 e-Mail this page to a Friend!
Pharmacy Equity Laws
Mail order pharmacy companies are expanding rapidly and capturing an ever larger share of prescription drug sales. In 2000, sales at mail order pharmacies grew 24 percent. Mail order now accounts for about 15 percent of all prescription spending.
The growth in mail order has little to do with consumer preferences. Numerous surveys have found that consumers strongly prefer retail pharmacies, which offer face-to-face consultations, medical information, and a range of healthcare services.
The growth in mail order can be attributed to insurance plans, many of which provide economic incentives to coerce consumers into using a mail order pharmacy. Pharmacy benefit management companies (PBMs), which contract with HMOs to provide prescription drug benefits, often, for example, require a substantially lower co-pay if the consumer purchases by mail rather than through a retail store. Their motivation? The top three PBMs, which cover two-thirds of all insured Americans, own their own mail order companies.
The National Community Pharmacy Association (NCPA) is working to pass state equity laws that require insurers to make co-pays equal regardless of the type of pharmacy the consumer chooses. The legislative fight has been an uphill struggle, but has succeeded in a handful of states, including Arkansas, Illinois, Mississippi, Missouri, and Tennessee.
Repeated efforts by Rep. Nita Lowey to pass a federal equity law have failed (in 1999, the bill was introduced as HR 3319).
RULES:
Ilinois Drug Benefit Equity Law
Illinois enacted an HMO reform bill in 1999 that includes a provision barring health insurers from favoring certain types of pharmacies (e.g., mail order) over others (e.g., independent retail pharmacies). The law requires that co-payments, deductibles, and limits on the quantity of drugs that can be dispensed at one time be applied uniformly regardless of the type of pharmacy the consumer chooses.
More:
|
