Consumer Choice for Pharmacy Benefits

Retail Council position

Allow health care consumers in New York State to use the community retail pharmacy of their choice and prohibit insurance companies from denying coverage for pharmaceutical benefits because the registered pharmacy providing same has not been approved by the insurer or other entity.

Legislative action

The Retail Council supports S.1449 (Maziarz)/ A.7930 (Abbate) which would prohibit the use of ‘approved pharmacies’ for prescription drug benefits. This bill remains before the Senate and Assembly Insurance Committees in 2009.

At a glance

• Since 1998, the state Legislature has protected the rights of Medicaid recipients to use the retail pharmacy of their choice through a modification of the state’s Medicaid/ Managed Care program, reversing an original plan that would have required Medicaid recipients to obtain their prescription drugs only from selected providers.

• Community retail pharmacies wishing to provide prescription services to Medicaid recipients agree to accept reimbursement levels determined by the state. This Medicaid “carve-in” was applauded by all community retail pharmacies for its recognition of fundamental issues of consumer choice and competitive fairness.
  
  
• Certain private insurance companies operating in New York State have established relationships with selected “provider pharmacies,” expressly excluding certain community retail pharmacies from providing prescription drug benefits to their insureds. As a result, consumers throughout New York State have been forced to switch from one pharmacy to another - perhaps severing trusted ties with health care providers with whom they have done business for many years.

• This practice mirrors the very situation which the retail pharmacy industry collectively and vigorously opposed during formulation of the Medicaid/ Managed Care plan.

• The Retail Council, on behalf of its chain and independent pharmacy retailers, continues to support the protection of consumer choice of pharmacy providers and the level playing field endorsed by the State Legislature.

• The Retail Council supports legislation that would require insurance companies to allow participation in pharmaceutical benefit plans by any community retail pharmacy willing to accept the terms of prescription reimbursement established under the insurance plan.