Taking the Pulse: Oklahoma SB 821 and Making Delivery Available for Everyone

  • ScriptDrop’s organization-agnostic solution allows pharmacies, health systems, and PBMs to give patients access to delivery
  • Oklahoma SB 821 led to arguments about the necessity of PBM mail-order pharmacies, but PBM mail-order is not the only option for home delivery of prescription medications

It’s no secret that American healthcare is wildly complex. Nevertheless, healthcare organizations big and small all have the same goal: to ensure that people everywhere get quality care and stay healthy. To meet that goal, we need to work together.

Here at ScriptDrop, we work with pharmacies of all sizes. We work with health systems all over the country. We’ve partnered with Uber to expand our reach.

But we also recognize that not everyone in healthcare gets along – especially when it comes to healthcare legislation.

A recent example: Oklahoma Senate bill 821, titled “The Patient’s Right to Pharmacy Choice Act.” As we understand it, the contentious part of the bill is the following:

Health insurers or PBMs are also prohibited from incentivizing or requiring customers to differentiate between in-network pharmacies, whether that pharmacy is in a preferred or nonpreferred network, a retail pharmacy, mail order pharmacy, or any other type of pharmacy.

- Taken from the text of SB 821

Some detractors of the bill argued that it would restrict the ability of pharmacy benefit managers “to secure a high-volume discount” from pharmaceutical manufacturers. Others claimed it would directly harm patients:

Senate Bill 821 would make it illegal to offer discounts to Oklahoma patients who want to use mail-order pharmacy services. It also would undercut current accountability measures and oversight in Oklahoma law that protect consumers from rogue pharmacists seeking to price-gouge customers, insurers and employers. … Rather than seek to make the delivery of prescription drugs more affordable, safer and convenient for Oklahomans who are undergoing their own medical and professional hardships, the pharmacist lobby has sought to enrich itself at the expense of Oklahoma families and loved ones.

- Taken from an opinion piece by Ericka McPherson

It should go without saying that ScriptDrop does not believe that pharmacists anywhere are seeking to price-gouge customers in order to enrich themselves. But let us consider what impact this bill would have had on patients.

The Intended Impact of SB 821

As we read it, the changes enacted by SB 821 would have been subtle. Currently, PBMs can require patients to use their PBM’s mail-order pharmacy in order to receive prescriptions at a lower price, or to obtain a 90-day fill as opposed to a 30-day fill. Those are the “incentives” that SB 821 would have eliminated.

Leanne Gassaway, CVS Health vice president of state government affairs, further clarified that the bill “would not allow her company to offer any kind of lower cost options for enrollees using a mail-order pharmacy. Instead, the option would have to be offered on the exact same terms and conditions as filling that drug at a retail pharmacy.”

In summary: SB 821 would have made PBM mail-order services a little less appealing to patients, but would have allowed patients to a) keep using mail-order, or b) use another pharmacy.

Since the bill has already been vetoed by Governor Kevin Stitt, SB 821 is a moot point. But the arguments around the bill highlight more than the relationship between healthcare entities. They also showcase the importance of prescription delivery.

Mail-Order Isn’t the Only Option

The crux of the arguments against SB 821 was that by removing mail-order incentives, the state would make patients less likely to use mail-order, and that in turn would harm patients. That argument holds some water. Mail-order has been shown to improve patients’ adherence to therapy. For example, one Kaiser Permanente study demonstrated that stroke patients who received their medications from a mail-order pharmacy were adherent about 74% of the time, whereas patients using a local pharmacy were only adherent about 47% of the time. That’s a significant difference.

However, patients also want some semblance of control over their therapy. A recent survey found that 85% of respondents preferred getting prescription drugs from a local pharmacy instead of a mail-order service because they wanted the option to talk to a pharmacist they know and trust.

In addition, shipping is the only available service level for mail-order pharmacies. This may be acceptable for refills of maintenance medications, but shipping is not ideal for new drug starts or urgent refills. Patients may end up using mail-order for some of their prescriptions but pick up others in person, negating the usefulness of mail-order.

Delivery for All

That’s where an organization like ScriptDrop can come in. Since we work with all manner of healthcare organizations to streamline their medication delivery processes, we can help independent and chain pharmacies, major health systems, pharmaceutical manufacturers, and even PBMs move prescriptions from the pharmacy shelf to the patient’s doorstep.

With multiple service levels and several ways to use our system, ScriptDrop offers the flexibility that healthcare entities need. Plus, by giving patients the convenience of delivery regardless of where they fill their prescriptions, we can provide accessibility and independence to patients. That’s our goal. We hope our colleagues across the healthcare industry agree.

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