NYAG urges 15 health plans to implement pharmacy-exemption rules

New York Attorney General Eric Schneiderman today sent letters to 15 New York–based health-insurance plans urging them to change their policies to permit certain members to purchase specialty-drug prescriptions at retail pharmacies instead of through mandatory mail-order services.

The letters urge the 15 companies to adopt “Specialty Prescription Drug Fulfillment Hardship Exception Criteria,” similar to one the attorney general helped negotiate earlier this year with Empire BlueCross BlueShield (BCBS).

Schneiderman’s office has sent letters of inquiry regarding specialty-pharmacy exemptions to Rochester–based Excellus BCBS, Schenectady–based MVP Health Care, and Minnetonka, Minn.–based UnitedHealthcare (NYSE: UNH), and Albany–based Capital District Physicians Health Plan.

It also sent letters to Hartford, Conn.–based Aetna Inc.; New York City–based AXA Equitable Life Insurance Company; and Philadelphia–based CIGNA (NYSE: CI); New York City–based EmblemHealth, Inc., Fidelis Care New York, Healthfirst, HealthNow New York Inc., Independent Health, Oxford Health Plans, LLC, The Guardian Life Insurance Company of America, and Indianapolis, Ind.–based WellPoint, Inc.

The attorney general’s push to release health-plan members from “unnecessarily burdensome” mail-order requirements comes as the office’s health-care bureau helpline has received dozens of “hardship” complaints from health-care plan consumers relating to mail order and non-retail pharmacies’ requirements, Schneiderman’s office said.

The bureau first intervened with Empire, among New York’s largest health-care plans, after the company notified its members that, as of Jan. 1, 2013, drugs on Empire’s “Exclusive Specialty Drug List” must be purchased through its specialty mail-order pharmacy, CuraScript, and could no longer be obtained through retail pharmacies.

Negotiations with Empire came as members complained that the insurance company’s new mandate would pose “undue hardships” for them, including “compromised privacy, delivery challenges, and interference in physician changes in drug-dosing schedules,” the attorney general’s office said.

Empire agreed to implement procedures that will permit qualifying members to be exempted from its specialty mail-order pharmacy mandate.

Contact Reinhardt at ereinhardt@cnybj.com