Missouri House bill would equalize copays charged pharmacy customers
Thursday, February 16, 2012
Pharmacists hope a bill in the Missouri House will give people more choices when it comes to filling their prescriptions.
Rep. Steve Hodges, D-East Prairie, has proposed a bill he says will put retail pharmacies on an even playing field with mail-order pharmacies.
House Bill 1581 would prevent health insurance companies from imposing copayment fees or other conditions on insured customers who choose local retail pharmacies if they are not also imposed on customers who buy from a mail-order pharmacy.
With most insurance companies, if a patient has a prescription for a three-month supply of medicine and chooses to refill it at a local pharmacy, the insurance company only allows the local pharmacy to fill a one-month supply and the patient is charged a copay each month they refill it, explained Abe Funk, a pharmacist at John's Pharmacy in Cape Girardeau. If that same prescription was refilled at a mail-order pharmacy in a three-month quantity, the patient would only be charged the copay once, Funk said.
"We have customers who come in that don't want to get their medicine through the mail. They want to deal with the person they've been dealing with for 20 years who knows them and can take care of them," Funk said.
Hodges, who previously owned a grocery store, said that he has a sympathetic heart for small businesses, which he calls key to small-town economies.
"A lot of small-town retailers have a hard time because they have a limited market. We need to keep this revenue in the state, instead of sending it to mail-order facilities out of state," Hodges said.
Also, going to the pharmacy has benefits customers don't get through the mail, Funk said.
"The pharmacist can look at you and see a lot of times if something's changed in your health care status," Funk said. "Sometimes it's something we can help them with or refer them to someone else."
Mail-order refills also take much longer to process, often leaving people without the medicine they need, Funk said. He's had customers who, while waiting for their mail-order prescriptions, ran out of their medication and were forced to have their doctor call in a refill for a few days' supply. But the insurance won't approve the prescription because it is shown as being processed at the mail-order facility. That leaves the customer either paying the entire cost out of pocket or going without, Funk said.
"This is a very important bill for the protection of fair trade in the pharmacy industry. We see more and more patients being either forced to use mail-order pharmacies or being enticed to do so with lower or no copay for their prescriptions," said Kevin Wood, pharmacist at Broadway Prescription Shop in Cape Girardeau.
The insurance company that manages the prescription benefits in many cases also owns the mail order pharmacy, retail pharmacists said.
Pharmacist Tripp Logan with Medical Arts Pharmacy in Sikeston, Mo. and L&S Pharmacy in Charleston, Mo., suggested this legislation to Hodges after seeing a similar law pass in New York last year.
"There has been a misconception that mail-order prescriptions are less costly to the health care system than retail prescriptions. This is simply not true and given their choice, most patients would prefer to fill their prescriptions locally," Logan said.
St. Louis-based Express-Scripts, which provides mail-order delivery for 54 million prescriptions, maintains its prescription services are more affordable and more accurate.
Michael Harrold, spokesman for Express-Scripts, said studies have shown people are more likely to stay on their medicine when using a mail-order pharmacy.
"It could discourage people from using mail order because it would decrease the financial incentive for the member and the health plan to go to mail order," Harrold said.
The legislation would also increase costs for both the plan sponsor and the patient, Harrold said.
The Federal Trade Commission's office of policy planning after reviewing the New York legislation released a report in August saying it would likely raise prices for, and reduce access to, prescription drugs.
A House committee hearing on Hodges' bill has not yet been scheduled.
East Prairie, MO