What is Mandatory Mail Order?
There has been a recent trend in Ohio with pharmacy benefit managers (PBMs) requiring enrollees to receive maintenance medications via mail order from a specific provider, for example CVS Caremark, instead of brick and mortar pharmacies. The insurance plan will not cover these medications at a pharmacy, even if it is in-network. Mandatory mail order is not always listed in a plan’s covered benefits, even when it is required.
What are 340B Pharmacies?
340B pharmacies are pharmacies participating in the 340B Drug Discount Program. This federal program protects certain health care organizations from increasing drug prices while requiring drug manufactures to provide medications at significantly reduced prices. The 340B Program enables covered entities to stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services. When a 340B entity dispenses covered drugs to a Medicare or private insurance enrollee, it is able to retain the difference between the reduced price it pays and the amount for which it is reimbursed.
How Does Mandatory Mail Order for HIV Medications Effect 340B Pharmacies?
Many 340B pharmacies rely on these drug discounts and rebates in order to provide pharmaceutical and medical services to those who are uninsured or underinsured while also avoiding a budget deficit. If specialty 340B pharmacies are not able to dispense HIV medications to Medicare and private insurance enrollees, they will not be able to provide additional comprehensive services for the clients they are currently serving. This outcome is in direct opposition to the purpose of the 340B Program.
How Does Mandatory Mail Order Effect People Living with HIV?
Mandatory mail order puts the privacy and health of people living with HIV at risk. Receiving regular medication deliveries when one is not open about their HIV status can potentially divulge their status to others. Most importantly, many HIV regimens are complicated—consisting of several medications with many drug interactions. People living with HIV rely heavily on their interactions with local pharmacists to monitor these interactions and provide advice on navigating their chronic condition. Requiring HIV medications to be mail ordered removes this partnership from an individual’s treatment.
Mandatory mail order impacts the existence of 340B clinics and the ability of people living with HIV to stay adherent to their medications.
- If your health plan requires mail order pharmacy for HIV medication, petition your health plan to allow opt-out of mandatory mail order for HIV medications.