N.Y. Attorney General calls for Exemption to Mandatory Mail-Order Policy

New York Attorney General Eric Schneiderman has sent letters to 15 state health insurance providers, urging them to modify their policies to allow some members to fill specialty prescriptions at their local drug stores instead of by mail order.

Schneiderman gave them until June 17 to send a copy of their policy exempting members with certain illnesses from buying specialty drugs via mail order or from non-retail pharmacies, or to indicate when they planned to implement a policy. Specialty drugs are high-cost drugs used to treat complex or rare conditions, such as multiple sclerosis, hepatitis C and HIV.

“Every New Yorker deserves easy access to the benefits they pay for,” he said in a statement on Monday. “Exempting beneficiaries with qualifying hardships from mandatory mail-order requirements will allow plan members to continue to get drugs they need from their local pharmacies.”

In recent years, many health insurers have put in place policies that require members to buy drugs from mail-order or specialty pharmacies, which refill prescriptions by mail and focus on the distribution of expensive drugs for chronic illnesses. Other insurers offer incentives, such as lower co-payments, to members who use mail order.

Schneiderman said the letters were prompted by dozens of complaints his office received from health plan consumers who had concerns about mandatory mail order. These ranged from privacy issues to the spoiling of drugs that required refrigeration.

New York state law permits commercial plan members, or those with insurance not paid for by the government, to obtain any covered prescription at a retail pharmacy, rather than at a mail-order or non-retail pharmacy, as long as the retail pharmacy agrees by contract to accept the same reimbursement terms and conditions as the mail-order or non-retail pharmacy.

MAIL-ORDER LAWSUITS

Mail-order requirements have already spawned litigation in California, where a consumer watchdog group brought a lawsuit against Blue Cross of California in San Diego County Superior Court. The January lawsuit said that requiring people to obtain prescriptions by mail instead of in person violated patients’ privacy rights and is discriminatory to HIV/AIDS patients.

That suit settled in May, with Blue Cross agreeing to allow HIV/AIDS patients to opt out of its new mail-order mandate.

Late last year, Empire BlueCross BlueShield, one of New York’s largest healthcare providers, notified customers that as of Jan. 1, 2013, drugs on its “Exclusive Specialty Drug List” must be purchased through its specialty mail-order pharmacy.

The policy applied to drugs that were available from a single drug manufacturer and cost more than $1200 per month, including medications for treating serious and debilitating diseases such as Crohn’s disease, cancer, hepatitis C and HIV.

After negotiating with Schneiderman’s office, Empire agreed to exempt qualifying members from it’s mail-order mandate.

Schneiderman referenced the Empire exemption in the letters, saying that such policies “ensure access to critical medicines for consumers.”

The attorney general’s office did not specify which diseases should qualify for exemptions to mandatory online ordering.

The letters were sent on Monday to Aetna Inc, AXA Equitable Life Insurance Company, CDPHP, CIGNA, EmblemHealth, Inc, Excellus BlueCross BlueShield, Fidelis Care New York, Healthfirst, HealthNow New York Inc, Independent Health, MVP Health Care, Oxford Health Plans, LLC, The Guardian Life Insurance Company of America, UnitedHealth Care and WellPoint, Inc.

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