The New York Anti-Mandatory Mail Order Victory and Community Pharmacists Nationwide

By Kevin Schweers

Community pharmacists in New York scored a significant win for their patients, communities and pharmacy choice in late 2011 with the enactment of the Anti-Mandatory Mail Order or AMMO with overwhelming, bipartisan backing. What lessons might the campaign in support of the AMMO law hold for community pharmacists across the country?

To find out, NCPA recently asked one of the legislation’s staunchest supporters and advocates to share his observations on the effort to enact the AMMO law. Craig Burridge, M.S., is Executive Director of the Pharmacists Society of the State of New York (PSSNY). Mr. Burridge credits PSSNY members as most instrumental to enacting AMMO over the fierce opposition of mandatory mail order proponents, principally large pharmacy benefit managers (PBMs). He notes people including Ray Macioci, Charles Catalano, Vinny Chiffy and literally hundreds of pharmacy owners helped win a hard fought battle by gathering tens of thousands of signatures on petitions from their patients and coordinating tens of thousands of phone calls, emails and letters.

What follows is a Q&A with Mr. Burridge, in hopes that his advice would benefit patients and independent community pharmacists in other states advocating for patient choice.

NCPA: When it comes to the forced or mandated use of mail order pharmacies, many of the concerns expressed by patients and the community pharmacists who care for them are not new and have, in fact, been voiced for a number of years. What made 2011 different in New York?

Mr. Burridge: In New York, consumers by the tens of thousands signed petitions at their local pharmacy against mandatory mail order. Patients wrote dozens of letters to the editor of many regional newspapers telling about their horror stories with mail order. Finally, pharmacy owners had had enough of losing their patients to self-dealing PBMs. Tens of thousands of phone calls to the Governor’s Office and to Legislators were made by pharmacy owners, their staffs and their patients in support of passage of the no mandatory mail order bill.

NCPA: One obstacle to ensuring patient choice of pharmacy is the myth of mail order savings. This persists in some minds despite what appears to be rampant mail order waste and studies demonstrating how health plan sponsors that incent or require the use of mail order can end up paying more for drugs. Did you encounter such misperceptions and, if so, what did you do to alter or overcome them?

Mr. Burridge: We did in New York. The PBMs came at us with ads stating that costs would go up and that it was a ‘prescription drug tax’ or that it would ‘prohibit mail order.’ We responded with evidence that exposed the ‘spreads’ being used at mail for generics and the fact that the legislation requires participating pharmacies to agree to the same reimbursement and the same co-pays.

NCPA: The health care benefits of a patient’s face-to-face consultation with a community pharmacist and the preference of most patients for going to a local pharmacy are both well-established. But how did you chronicle and reinforce the economic and tax benefits of buying local when it comes to pharmacies?

Mr. Burridge: According to national data (IMS Health) for 2009, the last year we had data before introducing legislation, 22.8 percent of the national drug spend was for mail order prescriptions. Using New York’s percentage of total drug spend (11 percent), we removed hospital expenditures and Medicaid (which had less than one percent mail order) and came up with a mail order drug spend in NY in access of $5.8 billion annually. New York State has no major mail order facilities so this represents thousands of lost pharmacy jobs.

NCPA: Like PSSNY, NCPA continually stresses to its members the importance of grassroots activism, whether it is at the federal or state levels or with local employers and leaders. Did you find that your memberships became more engaged than usual in 2011 and, if so, what did you do to encourage their further involvement?

Mr. Burridge: It helped to have the PBM industry fly in colleagues from around the country and host their own Lobby Day. They told legislators that New York’s pharmacies could survive on acute medications only. This only caused yet another round of thousands of phone calls from our pharmacists, their staffs and patients. Our grass roots turned into a raging grass fire. Livelihoods were at stake and our opponents showed their hand. They wanted ALL maintenance medications going to their wholly-owned out-of-state mail order facilities. Our legislators saw that too.

NCPA: What surprised you the most about your 2011 campaign against mandatory mail order?

Mr. Burridge: I’ve been doing this too long to be surprised. We expected the worst from our opponents and they did not disappoint us.

NCPA: What were some of your opponents’ most challenging arguments and how did you address them?

Mr. Burridge: That depends if you consider outright lies as a challenge. Their ads said that it was a “Prescription Tax” or, when that flopped, they said our bill “would prohibit mail order.” These were easily swept aside and only upset legislators who felt the PBM industry was accusing them of passing a tax on prescription drugs.

NCPA: Do you have any other words of wisdom that you would like to share with concerned patients or your colleagues in community pharmacy?

Mr. Burridge: Choosing one’s pharmacy should be a basic right. If the playing field is level, it only makes sense to buy local. Watch out for PBMs calling all maintenance medications so-called ‘specialty drugs’ as a way of getting around no mandatory mail order laws. We’ll have a lot more to say on that in the near future.


8 Responses to “The New York Anti-Mandatory Mail Order Victory and Community Pharmacists Nationwide”

  1. 1 john kelly April 30, 2012 at 10:50 pm

    I live in New York and my employer told me use express scripts or they are not paying, If is no a union plan.

  2. 2 steve June 19, 2012 at 7:43 pm

    i work in an independent pharmacy and i cheered when i heard that the ammo act was passed in NYC. however to this day i haven’t seen any new benefits from this AMMO law. patients are still being pushed to mail order and now more than ever they are getting penalties 100% cost of medication for using retail pharmacies. WTF that’s all i have to say. the law isn’t working. PBMs are still getting away with pushing for mail order.

  3. 3 Tommy October 7, 2012 at 1:47 am

    As an independent pharmacist, I cheered the passing of the bill, but its been 10 months and I have not seen one patient be able to switch. All though the bill is passed, it’s not enforced. When I call the insurance asking questions about why the “reject code” says “mandatory mail order only”, the insurance rep has NO CLUE of this bill or the procedure to opt out! As a community pharmacist, this is very disappointing.

  4. 4 Craig Burridge October 8, 2012 at 11:14 pm

    Because it took the Governor until late December to sign the AMMO bill in NY, it did not affect any contracts signed prior to January 12, 2012. (all) It does not affect union negotiated plans or other ERISA-type (self-funded) plans. We are posied to take on any plan that is ‘issued’ in NYS and nor an ERISA plan. Yes, the signing of this law was delayed but, it is in full force. In fact, we wil seek damages from the plans who ignore this law. Some independents have joined together to advertise locally about the AMMO rights and this has solicitied sit down meetings even with unions and self-funded plans. Once they understand the ‘terms’ of AMMO, they are willing to listen and somehave made changes. When the time comes and that will be soon, are independents willing to step up and demand their patients back? Several dozen have already done that. Stay tuned. We will be testing this law in the very near future.

  5. 5 L. Thiemann January 14, 2013 at 5:39 pm

    As an HIV patient, I fall into the “specialty pharmacy” bucket and was appalled when my private insurer, United Healthcare (Oxford), required I receive my antiretrovirals by mail as I really liked the level of care I received at my local pharmacy and did not want to change. I was told I had no choice. Twice my shipments were delayed for over two days and once three days oversome glitch they could have called me about but did not. If AMMO rights are in place, can I now contact my private insurer and dead a change back to my pharmacy of choice?

    • 6 ncpa1 January 16, 2013 at 3:14 pm

      We’re very sorry to hear about the problems you are experiencing. Certainly your experience further illustrates the need for patients to have adequate choice of pharmacy.

      If you live in New York State, yes contact your health plan because you may be able to switch back to a local pharmacy. The Pharmacists Society of the State of New York (PSSNY) may also be able to help offer advice if you live in NY. Also, on March 1, 2013 similar legislation is scheduled to take effect in Pennsylvania, giving patients more choice.

      If you live in another state, it may be worth contacting your health plan. Sometimes they grant “hardship waivers” as is referenced in a recent Los Angeles Times article about access to HIV medications.

  6. 7 AP McEwen February 4, 2013 at 4:05 pm

    I fall into the specialty pharmacy designation used by UnitedHealthcare. I obtained a temporary override and was able to pick up locally. I went to pick up a refill on Friday and was told by my local pharmacist that I had to use OptimumRX now. UnitedHealthcare neglected to tell me me about the change to Optimum. This resulted in going without meds again. I called and spent 58 minutes on one phone call and was told that because UnitedHealthcare does not have pharmacies in New York I must continue to use the mail order specialty pharmacy.

  1. 1 Millenium Medical Solutions Corp » Anti Mandatory Mail Order Victory Trackback on September 20, 2012 at 11:45 pm

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