Why physicians are fighting BCBS plan requiring use of mail-order pharmacies

Maia Anderson - Print  | 

A group of eight medical societies are pushing back against a proposal from BlueCross BlueShield of Tennessee that the groups fear will hurt patient access to critical drugs.

The proposed policy change would require physicians to use mail-order pharmacies to order drugs that have to be administered in-office, instead of allowing physician offices to bulk-order the drugs and keep them in-house. 

It would apply to drugs such as those given to rheumatoid arthritis patients that have to be administered by physicians in their offices. 

BCBS said the policy changes are designed to save money for Tennessee-based employers and the people covered by their healthcare plans. 

The medical groups argue that the policy, which would mean physicians can only order the drugs on an as-needed basis for each patient, would delay patient care, reduce access to much-needed drugs, inflate out-of-pocket costs and increase drug waste. 

Under the proposal, physicians would have to obtain the drugs from BCBS' preferred pharmacies and then wait for that pharmacy to ship them, which the groups argue is just a way for BCBS to get rebates from its pharmacy benefit managers. 

The groups are also concerned that they won't be able to ensure the drugs are safe and haven't been exposed to high temperatures. 

Additionally, extra doses would be required to be thrown away, increasing drug waste.

The new policy could also mean patients have to go to a more expensive hospital outpatient setting if their physician can't afford to obtain the drugs from the preferred pharmacies, which could be a significant barrier to access for some patients. 

"We're not asking members to see a different doctor or receive care at a different facility," BCBS said on its website. The company added that the changes apply to only 5,500 of its 3.5 million members. 

In a letter to BCBS, Ellen Gravallesse, MD, said: "We have had an alarming number of practices reporting they have been denied the ability to use therapies currently available in their offices to administer patient care quickly."

The letter, sent Feb. 6, was signed by the college as well as seven other groups representing different fields of medicine including the American Academy of Dermatology. 

Read the full news release here

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