The Pennsylvania General Assembly has just passed Senate Bill 201, which prohibits mandatory mail order pharmacy by health insurers and their agents. While it represents a compromise from the original Bill which greatly favored community pharmacies, this Bill nonetheless represents a large stride for PA retail pharmacies and endows them with new rights and opportunities against the Pharmacy Benefits Managers (PBMs).
Specifically, the Bill provides that “a health insurance policy or government program providing benefits for prescriptions shall not impose on a covered individual utilizing a retail pharmacy a copayment, deductible, fee, limitation on benefits or other condition or requirement not otherwise imposed on the covered individual when using a mail order pharmacy.” The retail pharmacy must be “willing to accept from the insurer the same pricing, terms, conditions or requirements related to the cost of the prescriptions and the cost and quality of dispensing the prescriptions that the insurer has established for a mail order pharmacy.” Thus, in Pennsylvania, PBMs can no longer impose different terms on patients using retail versus mail order, with the effort of steering patients towards their affiliated mail order pharmacies. Similar to New York’s recent AMMO Law, S.B. 201 allows a pharmacy to avoid losing its customer to the PBM’s mandatory mail order if the pharmacy is willing to accept payment in the same terms and conditions applicable to mail order. It bears noting, however, that notwithstanding similar laws, PBMs in the past have taken the position that because a given patient is covered by an ERISA plan, the State law does not apply, and have tried to get around these laws.
However, if you still find that your Pennsylvania patients are being siphoned to mandatory mail order after this Bill is signed by the Governor and becomes effective, contact Frier Levitt. Senate Bill 201 is meant to protect community pharmacies, and Frier Levitt can help you assert your rights. We can provide guidance on Senate Bill 201 and draft letters on your behalf to non-compliant PBMs. For more information, contact Frier Levitt today.
