To The Editor: Governor Cuomo has a chance to greatly improve the health and well-being of New York’s brave police officers—and all other workers for that matter—by a signing a bill that just arrived on his desk that would limit the role Pharmacy Benefits Managers (PBMs) play in making health-care decisions that should rightly be left to doctors.
Pharmacy Benefit Managers (PBMs) essentially are middlemen who use questionable business tactics to circumvent the doctor-patient relationship to pad their pockets by steering patients away from more-expensive drugs or toward medications with a higher rebate from manufacturers. Either way, the patient loses just to make PBMs more money.
Fortunately, the New York Senate and Assembly recently passed S6531/A2836 to provide important protections for the health of New Yorkers and their ability to receive the drugs their doctors have prescribed. Now, it is up to the Goivernor to sign this critical legislation into law. He will undoubtedly be under pressure to amend or veto the bill. He should resist any industry efforts to do so and sign the bill as is.
PBMs use management tools to deny or delay access to drugs that have been prescribed to patients—such as step therapy (or “fail first”) and non-medical switching. Both tactics are detrimental to a patient’s health, whether worsening symptoms or in extreme scenarios, causing death.
In step therapy, patients are required to first try medications that the insurance company or PBM prefers before they’re given access to their doctor’s prescribed choice. The process can often take weeks or even months, delaying necessary treatment to benefit the PBM’s profits while increasing a patient’s chances enduring complications.
A 2017 study by The Doctor-Patient Rights Project revealed that step therapy “can lead to an increase in costs for emergency-room visits and in-patient hospital admissions.” With the surging prescription costs, extra medical fees for additional ER visits are unacceptable and unnecessary.
The bill would ensure that hard-earned health benefits are preserved for all workers by banning PBM policies like step therapy that place roadblocks between the patients and the drugs they need to manage their health.
Specifically, it would bar the substitution of prescribed drugs and require PBMs, whose secretive policies have been described as a “black box,” to fully disclose which providers they contract and to provide fiscal transparency by describing all revenue streams they use.
It also would require PBMs to register with the Department of Financial Services, which would regulate PBMs and monitor them for conflicts of interest and deceptive practices and anti-competitive practices.
After years of collective bargaining for better union health plans, it’s unjust for New York’s police officers and their families to be put in a position where they must choose between delayed treatment or no treatment at all.
Due to irregular work schedules and increased stress, officers’ health risks are magnified—and cardiac issues have been the third leading cause of line-of-duty death to officers. Therefore, it’s imperative that they are given swift, affordable access to health care. The New York Police Conference represents more than 25,000 members in 230 localities, and we are dedicated to ensuring that our members are provided high-quality, affordable health benefits.
I urge the Governor to quickly sign this legislation into law.
Police Conference Of New York
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