Mail Order Pharmacy Said to Save Money

May 20, 2010 -- Controversy is brewing over a proposed cost-saving measure that could offset CAREAssist’s projected $2.1 million biennial shortfall -- and change the way some of its 2,300 clients receive their HIV medications.

Local pharmacies are pushing back, insisting it would hurt their business. “We will close,” says Shelley Bailey, co-proprietor of Central Drugs in downtown Portland, who insists a mandatory mail order system will mean the end of her 107-year-old independent pharmacy. “We’ve foregone other opportunities so we could serve an at-risk patient population.”

But state officials insist the mail order option would be voluntary. “At no time did we consider this mail order to be a mandatory system for every client enrolled in the program,” says Dr. Katrina Hedberg, state epidemiologist. “We know there are people who cannot receive medications through the mail.”

A request for proposal will be released in June, and a number of cost saving measures were considered such as  putting clients on a waiting list, temporarily dis-enrolling patients and changing covered services, Hedberg says.

“One of the things that’s going to change is what we call a central pharmacy that will be purchasing medications,” Hedberg explains.

This centralized pharmacy will distribute drugs through voluntary mail order and local pharmacies for CAREAssist clients who prefer walk-in service. “Our job is to look at a variety of ways that we can make taxpayers’ dollars go the furthest. The system is less expensive if you use mail order.”

But Bailey questions the mathematical model used to arrive at this conclusion, and believes analysts have overestimated the potential savings of moving to a direct purchase model.

She believes the state didn’t take into consideration what’s known as Maximum Allowable Cost, which allows officials to set a price cap on brand and generic drugs.

“Not only are you not going to receive the savings that you estimated, but frankly you’re going to have a lot of other impact costs on the entire delivery channel,” says Bailey who’s concerned about the impact on homeless and rural HIV-infected clients, who may lack access to postal mail.

Both mail order and pharmacy walk-in options will be available to CAREAssist clients, Hedberg says, and no one will get lost in the shuffle. “We in public health are very concerned in making sure that people with HIV get treated. It’s not just drug purchasing. We want to be sure that people not only have access to medical care but have their basic necessities covered, such as housing and food.”

State officials have already talked with CAREAssist clients about the mail order option. “When I went to some client meetings, many of them were very happy,” says Christine Stone, communications officer with the Public Health Division. “They prefer [mail order] for privacy reasons. People with health insurance -- we have that option to get something in the mail, or we can go to our pharmacy. This is opening it up to [CAREAssist clients] also. Our goal is to never have a wait list, and to keep as many people on the program as possible.”

State legislators will learn more about the mail order option during a hearing May 24 before the Senate Committee on Health Care.

“I knew very little about it, until Central Drug came and talked to me about it,” says Senator Laurie Monnes Anderson (D-Gresham). “This concerned me because of the economy. We don’t want to decimate businesses, but at the same time we have directed the Health Authority to take cost-saving measures.”

She has concerns about whether mail order will package a patient’s multiple drugs into daily doses, how the change will be communicated to CAREAssist clients and what the impact may be on local pharmacies. “[There’s] just a lot of logistics that we want to have explained.”