Under the Gun: Mandated Mail-Order Pharmacies

By: Brandon M. Macsata, CEO, ADAP Advocacy Association

At the heart of any successful disease management is informed consumer choice; without it, access to timely and appropriate health care services, and adherence to treatment options will likely suffer. HIV/AIDS disease management is certainly no exception. People living with HIV/AIDS must play a central role in determining their care and treatment options, which may -- or may not -- include the use of mail order pharmacy programs.

Mail-order pharmacy programs can serve an important resource for some people living with HIV/AIDS, including prescriptions delivered under the AIDS Drug Assistance Programs (ADAPs). Mandating such programs, as often is the case with some ADAPs and insurance carriers, can present numerous obstacles. Many patients and their advocates view these services as counterproductive, too.

Photo Source: MichRx Pharmacist Consulting Services, Inc

It is an issue that has routinely raised cautionary flags. So was argued in an earlier blog by Michelle J. Sherman, RPh, FASCP, AAHIVP, MichRx Pharmacist Consulting Services, Inc., "Many of these mail order pharmacies are owned and operated by the insurance company themselves. There are so many conflicts of interest in this behavior you would think the FTC [Federal Trade Commission] would put a stop to it, but instead they seem to turn a blind eye and is encouraged. In recent weeks, we have seen major insurance company mergers. Aetna spent $37 billion to buy its rival Humana; Centene spent $6.3 billion to buy Health Net and Anthem is close to a $47 billion deal to buy Cigna."

Mandating the care and treatment of any chronic disease posses numerous challenges. Among some of the most common challenges faced by patients include the potential breach of privacy, lack of oversight on negative drug interactions, lost/late shipments, and loss of face-to-face consultations with pharmacists. These challenges, as well as others, have led to several states banning, or attempting to ban the use of mandated mail order pharmacies—including Maryland, New York and Pennsylvania.

Now, Florida can be added to the mix of states aggressively tackling mandated mail-order pharmacy programs. Last week, Senator Rene Garcia (R, 38th District - Miami) and Representative Debbie Mayfield (R, 80th District - Vero Beach) filed legislation in the Florida Senate (S.B. 780) and Florida House (H.B. 583), respectively. The news was welcomed by advocates in the community.

In a statement issued by the AIDS Healthcare Foundation (AHF), David Poole, AHF’s Director of Legislative Affairs, argued, "...[T]he problem is these arrangements are often more focused on minimizing financial risk for the insurers and not focused on providing the patient or beneficiary with options that work best for the individual patient’s situation."

Bill Arnold, President & CEO of the Community Access National Network (CANN), echoed those sentiments when he summarized mandated mail-order pharmacies violate the right of every patient to choose how they wish to receive medications. He said, "The process over rules free choice for the patient, potentially exposes private health information to other present at the mail deliver site, and subverts the relationship of a patient with their local pharmacist. This relationship is  virtually important to many seniors and to many patients with life threatening and chronic diseases. The requirement fails the basic test of treating patients as American consumers.”

Most organizations, including the ADAP Advocacy Association, are not necessary opposed to mail-order pharmacy programs, but mandating that patients use these programs can pose significant barriers to care and treatment. It is paramount that patients, advocates, social workers and other stakeholders continue to monitor damaging policies, such as mandated mail-order pharmacies.

To that end, there is a free webinar being held on Wednesday, November 18th. The webinar - hosted by the ADAP Advocacy Association, and held in partnership with the Great Lakes ADA Center and the Community Access National Network - will focus on the challenges associated with mandated mail-order pharmacies. It will review three case studies, each presenting different obstacles presented by mandated mail order pharmacy programs and how best to overcome them. To register, go to http://www.adapadvocacyassociation.org/events.html.