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New York prescription drug change (requiring mail-order pharmacy for "specialty medications includes HIV & HCV) putting lives in danger?
 
 
  "A change in state policy requiring Medicaid recipients who take certain drugs to get them via mail has led to delivery problems, leaving patients without life-sustaining medications for days or longer"......... The profit potential is extraordinary.....$4-5 Billion at Stake for pharmacy benefits companies....multibillion-dollar issues...... The Pharmaceutical Care Management Association, a Washington-based PBM{pharmacy benefits managers) trade group representing Express Scripts, CVS Caremark and other PBMs as well as for-profit insurers such as Aetna Inc..... Express Scripts Inc., which recently merged with Medco Health Solutions Inc. The third-party drug-benefit administrators develop formularies and manage drug claims for health insurance carriers.

Known as PBMs, benefit managers own the mail-order houses they steer health plans' drug business to, creating a clear conflict of interest in his organization's view, said Craig Burridge, executive director of the Pharmacists Society. .,.......patients report: "I had to deal with a lot of stress,"......multi-million dollar pharmacy benefits companies claim: Express Scripts, called the criticism "unfounded." Both Henry and Christine Cramer, director of public relations for CVS Caremark, said their companies offer a high level of expertise in specialty medications. The companies' 24/7 hotlines provide patients access to experts with knowledge of their specific conditions, they said.......patients report

".......people living with HIV who've missed doses of critical medication or who've had their HIV status exposed when a package was left in the open...... Those living in large apartment buildings sometimes find their prescriptions left in a hallway near a wall of mail slots. Or worse: "Leaving a $10,000 hepatitis drug on the stoop outside in the summer might not be a good idea,"

........a patient who couldn't meet the delivery person at home opted to get a package of medications sent to his workplace, explained David Fazio, the group's chief financial officer. An unknowing co-worker signed for the box.......Further, Clark argued, state law forbids requiring patients to get prescriptions by mail. She said the law is clear for those with private insurance as well as for those on Medicaid. "You can't be forced into mandatory mail order," she said........A HIV-positive Medicaid plaintiff complains in a separate affidavit that heat-sensitive drugs and supplies languished in an unrefrigerated processing center for days after a Federal Express delivery from a mail-order pharmacy went awry because the patient was not at home to sign for it. A representative of the mail-order house advised the patient to drive to the processing center and pick up the medication. But the patient, knowing the drugs would be ruined for lack of refrigeration, refused. A 30-day supply of pills had melted into a single, solid clump."

The Supreme Court of Albany County issued an injunction Oct. 8 stopping the health department from requiring that Medicaid patients taking any of about 400 "specialty" drugs get their medicine through mail order. The court temporarily prohibited the mail-order requirement on grounds that it might violate federal patient protections, state anti-trust laws and due process provisions in both the state and federal constitutions.

Although the injunction extends to at least late-March 2013, the health care plans used by the state have their own lists of "specialty" drugs and are still requiring the medications to be mail-ordered while the Health Department's action is on hold.......
Gottfried said the state's explanation behind compiling a list of "specialty" prescriptions to be filled by mail-order pharmacies is that traditional pharmacies do not have the expertise to handle and dispense such drugs

However, in March this year, the Legislature, while reaffirming patient choice, amended state social services law "creating an exception allowing managed-care Medicaid providers to 'limit' their networks of pharmacies for so-called specialty drugs" based on "clinical, professional or cost criteria,"

".....pharmacy benefit managers, which administer prescription drug coverage for the providers, have argued that the injunction doesn't apply to them.......the pharmacy benefit managers own the out-of-state mail-order pharmacies where they're sending the state's Medicaid business.......$4 billion to $5 billion is an accurate estimate, she said, with about $3 billion going to the pharmacy benefit managers......"That gives you a sense of the enormous stakes we're talking about here - multibillion-dollar issues. The profit potential is extraordinary," she said. "And if the pharmacy benefit managers can divert the greatest share possible of that $5 billion internally to their own pharmacies or to their mail-order pharmacies, they stand to make tens of millions of dollars, maybe more."

Critical Background Information on AMMO for ALL Pharmacies:

Click here for the full News Update

Patient Complaints on Mandatory Mail Order web site URL below

www.patientmedschoice.org

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NY Pharmacists Society Sues NY State Over Mail-Order Delivery of Medications

http://www.courthousenews.com/2012/10/15/51272.htm

from Jules: private insurers do this to: required mail-order pharmacy for so-called "specialty-medications' which includes HIV meds is being done by private insurers as well.

Linda Clark, an attorney for Hiscock & Barclay who represented PSSNY in front of McDonough, said requiring patients to receive prescriptions by mail threatens their health. She told of a patient who needs to take drugs to prevent his body from rejecting a transplanted liver. He needs to take the drugs at specific times, but has no idea when the Postal Service or UPS will show up with his medicine, she said.

Those living in large apartment buildings sometimes find their prescriptions left in a hallway near a wall of mail slots. Or worse: "Leaving a $10,000 hepatitis drug on the stoop outside in the summer might not be a good idea," she said.

Further, Clark argued, state law forbids requiring patients to get prescriptions by mail. She said the law is clear for those with private insurance as well as for those on Medicaid. "You can't be forced into mandatory mail order," she said.

A HIV-positive Medicaid plaintiff complains in a separate affidavit that heat-sensitive drugs and supplies languished in an unrefrigerated processing center for days after a Federal Express delivery from a mail-order pharmacy went awry because the patient was not at home to sign for it. A representative of the mail-order house advised the patient to drive to the processing center and pick up the medication. But the patient, knowing the drugs would be ruined for lack of refrigeration, refused. A 30-day supply of pills had melted into a single, solid clump.

The pharmacy eventually sent a replacement, the patient states. "(But) it took two days before their regional manager let me know that the shipment would finally be sent out.
Luckily, I had only missed one dose of HIV medications before this shipment arrived."

ALBANY, N.Y. (CN) - Independent pharmacies sued New York State to stop the state from steering Medicaid recipients to mail-order delivery of certain drugs, which the state Pharmacists Society claims violates patients' rights and threatens neighborhood drugstores.

The class action in Albany County Supreme Court claims the state Department of Health compiled a list of expensive specialty drugs that Medicaid managed-care providers likely would want filled by a limited network of pharmacies, most likely mail-order ones.

The plaintiffs, the Pharmacists Society of New York, five drugstores and two Medicaid patients claim the list was compiled after "secret meetings" the state held with managed-care plans, pharmacy benefit managers and large mail-order pharmacies.

"[T]hese ill-advised changes have already begun to endanger the health and lives of many of New York's most vulnerable citizens and in many cases effectively severed the longstanding professional relationships that existed between pharmacists, prescribers and their patients/customers," according to the complaint.

"They further threaten the continued viability of community pharmacy providers currently serving the Medicaid population."

Named as defendants are the State of New York, its Department of Health, Health Commissioner Nirav Shah, and Janet Zachary-Elkind, a deputy director in the department's Office of Health Insurance Programs.

The plaintiffs ask the court to enjoin the state from going forward with the plan, which they call "illegal, irrational, arbitrary and capricious."

Medicaid is the joint federal-state program that pays for medical services for the poor and disabled, "70 percent of whom are minorities [and] suffer disproportionately from socioeconomic challenges such as cultural, literacy and language barriers, transience and limited transportation resources," according to the lawsuit.

In 1997, New York began to shift medical care for Medicaid recipients from a fee-for-service model to a managed-care one. Under the former, recipients chose a doctor from among those enrolled in New York's Medicaid provider network; with the latter, they choose a doctor from a list of providers in a managed-care network, generally a health maintenance organization, or HMO.

The shift was designed to expand health coverage to more low-income New Yorkers, using savings generated through managed care, which reimburses providers on a per-patient basis rather than varying by complexity of the service.

Prescription drugs continued to be provided under the fee-for-service model until October 2011, when they were "carved in" to the managed-care model, the lawsuit states. As with doctors under managed care, Medicaid recipients would choose from pharmacies in the network when filling prescriptions.

Federal law provides a "freedom of choice requirement" for Medicaid recipients, meaning the list of doctors or pharmacies offering services must be robust. To underscore its commitment to that standard, New York's Legislature amended state insurance law in late 2011 "to prohibit insureds from being mandated to use a mail-order pharmacy," according to the lawsuit.

Known as AMMO, for anti-mandatory mail order, the amendment required that "any pharmacy" - mail order or bricks-and-mortar retail - could be used by patients "as long as the pharmacy offers the same pricing and terms."


"The AMMO bill thus leveled the pharmacy playing field by requiring health insurers to provide patients with equal access to retail Medicaid pharmacy providers as long as equivalent pricing and terms are offered," the complaint states.

However, in March this year, the Legislature, while reaffirming patient choice, amended state social services law "creating an exception allowing managed-care Medicaid providers to 'limit' their networks of pharmacies for so-called specialty drugs" based on "clinical, professional or cost criteria," according to the complaint.

Pharmacists assumed these drugs "would apply to rare drug classes of limited distribution or those not traditionally available at the retail level, and recognized to be not generally available via community pharmacies," the plaintiffs say.

But through several drafts of qualifying criteria, groups such as the New York State Board of Pharmacy (the licensing body for pharmacies in the state), the Chain Pharmacy Association and the plaintiff Pharmacists Society (the trade group for pharmacists) expressed concern to the Department of Health that the list of eligible drugs was too broad.

In the end, the list included nearly 350 drugs that are used to treat complex, chronic or rare conditions; that require special handling or storage; that warrant monitoring or administration by a health care professional; and that cost at least $1,500 a month.

The plaintiffs claim the list was developed by the Department of Health "through secret meetings with large PBMs" - pharmacy-benefit managers that oversee the managed-care plans' pharmacy services - "that have a vested interest in capturing the largest possible share of the Medicaid drug market for their related mail-order businesses.

"Forcing patients into mandatory mail order has been an open secret among these plans and PBMs even before the specialty drugs program was promulgated," the complaint claims.

The final drug list was issued Sept. 7 with an effective date of Oct. 8.

"The list is extremely broad, containing many common medications that have been filled reliably by community pharmacies for decades for such widespread diseases as multiple sclerosis, rheumatoid arthritis, cancer and hepatitis C, among others, and represents a dramatic incursion into the drug formularies traditionally served by retail pharmacies representing a significant portion of the $5 billion Medicaid drug program serviced by the 4,000-plus pharmacies currently in the Medicaid program," the pharmacies say.

The lawsuit expresses concern about the list's impact on patients' health.

"In a mail-order scenario, patients - many of whom are high risk - are required to use designated mail-order providers in a setting in which there is no face-to-face contact with the dispensing pharmacy, or its staff; no routine counseling provided or required; and without the benefit of interpersonal contact that can be critical to a patient's understanding of drug regimens, interactions, side effects and other related factors," the complaint states.

And, it contends, "In addition to harming patients in the short run, the specialty drug program coupled with mandatory mail order will drive many independent pharmacies out of business, resulting in a significant increase in the concentration of market power among the mostly out-of-state mail-order pharmacies associated with PBMs.

"The new marketplace for pharmacy services, denuded of many community pharmacies that have loyally served patients locally for decades, will restrict patient choice and access even further."

The plaintiffs ask the court to find the defendants in violation of the federal freedom-of-choice requirement, state and federal antitrust laws, state insurance law's AMMO provisions, and New York drug utilization record requirements, which mandate that patient prescriptions be monitored to avoid harmful interaction.

Linda Clark of Hiscock & Barclay in Albany represents the plaintiffs

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Is New York prescription drug change putting lives in danger?

http://www.democratandchronicle.com/article/20121217/NEWS01/312170020/New-York-Medicaid-prescription-drugs-mail-order

7:34 AM, Dec 17, 2012

ALBANY - A change in state policy requiring Medicaid recipients who take certain drugs to get them through the mail has led to delivery problems, leaving patients without life-sustaining medications for days or longer.

Patients, doctors and pharmacists said the policy shift - which is meant to save money in the most expensive Medicaid program in the country - endangers lives and the health of patients and might be violating state and federal law.

Recipients of Medicaid, the government health insurance program for low-income and disabled people, sometimes live in housing projects, are homeless or move often, patient advocates said. Those circumstances make it difficult to ensure expensive and necessary medications end up in the right hands.

Patients have complained of medications being stolen, signed for by strangers or returned to hard-to-reach central mail facilities, where they languished for days. Medications have also frozen, melted, spoiled or lost potency after being left in inappropriate environments.

"UPS (the United Postal Service) will put a sticker near your mailbox, or they could leave (the package) on your porch or on the floor in front of ... rows and rows of mailboxes in a tenement," said Craig Burridge, executive director of the state Pharmacists Society. "It could be a $23,000 drug. How long do you think that package is going to last?"

Burridge's group, a lobbying organization representing mostly retail pharmacists, filed a lawsuit against the state Department of Health in October. The complaint alleges that the department violated state and federal laws that protect patient choice.

Health Department officials would not comment on pending litigation.

The Supreme Court of Albany County issued an injunction Oct. 8 stopping the health department from requiring that Medicaid patients taking any of about 400 "specialty" drugs get their medicine through mail order. The court temporarily prohibited the mail-order requirement on grounds that it might violate federal patient protections, state anti-trust laws and due process provisions in both the state and federal constitutions.

Although the injunction extends to at least late-March 2013, the health care plans used by the state have their own lists of "specialty" drugs and are still requiring the medications to be mail-ordered while the Health Department's action is on hold.

The Pharmacists Society and other plaintiffs argue that the companies offering the health care plans must also abide by the injunction and that the Health Department should enforce it.

The pharmacy benefit managers, which administer prescription drug coverage for the providers, have argued that the injunction doesn't apply to them.

"That to me is one of the most shocking legal claims I've seen in a long time," said Assembly Health Committee Chairman Richard Gottfried, D-Manhattan.

The state Legislature inserted in March the provision of state law that allowed the mail-order requirement, which the court has suspended.

The change was a recommendation of the Medicaid Redesign Team, which Gov. Andrew Cuomo formed in January 2011 to identify cost savings in the program. New York spends more than $1 billion a week on Medicaid.

Gottfried said the state's explanation behind compiling a list of "specialty" prescriptions to be filled by mail-order pharmacies is that traditional pharmacies do not have the expertise to handle and dispense such drugs. The Health Department would not confirm or deny that it offered this reasoning.

Gottfried doesn't buy it. He explained that retail pharmacies still dispense those drugs to patients with private health insurance and some Medicaid recipients on a different type of plan.

"If a pharmacy is incapable of handling a particular drug, they shouldn't be allowed to sell it to me or you. It's not a Medicaid issue," he said.

In many cases, the pharmacy benefit managers own the out-of-state mail-order pharmacies where they're sending the state's Medicaid business.

Linda Clark, an Albany-based lawyer with Hiscock and Barclay LLP, which is representing the Pharmacists Society in the lawsuit, said it is difficult to determine the cost to the state of prescription drugs under the health plans. But $4 billion to $5 billion is an accurate estimate, she said, with about $3 billion going to the pharmacy benefit managers.

"That gives you a sense of the enormous stakes we're talking about here - multibillion-dollar issues. The profit potential is extraordinary," she said. "And if the pharmacy benefit managers can divert the greatest share possible of that $5 billion internally to their own pharmacies or to their mail-order pharmacies, they stand to make tens of millions of dollars, maybe more."

The pharmacy benefit managers reject the claim that they're taking advantage of the system to make a profit.

Brian Henry, vice president of corporate communication for Express Scripts, called the criticism "unfounded."

Both Henry and Christine Cramer, director of public relations for CVS Caremark, said their companies offer a high level of expertise in specialty medications. The companies' 24/7 hotlines provide patients access to experts with knowledge of their specific conditions, they said.

"The services of CVS Caremark Specialty Pharmacy extend beyond the general distribution services of traditional pharmacies," Cramer said in a statement. "By focusing on a limited range of conditions, we have developed a significant level of clinical expertise and knowledge."

Despite reports otherwise, the mail-order pharmacies argue that their delivery services are on-time and convenient.

"We ensure that patients receive the medicine they need where they need it," Henry said. "We've been doing this through home delivery for years and have high satisfaction rates from members and clients who opt for it."

Gay Men's Health Crisis, a patient advocacy group based in New York City, has voiced concerns over people living with HIV who've missed doses of critical medication or who've had their HIV status exposed when a package was left in the open.

For example, a patient who couldn't meet the delivery person at home opted to get a package of medications sent to his workplace, explained David Fazio, the group's chief financial officer. An unknowing co-worker signed for the box.


"You don't want people to know your business, but you can't risk being non-compliant," Fazio said.

George Mavrakis, of Huntington, Suffolk County, who is a Medicaid recipient and a plaintiff in the lawsuit against the state, recently had his drug coverage switched to a plan with more restricted pharmacy options. He said his life was endangered when the anti-rejection medication he was required to take following a liver transplant did not arrive through mail order in time.

"One time, I went without medicine for about four days," Mavrakis said. "I could have lost the liver that I have inside, which is worth about a million and a half (dollars), with all the treatment and everything.

"I had to deal with a lot of stress," he said.

---------------------------

Pharmacists' group files lawsuit over N.Y. policy

By WILL ASTOR

Rochester Business Journal

November 23, 2012

A community pharmacists' trade group has filed a lawsuit seeking to reverse a temporarily halted state Department of Health policy that would let Medicaid HMOs force enrollees to get some prescription drugs from mail-order pharmacies.

The suit, which seeks class-action status, was filed in a state Supreme Court in Albany last month. Five New York City independent pharmacies and one in Niagara County, along with two anonymous Medicaid patients and the Albany-based trade group, the Pharmacists Society of the State of New York, are lead plaintiffs.

The court case is the most recent skirmish in an ongoing battle between the Pharmacists Society and pharmacy benefit managers such as CVS Caremark Corp. and Express Scripts Inc., which recently merged with Medco Health Solutions Inc. The third-party drug-benefit administrators develop formularies and manage drug claims for health insurance carriers.

Known as PBMs, benefit managers own the mail-order houses they steer health plans' drug business to, creating a clear conflict of interest in his organization's view, said Craig Burridge, executive director of the Pharmacists Society.

In addition to the Department of Health and state Health Commissioner Narav Shah M.D., the lawsuit names the state's director of pharmacy programs, Janet Zachary-Elkind, a onetime Express Scripts vice president and former Empire BlueCross BlueShield official, as a defendant.

DOH spokesman Jeffrey Hammond declined to comment, citing a DOH rule against speaking on pending litigation.

Other than sending close to $1 billion a year in taxpayer dollars to out-of-state firms instead of to New York-based businesses, the Health Department policy accomplishes nothing, Burridge maintains. To the contrary, he insists, allowing Medicaid managed-care plans that require subscribers to order some prescription drugs through the mail hurts fragile seniors and saves the state no money.

The policy stands in direct contradiction to the state's Anti-Mandatory Mail Order law, said Pharmacists Society attorney Linda Clark, a partner in Hiscock & Barclay LLP's Albany office.

The anti-mail-order law bars insurance plans from forcing enrollees to use mail-order pharmacies. It also forbids insurers from using rules such as higher co-pays or smaller refill allowances for locally filled prescriptions to move subscribers into mail-order prescriptions. The law requires independent, local druggists to match any cost savings mail-order drug suppliers offer.

The society lobbied for the law's adoption. The bill was signed into law by Gov. Andrew Cuomo at the end of 2011.

After its passage, the society took the position that the law banned all insurers from forcing enrollees to use mail-order drug suppliers, but state Medicaid officials believed otherwise, Clark said. At the society's urging, the Legislature passed an addendum to the law specifically applying the law to Medicaid.

But the addendum also carved out a list of excluded "specialty" drugs named on the Final Criteria and Exclusive Pharmacy Network Drug List. Virtually all are high-cost, high-profit items, Clark said.

The specialty-drug carve-out affects only Medicaid HMOs. Enrollees in traditional, fee-for-service Medicaid can get all prescriptions filled locally.

Managed-care Medicaid plans, such as the locally based and Excellus BlueCross BlueShield-affiliated Monroe Plan for Medical Care HMO, which covers Monroe County Department of Social Services clients, are privately run and function much like group plans offered by private carriers.

"The beneficiaries (of the state's Medicaid HMO exceptions) are ... PBMs, which frequently pocket large profit margins using an opaque reimbursement scheme based upon high volume," Clark maintained in an email.

PBMs disagree, contending the mail-order houses they own save money and offer service as good as or better than local druggists.

The Pharmaceutical Care Management Association, a Washington-based PBM trade group representing Express Scripts, CVS Caremark and other PBMs as well as for-profit insurers such as Aetna Inc., credits its PBMs and mail-order pharmacies with helping government insurance programs achieve billions of dollars in savings.

A study commissioned this year by the group estimates that mail-order pharmacy savings could total $47 billion over the next 10 years.

"With the help of pharmacy benefit managers, (Medicare's) Part D (prescription drug program) sponsors continue to exceed expectations in terms of savings, choice and satisfaction in Medicare," PCMA president and CEO Mark Merritt said in a statement issued as part of the association's recently launched "That's What PBMs Do" ad campaign.

A glowing review on the PCMA website highlighted savings achieved through reforms of New York's Medicaid kicked off by Cuomo last year. The PBM trade group maintains the state can save even more money once it "tap(s) into the savings available through affordable pharmacy networks and targeted use of mail-service pharmacy."

The Anti-Mandatory Mail Order law provision requiring local druggists to match mail-order prices negates the PBMs-save-money argument, Clark said. And mail-order drug suppliers often provide worse service than community pharmacists, she maintained.

The so-called list of specialty drugs included in the Department of Health carve-out is not recognized by any other agency, and drugs on the list can be as easily and often more safely supplied by local pharmacies, the Pharmacists Society's Burridge said. Rather than offering Medicaid HMOs savings, the PBMs cut deals with pharmaceutical companies to boost their mail-order subsidiaries' profits, he believes.

An affidavit filed by one of the Medicaid plaintiffs in the class action, identified as a liver transplant patient with hepatitis C, details poor service by CVS Caremark. On one occasion, the mail-order pharmacy sent 20 pills instead of a month's supply, the patient states.

On another, it claimed to have contacted the patient's physician after failing to receive a prescription authorization but, according to the doctor, had never done so. The consequences of not taking the required medication could include death, the patient states.

A HIV-positive Medicaid plaintiff complains in a separate affidavit that heat-sensitive drugs and supplies languished in an unrefrigerated processing center for days after a Federal Express delivery from a mail-order pharmacy went awry because the patient was not at home to sign for it. A representative of the mail-order house advised the patient to drive to the processing center and pick up the medication. But the patient, knowing the drugs would be ruined for lack of refrigeration, refused. A 30-day supply of pills had melted into a single, solid clump.

The pharmacy eventually sent a replacement, the patient states. "(But) it took two days before their regional manager let me know that the shipment would finally be sent out. Luckily, I had only missed one dose of HIV medications before this shipment arrived."

In an agreement between the society and Department of Health last month, the state's specialty drug list, which was to have gone into effect Oct. 8, is on hold pending the lawsuit's outcome.

----------------------------

Court: Medicaid patients don't have to get prescriptions by mail

By Charles McChesney, The Post-Standard

on October 05, 2012 at 5:01 PM, updated October 05, 2012 at 5:05 PM

Medicaid patients in New York state don't have to use mail order to purchase the most expensive prescriptions under an agreement reached Friday in an Albany court.

Judge Roger D. McDonough got the state Department of Health to agree to stop letting managed care plans refuse to pay for prescriptions filled locally.

The Pharmacists Society of the State of New York and several pharmacies went to court, saying managed care plans were breaking state law by forcing patients to order drugs by mail instead of getting them from a local pharmacy.

Hundreds of millions of dollars are involved, said Craig M. Burridge, executive director of PSSNY. Managed care plans have created a list of more than 400 of the most expensive prescription medicines and blocked local pharmacies from providing them.

It creates no savings for the state, Burridge said, because local pharmacies are required to meet or beat the prices of mail-order pharmacies.

More, the mail-order pharmacies are all outside of New York. Unlike PSSNY's 3,800 members and the thousands of assistants and others with whom they work, those filling mail-order prescriptions don't pay taxes to New York, he said.

Burridge said the number of pharmacies in the state has dropped by hundreds in recent years. Blocking those that remain from providing the most expensive medicines to Medicaid patients will make it harder for those that remain to survive, he said.

Linda Clark, an attorney for Hiscock & Barclay who represented PSSNY in front of McDonough, said requiring patients to receive prescriptions by mail threatens their health. She told of a patient who needs to take drugs to prevent his body from rejecting a transplanted liver. He needs to take the drugs at specific times, but has no idea when the Postal Service or UPS will show up with his medicine, she said.

Those living in large apartment buildings sometimes find their prescriptions left in a hallway near a wall of mail slots. Or worse: "Leaving a $10,000 hepatitis drug on the stoop outside in the summer might not be a good idea," she said.

Further, Clark argued, state law forbids requiring patients to get prescriptions by mail. She said the law is clear for those with private insurance as well as for those on Medicaid. "You can't be forced into mandatory mail order," she said.

She said Medicaid patients who have received letters telling them they had to use mail order can now go to their own pharmacy. If there is a problem, she said they should call the state Department of Health. And, she said, they can call the PSSNY which is gathering information on the issue.

The matter will be heard again by McDonough at a show-cause hearing in December, according to court documents.

The state Department of Health did not return a phone call seeking comment.

 
 
 
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