SYRACUSE — The state pharmacists society and several individual pharmacies are suing the state’s Medicaid program over rules requiring beneficiaries to use mail-order pharmacies for some prescriptions. Syracuse–based Hiscock & Barclay LLP is representing the plaintiffs, including the Pharmacists Society of the State of New York, a number of named pharmacists, and Medicaid beneficiaries. Requiring […]
SYRACUSE — The state pharmacists society and several individual pharmacies are suing the state’s Medicaid program over rules requiring beneficiaries to use mail-order pharmacies for some prescriptions.
Syracuse–based Hiscock & Barclay LLP is representing the plaintiffs, including the Pharmacists Society of the State of New York, a number of named pharmacists, and Medicaid beneficiaries. Requiring prescriptions to be filled by mail deprives patients of one-on-one counseling with pharmacists they trust, says Linda Clark, an attorney with Hiscock & Barclay.
“There’s a risk that there will not be adequate coordination in terms of drug interactions and the like,” she says. “There’s really no one there to effectively look at the whole patient profile that a pharmacist would normally look at.”
The issue arose last year when prescription drugs became part of Medicaid Managed Care, in which subsidized health plans reimburse pharmacies for prescriptions as opposed to Medicaid paying directly, Clark says.
When the plans became responsible for drug coverage, the New York Legislature specifically passed laws mandating that patients have the right to choose their pharmacies, as long as that pharmacy meets or beats the mail-order price, Clark explains. The one exception was for drugs that are extremely expensive, exotic, or difficult for a local pharmacy to handle.
The Department of Health began developing a list of those drugs, but it quickly became clear that many routine prescriptions were being added, Clark says.
“The exceptions started to swallow the rule,” she says. “They came up with a list of over 400 routine drugs for all kinds of basic chronic conditions that community pharmacies have been serving forever. It’s pretty clear that was not the intent of the exception. That’s why we ended up in court.”
Mail-order drugs can create serious issues for patients, Clark says. Some people might get some drugs from the mail while others come from the pharmacy. That can create confusion.
And some of the drugs involved are critical and time sensitive, Clark notes. One patient in the case is taking anti-rejection drugs after a liver transplant.
“If you’re not at home at the moment that UPS stops by, you don’t get your drugs,” Clark says.
UPS could just leave the drugs, but that’s not a great option when therapies can cost thousands of dollars per month.
The lawsuit, filed in State Supreme Court in Albany County, is seeking to stop the list of exceptions from moving forward. Clark notes that pharmacists recognize there are some drugs that legitimately belong on the list.
The mail-order program is temporarily on hold while the suit moves ahead, she adds. No one from the state Health Department could be reached for comment on the matter.
The issues in the suit don’t just relate to patient health, Clark says. There are hundreds of millions of dollars at stake.
The mail-order program could send up to $1 billion in taxpayer funds to mail-based pharmacies that are located outside New York state, Clark says.
“Medicaid patients lose choice and access, in-state pharmacies lose prescription volume, and New York state loses the tax revenues it needs,” Craig Burridge, executive director of the Pharmacists Society of the State of New York, said in a news release. “It’s a money-grab by the nation’s largest prescription-benefit managers who are building prescription volume on pharmacies they own and control.”
Hiscock & Barclay has 360 lawyers and support-staff members. The firm has additional offices in Albany, Buffalo, New York City, Rochester, Boston, Toronto, and Washington, D.C.
Contact Tampone at ktampone@cnybj.com