This week, the New York governor signed into law a bill that limits the way pharmacy insurance regulates and mandates that you use their mail order pharmacies. Prior to this bill, pharmacy insurance companies could exclude coverage at certain pharmacies which were typically retail establishments. They usually did so for medications labeled “specialty” which were typically very high in price. By funneling insurance claims to one particular location, they were able to buy in larger bulk and control costs from one facility. The new New York law addresses this issue for consumers who would like to use a retail pharmacy say, down the street from their house instead of having it delivered by the mail. If other states follow suit, the world of pharmacy and their corresponding price differences at mail order vs. retail settings could change dramatically.
As the debate over healthcare in the United States escalates, it is worth some time to take a look at your own medical benefits (if applicable) and analyze what it is your benefits offer you. Too often, people (both insured and uninsured) are under the impression that filling their prescription medicines will cost huge amounts of money, and don’t do so as a result. In many cases, this is false, and may actually end up costing you more down the road. Today’s prescription insurance structure is a complicated maze of different copays/coinsurance, certain drugs not being covered because they are not “preferred,” and less coverage for more money. Meanwhile, pharmacy insurance companies (othewise known as PBM’s or Pharmacy Benefit Managers) are making more money than ever by dictating what medication your doctor can prescribe you based on what medications they can get … Continue reading
