Should people in rural communities be allowed to buy medications from the pharmacies of their choice or should they be forced to order their prescriptions through the mail or schlep to the nearest town with an in-network pharmacy?
For the last two weeks, that question has pitted Democrats against Democrats, Republicans against Republicans, rural lawmakers against rural lawmakers and business leaders against business leaders.
Republican Rep. Jon Becker of Fort Morgan teamed up with Democratic Rep. Dianne Primavera of Broomfield to push House Bill 16-1361, on pharmacy choice, through the House, where it squeezed through Thursday on a narrow 34-31 vote.
Under the bill, patients — not insurance companies — would choose where to shop for medications. If a pharmacy falls outside of an insurance company’s network, there would be no additional charges foisted on the patient. Out-of-network pharmacies would have to agree to the insurance company’s reimbursements.
At first, the bill was pitched as a fix for rural communities where pharmacies are few and far between. But it would benefit city dwellers, too, said its sponsors, who added, 27 states have passed similar laws.
Not one of those other states has seen an increase in costs that they can attribute to a pharmacy choice law, as Becker tells it.
Opponents argue that allowing consumers to choose where to shop will spark price hikes, or jeopardize contracts between insurers and pharmacies. The bill has triggered some of the most intense opposition of the session from lobbyists for business groups, insurance companies and large-chain pharmacies.
Charles Scheffield of the Colorado Association of Health Plans touted the virtues of mail order prescriptions at the April 5 hearing in the House Public Health Care and Human Services Committee. Meds from a mail order company can be 27 percent cheaper than those from a retail pharmacy, and 24/7 pharmacy hotlines are available for those who want to talk with a pharmacist. That’s not something independent pharmacies can staff, he said.
The bill is sharply opposed by ExpressScripts, the nation’s largest company managing pharmacy benefits for insurance providers and subscribers.
According to lobbyist Patrick Boyle, who represents ExpressScripts, 95 percent of Colorado pharmacies are in the company’s network. Out of 104 independent pharmacies — those that aren’t part of a chain like Rite-Aid, Walgreens or WalMart — only nine aren’t members of ExpressScripts, he said.
Nearly all Coloradans can get prescriptions filled by mail from at ExpressScripts pharmacies, said Boyle. Allowing consumers to buy prescriptions at local pharmacies instead of mandating mail order will drive up insurers’ costs.
Boyle said no independent pharmacies in Becker’s district would benefit from his bill.
That riled up Becker, who said Boyle’s remarks were “disingenuous” and claimed ExpressScripts is trying to protect its monopoly.
The issue is not whether an independent pharmacy is being cut out of the market, Becker said.
The real issue is that people in rural communities would like to be able to choose whether to obtain their prescriptions from a local pharmacy or a mail-order pharmacy.
When a doctor prescribes a patient a medicine, the prescription is filled at a local pharmacy.
Most insurance plans then require refills to be filled via mail order.
That isn’t always convenient in rural communities, where mail service can be slow, Becker said. Medication may be delivered late, forcing patients to go to the pharmacy for a 7-day refill to tide them over, which most insurance companies refuse to cover.
Independent pharmacies, like those run by Tom Davis of Kiowa County, who owns several pharmacies in southeastern Colorado, are becoming scarce. The bill would help keep them in business, he explained, which is vital for patients in rural communities for those occasions when they need critical medications in a timely manner.
It’s an issue for insurers, too, Davis said. Some fear the end of pharmacies in rural communities will result in class-action lawsuits for denial of medical services when patients lose access to medications and have to drive farther and farther to get them.
Privacy issues come up for those who use mail order pharmacies. Shannon Southall of Denver runs RockyMountainCares, which works with HIV-positive people. She says her patients are stigmatized and mail-order prescriptions raise privacy issues.
Patients risk being outed as HIV positive to their family, housemates, neighbors and landlords who may stigmatize patients. And what happens to the homeless who often have no address to mail prescriptions to, she asked.
After two furious floor fights in the House, Becker took his measure to the floor last week in one last attempt to grab a few needed votes.
“If you want to use mail, use it. If you want to drive 40 or 50 miles to a pharmacy, do it.” It’s about choice, Becker thundered, convincing enough of his colleagues to pass the measure.
The bill now heads to the Senate, where it will be sponsored by Sen. Jerry Sonnenberg of Sterling and will face another round of tough opposition.
Photo credit: Mike Mozart, Creative Commons, Flickr.