Specialty medications are one of the fastest growing categories of drugs in today’s heath care environment. These drugs are usually developed by the biotechnology industry and are prescribed for patients with severe diseases such as Hepatitis C, Cystic fibrosis and cancer. These drugs are also often prescribed for patients with rare diseases who generally have no alternatives to getting these therapies for their condition.

Patient generally need these medicines immediately and insurance companies and their Pharmacy Benefit Management (PBM) partners usually require extensive administrative work by prescribers or others on the patient’s care prior to ordering these therapies. This delays treatment and frustrates many physicians who feel they are forced to spend excessive time dealing with paperwork and less time treating patients.(1)

Further, many insurance plans require patients to use PBM-owned specialty pharmacies that provide these drugs via mail, delaying treatment even further. The primary reason is to allow the PBM to capture lucrative rebate monies from pharmaceutical companies. These same medications are routinely available at the patient’s local pharmacy and could be dispensed by the patient’s own pharmacist if permitted by the insurance company.

In a 2016 report (2), the Massachusetts Attorney Generals office found that using restricted distribution for these drugs had little or no benefit in reducing costs. More recent information has also come forward that using mail service pharmacies for temperature sensitive drugs may put patients at additional risk due to the packaging and shipping of these drugs and exposure to extreme fluctuations in temperature during the process.(3) Again, these same drugs are frequently available at the patient’s local pharmacy and could be obtained directly by the patient without the additional risk and expense of shipping through the mail

This legislation amends the “Any Willing Provider” law to allow retail pharmacies to fill prescriptions for “specialty medications” provided the pharmacy is able to provide the required administrative, handling, and monitoring services required by the drug.  Insurers and pharmacy benefit managers have been circumventing MGL Chapter 176D section3B by designating a medication a “specialty medication” even when the drug requirements are minimal (e.g., Humira).  This legislation will close this loophole and will also assist patients by allowing them to obtain all their medication from one pharmacy instead of trying to coordinate mail shipments from a specialty pharmacy located in another state.

The bill also sets a new category of registration at the Massachusetts Board of Pharmacy that would establish standards for specialty pharmacies and ensure the safe and efficient distribution of the medications in the Commonwealth.