New York is currently one of only a handful of states that prohibit physician dispensing of pharmaceuticals. However, under section 6807 of the NYS Education Law, there are certain exceptions to the prohibition on physician dispensing, and one of the exceptions is dispensing of oncological protocol drugs. This exemption is in place because the state recognized the intricacies of care for cancer patients, and the vital role that physicians play in fine-tuning doses during the course of treatment.
Since the last time that the law regarding physician dispensing was amended, a lot has changed in the way that services are delivered and how insurance companies pay for services. One of the most significant developments is the rise of Pharmacy Benefit Managers (PBM).
Pharmacy Benefit Managers manage coverage of drugs to save insurance companies money, often through mail order or other restrictive requirements. Recently, CVS Caremark has changed the way that it covers oncology drugs to effectively exclude physician dispensed
What does this mean to you?
Oncology medications are typically given to patients either by injection (IV) or are taken by mouth. These potentially life-saving medications have for many years been administered to patients by their oncologists in the office. With the growth of oral cancer treatments, many oncology practices have undertaken the role of dispensing these treatments to their patients as well.
We oncology practices perform close and careful monitoring of our patients. Knowing our patient’s medical history in great detail is crucial and only the authorized physician and the practice’s pharmacist are privy to this complex information. In this way, your oncologist has the information at hand to be certain that you, the patient, can receive the specific care you deserve.
Recently, some insurance programs, who may control your pharmacy benefits (PBMs), have begun to limit your ability to have your oral oncology prescriptions dispensed through practices like ours. Although this has been the standard for over 10 years, they will now require their own pharmacies to fill your prescription and send them to you, typically by mail. These outside pharmacies do not know you as a patient, but only as a customer. But that is of little concern to them. Their goal is to reap more business by preventing physician practices like ours from delivering personal service. We think this is a step backward in terms of improving patient care and coordination, potentially at your health’s expense. And the reason for this change they are offering is suspect. There is at least one insurance company suing its PBM because the promised savings were never delivered.
At this critical time in your life, it is important that you stand up for your rights and be certain that your potentially life-saving medications are dispensed directly to you from your oncologist. Don’t allow your cancer care to be compromised.
We are here to provide you with the best, coordinated care and we are very involved in defeating this negative policy but we need your help.
You may have, or may soon receive a letter from your PBM describing these changes which go into effect January 1, 2017. Please contact your insurance provider and/or your human resources department to ask them to stop this from being implemented. Please also contact your NYS Legislator, Congress Member and Senator to tell them you do not want profits placed above your cancer care. We have staff to guide you and materials to give you that explains the details for your use, please click here to request more information on this matter by filling out our contact form.
We can only reverse this change if we work together.
Written by: Susan Dicosola, MS, CMPE – Executive DirectorLeave a reply