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Health plans should let customers fill specialty prescriptions at retail, N.Y. attorney general says

BY Alaric DeArment

NEW YORK — The state attorney general of New York is urging health insurers to let patients buy specialty drugs through retail pharmacies instead of having to use mail-order.

In a letter sent to 15 New York-based health insurance plans, Eric Schneiderman said they should adopt "specialty prescription drug fulfillment hardship exception criteria" similar to the one the office helped negotiate earlier this year with Empire BlueCross BlueShield. The letters were sent to Aetna, AXA Equitable Life Insurance Co., CDPHP, Cigna, EmblemHealth, Excellus BlueCross BlueShield, Fidelis Care New York, Healthfirst, Healthnow New York, Independent Health, MVP Health Care, Oxford Health Plans, The Guardian Life Insurance Company of America, UnitedHealth Care and WellPoint.

"Every New Yorker deserves easy access to the benefits they pay for," Schneiderman said. "Those suffering from debilitating diseases like cancer, rheumatoid arthritis and HIV should not be made to suffer further hardship to get prescription drugs that are critical to their care. Exempting beneficiaries with qualifying hardships from mandatory mail-order requirements will allow plan members to continue to get the drugs they need for their local pharmacies."

Following dozens of complaints to its helpline when Empire members received notification that they would have to obtain their drugs through mail-order via Express Scripts’ CuraScript specialty pharmacy starting on Jan. 1 in order to obtain coverage, the office’s healthcare bureau negotiated with the insurer, leading it to allow exemptions from the mandate. Under New York state law, a commercial health plan member can obtain any covered prescription at a retail pharmacy as long as the retail pharmacy agrees by contract to accept the same reimbursement terms as the mail-order or other non-retail pharmacy.

Last week, Anthem Blue Cross settled a lawsuit filed by an advocacy group representing several specialty pharmacies and their patients in California who had sued after receiving a similar notification in mid-November.


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J.Ward says:
Jun-12-2013 11:22 pm

No sale. Specialty pharmacies did not invent helping people obtain financing or expediting PA's. Our numbers don't add up to millions per month, but we consider these practices part of routine good business. It's not about specialty vs. community pharmacies. The real distinction is good vs. poor service. (BTW...your numbers are truly impressive! If you help people obtain millions per month, and you are helping 50% of your patients, conservatively I estimate your store must do roughly $50 million per year. That's a busy store.)

J.CIVITELLO says:
Jun-07-2013 08:30 am

I agree with this comment but only in part. Yes, specialty pharmacies do perform extra care duties like obtaining PA's and educating the patients about their meds, but the fact is that only certain specialty pharmacies are currently being used by the insurance companies. As an owner of a specialty pharmacy in New York whose client base includes HIV, HCV, and Oncology patients, our specialty pharmacy does not get equal access to service these patients. You are correct to say that specialty pharmacies provide a better clinical support and service to these patients, but if a specialty pharmacy meets the criteria to do so, then they should be included in these often closed networks. By doing so, you allow more access to patients to use a local specialty pharmacy and not have to wait for their meds to be delivered from some out of state mail order pharmacy.

mcrowe says:
Jun-05-2013 08:54 am

I am a pharmacist at Diplomat Specialty Pharmacy. Yes, there are some specialty pharmacies that provide very poor service to their patients as described in this story. And yes, I admit that I'm biased. However, there are benefits to using a specialty pharmacy that I don't believe are being considered here. The whole basis of the formation of specialty pharmacies is that the diseases specialized in are rare, the medications are extremely expensive, and most community-based pharmacists do not have enough experience in these diseases to be providing care for the patients. You cannot have every community pharmacy in the country maintaining an inventory of these medications. And, even if the community pharmacies can dispense a patient's specialty medication (many are not able to because the medication is limited distribution and not available to them), they are going to have to order it. Specialty pharmacies, when necessary, ship these medications next-day. And many specialty pharmacies provide services to patients that the community pharmacy cannot. I don't think the corner drug store pharmacy is going to collaborate with the physician to facilitate completing a prior authorization (PA), finding funding for a patient that cannot afford their medication, or file an appeal when a PA is rejected. At my specialty pharmacy we help thousands of patients get a PA for their much-needed medication and help obtain millions of dollars per MONTH so that patients can afford their medications. Again, even if a community pharmacy can dispense the medication, who is to say they have lowered the patient's out of pocket cost to something the patient can afford in the long-run. And who is to say the patient obtained all the necessary education from the pharmacy that cannot staff experts in specialty medications. Will optimal adherence be maintained? Overall, the use of the community pharmacy to provide specialty medications in order to increase access, may actually hinder patient access in the long run. There is a reason the specialty pharmacy model exists! In fact, there are many.

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Sparky Edwards
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Dollar General and P&G partner on Every Day Heroes program for June

BY Michael Johnsen

GOODLETTSVILLE, Tenn. — In June, Dollar General will be partnering with Procter & Gamble to celebrate soldiers making a difference in their communities after returning from service as part of its Every Day Heroes program, the dollar channel operator announced Monday. Dollar General will feature decorated veteran Sparky Edwards in a national campaign thanking the nation’s military across the country.

“Sparky exemplifies the Dollar General Every Day Hero, not just through his bravery and military service, but through his commitment to community,” stated Todd Vasos, Dollar General’s EVP and chief merchandising officer. “Through his perseverance in the face of adversity and his enduring commitment to family, education and volunteerism, he is the embodiment of what it means to be an Every Day Hero.”

Photo of Sparky Edwards

Once an at-risk teenager, Edwards turned his life around with the help of the Thunderbird Youth Academy, one of the National Guard’s 34 Youth ChalleNGe academies. The program helped him earn his GED and prepared him to enter the military where he served tours of duty in South Korea and Iraq. Today, Edwards is a successful business owner and is pursuing his Ph.D. He credits TYA with saving his life.

“I went from being on track for a jail cell to being a decorated war veteran, business owner, former senior federal government employee and soon-to-be Dr. Sparky D. Edwards,” Edwards said.

According to Edwards, TYA also taught him the importance of volunteer work. Today, he continues to volunteer with organizations working with at-risk youth and is currently mentoring young people through the National Guard Youth ChalleNGe Program in Northern Virginia.

“We offer a second chance for at-risk youth,” said Gen. Craig McKinley (ret.), chairman of the National Guard Youth Foundation. “These are kids who are struggling in school and making poor choices. They look up to Edwards as a role model and proof that you can turn your life around.”


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AmerisourceBergen closes deal on Canadian distribution business divestiture

BY Michael Johnsen

VALLEY FORGE, Pa. — AmerisourceBergen on Monday announced that it has completed the divestiture of its Canadian pharmaceutical distribution business, AmerisourceBergen Canada Corporation. As previously announced, the business has been sold to Kohl & Frisch Limited, a Canadian-owned national full-line distributor. 

AmerisourceBergen will retain its Canadian specialty business.

In the quarter ended March 31, 2013, the company recorded an estimated loss on sale and other impairment charges of $161.7 million, which is subject to post closing purchase price adjustments. AmerisourceBergen expects to finalize these adjustments with Kohl & Frisch Limited during the quarter ending Sept. 30, 2013.


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