New York Attorney General Sends Letter Urging Health Plans to Reconsider Mandatory Pharmacy Rules

The letters ask 15 health insurance companies in New York to adopt a "Specialty Prescription Drug Fulfillment Hardship Exception Criteria" so that patients who want to get their specialty prescriptions at a community pharmacy may do so without penalty.

The letters ask 15 health insurance companies in New York to adopt a “Specialty Prescription Drug Fulfillment Hardship Exception Criteria” so that patients who want to get their specialty prescriptions at a community pharmacy may do so without penalty.

A.G. Schneiderman, the Attorney General of New York, today sent letters to 15 health insurance companies asking them to permit certain beneficiaries to fill their specialty prescriptions at their local retail pharmacies.

The request was made in response to the numerous “hardship” complaints submitted to the office’s Healthcare Bureau Helpline about pharmacy mail-order requirements.

Earlier this year, Schneiderman was responsible for brokering a similar deal with Empire BlueCross BlueShield after complaints about its mandatory pharmacy policy were received. This policy mandated that members with prescriptions for drugs on Empire’s “Exclusive Specialty Drug List” have them filled through CuraScript. Beneficiaries complained that this rule caused “undue hardship,” such as compromised privacy, delivery and drug spoilage issues, and dosage change problems, according to the letters from Schneiderman’s camp.

Although Empire agreed to exempt certain “qualifying” members from its mandate, the retail pharmacy filling the specialty drug must agree to provide and maintain certain clinical services, including disease management programs, and a toll-free hotline to pharmacists and patient care advocates. Whether a patient would qualify to opt-out of the mandatory pharmacy program would be up to each health plan’s discretion, a representative from Schneiderman’s office said over the phone.

“Exempting beneficiaries with qualifying hardships from mandatory mail-order requirements will allow plan members to continue to get the drugs they need from their local pharmacies,” Schneiderman said in a press release. “I commend Empire for taking this step and strongly encourage all insurance plans operating in New York to do the same.”