists at retail pharmacies can offer face-to-face, personalized counseling, monitoring, attention to side effects and potential drug interactions as well as support with medication adherence challenges. Many people with HIV have been getting their medications from the same pharmacy for many years and have developed strong relationships with their pharmacist. A trusted pharmacist can be an effective advocate if an individual faces complex coverage and medication access issues and is often able to supply small amounts of necessary drug to bridge gaps in coverage that could otherwise mean a serious treatment interruption.
There are other factors that could make mail order inappropriate for some. With the advent of USPS cost containment mechanisms such as stopping Saturday deliveries, people could find themselves without necessary medications for a period of time. Anonymity may also be important for some with stigmatized diseases like HIV; deliveries to mail boxes and/or door steps can’t assure that. Security of medication delivery is critical for those with HIV and other diseases who rely on daily medication and in some instances can’t be assured through mail order. For HCV medication, which frequently requires refrigeration, there may also be significant complications with mail order delivery.
Project Inform supports California Assembly Bill 299 (AB 299), introduced by Assemblymember Holden. AB 299 would make it illegal for insurance companies to require beneficiaries to receive certain types of medications through the mail. It is the right step to ensure that patient choice, not cost, drive appropriate HIV care as well as care for other conditions.
Great strides have been made in fighting HIV through effective treatment. Anti-retroviral drugs now available make it possible for people with HIV to live longer, and have a better quality of life, than those who contracted the illness years ago. In addition, effectively treating HIV dramatically lowers the risk of transmission. However, adhering to an effective treatment regimen can be challenging and a trusted relationship with a pharmacist can provide the support to meet those challenges.
Please join us in supporting California Assembly Bill 299. It will prevent insurance companies from limiting beneficiary pharmacy choice and ensure that patient care is driven by best practices not cost.