"When you see the word 'specialty drug,' it usually just means expensive, and [pharmacy benefit managers] are just steering the profitable medications to their own pharmacies," D'Angelo said.
PBMs such as Optum have their own specialty pharmacies, and by locking patients into mail orders, patients are unable to obtain those drugs at the independent or mom-and-pop pharmacy of their choice, even though the location would be capable of filling that prescription, he said.
"They're trying to keep all of the revenue within their system," he added.
Bill sponsor Assemblywoman Latoya Joyner, who serves a district in the Bronx, said the legislation protects consumers' ability to choose how they want to receive their prescription medications—whether in-store or by mail.
"I am very optimistic that the bill will pass the Assembly this year because we have had widespread support from patient groups and independent pharmacies that has grown since I first introduced this legislation," Joyner said. The bill was first introduced in the 2013-2014 legislative session.
The current version of the bill has added an exemption for collectively bargained union contracts, which should enhance its appeal, Joyner added.
Opponents of the bill voiced their displeasure this week.
Mail-order services aren't about keeping revenue away from independent pharmacies; they achieve cost savings and ensure patient safety, said Leanne Gassaway, vice president of state government affairs at CVS Health, a pharmacy benefit manager. Some specialty medications are expensive, but by funneling them through specialized avenues, scale can be achieved to negotiate prices down, she said.
"They are often branded drugs with little competition, and we lose that ability to negotiate with them if you take prescriptions away from these cost-effective channels," she said, adding that higher prices could be passed on to employers and patients.
Additionally, some drugs require specialized equipment for preparation and storage, and weakening provisions that require retail pharmacies to meet preset terms and conditions to dispense them compromises safety, Gassaway said.
Pharmacists are already regulated by the state, and there's no need for additional credentials just to dispense expensive medication, D'Angelo countered. One such condition includes accreditation from third-party organization Urac, which costs about $40,000 to start with, renewal fees notwithstanding, he noted.
The legislation is estimated to raise health care costs by nearly $9 million if it passes, Gassaway said. Joyner, in response, said that PBMs have yet to provide documentation to support that claim.
Mail-order specialty pharmacies likely have not been detrimental to retail ones, Gassaway argued. The number of independent pharmacies has increased nearly 30% in New York in the last decade.
When it comes down to it, D'Angelo said, the mail-order option should be left to the consumer.
"Offer it to them, but it's not fair to [retail pharmacies] and the patient if you force it on them," he said.
"I also want to be very clear—the legislation doesn't require consumers to stop receiving their medications via mail order," Joyner said. "If the consumer is happy with mail-order service, they will still be allowed to use it."
