Bill to require backup access for delayed mail‑order prescriptions draws industry pushback and calls for limits
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Summary
Sen. Donna Bailey’s LD 2005 would require mail‑order pharmacies and PBMs to provide a bridge supply at local pharmacies when deliveries are delayed or unusable; PBMs, carriers and plans supported the intent but urged limits (3‑ or 7‑day bridge, in‑network constraints) to avoid waste and cost.
Senator Donna Bailey told the committee LD 2005 is modeled on a Washington state law and aims to protect Mainers who rely on mail‑order pharmacies from missing essential medications when deliveries are delayed or damaged. Bailey said a backup plan would ensure patients—particularly those in pharmacy deserts or who must use mail order because of plan design—can access drugs locally rather than miss doses.
Speakers representing pharmacy benefit managers and carriers (Sam Hollomire of PCMA; Dan DeBarrett of the Maine Association of Health Plans; Margaret Reynolds of Cigna/Express Scripts) agreed with the goal of ensuring access but opposed the bill as drafted. They told the committee PBMs and carriers already use standard workarounds—temporary bridge fills at local pharmacies, expedited shipping, tracking notifications—and recommended amendments to limit duration and scope (suggested examples included a 3‑day bridge if a 90‑day mail order is delayed, a 7‑day fill if a shipment is unusable, and limiting fills to in‑network pharmacies) to prevent waste and control costs.
Community Health Options provided data indicating higher adherence among mail‑order users for chronic conditions (example cited: diabetes adherence of 92.7% mail vs. 82.2% retail) and suggested a 7‑day temporary fill with prorated copay as a compromise. PBMs and carriers said home‑delivery accuracy and tracking are high in their operations but conceded carriers should provide documentation about PBMs used and performance metrics for the committee’s work session. Committee members asked detailed questions about rural network adequacy, tracking practices, what constitutes "unusable" deliveries, and copay proration. Witnesses recommended drafting limits to bridge supplies to avoid duplicate fills and medication waste.
The committee closed the hearing and requested suggested amendment language (3‑ vs 7‑day options), data on PBMs used by state carriers and exchange plans, delivery/tracking accuracy metrics, and complaint counts for work session consideration.
