Restricting Patient Choice

Every patient wants a choice of pharmacy. Patients overwhelmingly prefer a local pharmacy for a face-to-face health care experience. Others, nonetheless, prefer a mail order pharmacy.

To counteract patients' strong inclination towards local pharmacies, PBMs sometimes impose higher co-payment requirements on patients for filling prescriptions filled locally than they would otherwise pay via the mail.

In other circumstances, patients are required to use a dedicated mail order pharmacy. These patients must pay out-of-pocket to use other pharmacies (retail or mail). Such plan requirements create "captive" patients. No matter how dissatisfied these patients may be with the PBM's mail order pharmacy service, these patients have no meaningful ability to choose another pharmacy provider unless their plan sponsor switches mail order providers or selects a different drug benefit design. No one wants to pay good money for bad service with no hope of changing pharmacies, so why should these patients?

Under both the incentivized co-pay and the mandatory mail scenarios, these restrictions on patients are misleadingly marketed to health plans and plan sponsors as a means to reduce costs (For more, see Mail Order False Economies).

"They aren't loyal customers. They're hostages, and they don't like it." – J.D. Power and Associates official describing patients in mandatory mail order pharmacy plans, Drug Topics article, Mar. 2010.