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Washington pharmacies struggle as health insurers shift to mail-order prescription services

A new bill would allow people in Washington to choose how they want to receive their medications as health insurers incentivize mail-order prescription services.

SEATTLE — A growing number of Washingtonians are being incentivized to ditch local community pharmacies and instead get their prescriptions sent directly to their homes via a mail-order pharmacy.

Companies that manage prescription drug benefits on behalf of health insurers are called pharmacy benefit managers. The incentive is a significantly lower copay when opting to receive prescriptions in the mail.

“They are the contracted entity that your health plan contracts with to control and manage your medications that you receive and fill,” explained Dr. Jenny Arnold, CEO of the Washington State Pharmacy Association. “More and more pharmacy benefit managers own the mail-order pharmacies, own the specialty pharmacies and now require patients to use their pharmacies or highly incentivize patients to use their pharmacies.”

This can negatively impact local pharmacies by taking business away from them. It also affects the communities they serve.

“Being in the community allows us to take care of that community,” said Dr. Andrew Heinz, co-owner of Kirk’s Pharmacy in Puyallup. 

“As a community pharmacy, most people just think of us as dispensing medications, but being a pharmacist is significantly more”, said Heinz, who told KING 5 News that his team has been working to get the community tested for and vaccinated against COVID-19. “We were told by the Pierce County Health Department that Kirk’s Pharmacy was the second single highest vaccine giver, second to them, in our county.”

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Heinz said he regularly gives health advice to those who ask for it, in addition to the counseling he gives patients when they pick up their prescriptions.

“We run our business as health care providers, not necessarily business owners,” Heinz explained. “We do what’s needed to provide the best patient care.”

Arnold said those who rely solely on mail-order pharmacies may not get the same kind of treatment they might get at a community pharmacy.

“Many of these mail-order pharmacies operate outside of Washington, almost all of them operate outside of Washington, so they don’t have to follow Washington state laws requiring counseling of every patient and some other provisions we have in Washington to keep patients safe," said Arnold.

However, state lawmakers are considering new legislation that would regulate the way pharmacy benefit managers operate. 

“The Washington legislature introduced House Bill 1813 this year which gives patients the choice to choose between mail order pharmacy and their community pharmacy,” said Arnold. “It prohibits the pharmacy benefit plans from requiring their own mail-order pharmacies be used by patients. We are hopeful this will give patients a choice and a voice for how they receive care.” 

If passed, the result would let patients choose how they receive their prescriptions. 

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“We’re not anti-mail order medications,” explained Arnold. “I get some medications mail ordered. It’s giving the patients the choice of where they get that care.”

We reached out to the Pharmaceutical Care Management Association, the national group which represents pharmacy benefit managers across the United States. We asked them to respond about the pending bill in Olympia. 

They sent the following statement:

“Health plans rely on PBM mail-service pharmacies to provide safe, accurate, and reliable home delivery of medications for patients, which is often more affordable and more convenient for patients than going to a pharmacy. The legislation, SB1813, would discourage the use of mail-service pharmacies, which could increase prescription drug costs. Restricting mail-service pharmacy is especially problematic during a pandemic when it’s important to allow patients to stay safely at home while dependably being able to access their needed prescription drugs.”

The bill, HB 1813, has passed the state House and is currently making its way through the state Senate.

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