TALLAHASSEE, Fla.--(BUSINESS WIRE)--This week Senator Rene Garcia (R, 38th District - Miami) and Representative Debbie Mayfield (R, 80th District - Vero Beach) filed bills in the Senate (S.B. 780) and House (H.B. 583) that will provide a critical and very important healthcare option for persons living with Diabetes, Epilepsy and HIV/AIDS. This option will allow patients to choose whether or not to participate in mail-order delivery of their life saving medications. Currently, our ever-changing insurance and pharmacy systems, more often than not mandate mail-order delivery of medications for patients usually after the first prescription fill and allow for no “opt-out” provision.
A patient should be allowed to select accessing their prescriptions by visiting a brick and mortar pharmacy with the opportunity to interact ‘live’ with pharmacy staff. This requirement is most always tied to financial incentives for the insurer based on contract negotiations with entities known as PBMs or Pharmaceutical Benefits Managers.
In the United States, a pharmacy benefit manager (PBM) is most often a third party administrator (TPA) of prescription drug programs but sometimes can be a service inside of an integrated healthcare system (public or private payers). They are primarily responsible for processing and paying prescription drug claims. They also are responsible for developing and maintaining drug formularies, contracting with pharmacies, and negotiating discounts and rebates with drug manufacturers. AHF’s Director of Legislative Affairs, David Poole, points out that the 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.
AHF’s Southern Bureau Chief, Michael Kahane agrees that patient choice is important but also agrees there is benefit to using PBMs to negotiate the best possible price from drug manufacturers. The key is striking a balance and we believe these bills do just that – the option of choice is dependent on there being financial parity with no advantage given to either the brick and mortar pharmacy or the PBM. Operationally we believe this is doable but it will require the efforts of all key stakeholders to make this work. This type of legislation has been successfully implemented in other states so Florida should certainly be able to make this work. We also want to acknowledge that there are some large health insurers such as Aetna that have already stepped up to the plate and integrated choice into their plans; however, it is not the rule in the industry, it remains the exception.
AHF’s Jason King, Legislative and Advocacy Manager, believes it is extremely important to note that choice of pharmacy access is critical to successful treatment of both chronic and infectious diseases as the treatments can be very complex and the diseases can be complex as well. Having the option to consult with a pharmacist in a private and confidential manner in a real time, face-to-face manner, allows for total confidentiality, for assessment of the patient by the pharmacist, for immediate adherence counseling tailored to the situation and for conversations that simply are not as likely to occur with phone counseling provided with the mail-order models being mandated.
About AIDS Healthcare Foundation
AIDS Healthcare Foundation (AHF), the largest global AIDS organization, currently provides medical care and/or services to more than 495,000 individuals in 36 countries worldwide in the US, Africa, Latin America/Caribbean, the Asia/Pacific Region and Eastern Europe. To learn more about AHF, please visit our website: www.aidshealth.org, find us on Facebook: www.facebook.com/aidshealth and follow us on Twitter: @aidshealthcare.
