HONOLULU - A bill sitting on Gov. Neil Abercrombie's desk could increase competition for Hawaii pharmacies and make it easier for some residents to receive their medications.
The Hawaii Legislature passed the bill to allow residents to go to their local pharmacies to get their prescription drugs. Some plans, including current state and county employee health plans, require people to receive certain drugs by mail.
Kauai resident Rosemary Costales is one retiree who wishes she could opt out of the requirement. The 68-year-old diabetic patient said she prefers to get medication from a pharmacist who knows her and her medical history.
"I should be able to do that," she said. Costales had a bad reaction to blood sugar medication she received in the mail and ended up going to the emergency room. She said she feels safer receiving prescription drugs directly from her local pharmacist.
State Rep. Cindy Evans, who introduced the bill, says it is an issue of consumer choice. She says many people, like herself, prefer the face-to-face contact and assurances of having a personal pharmacist, a far cry from talking to a telephone operator or filling in an online form.
But critics say the bill will drive up costs. The Hawaii Medical Service Association and CVS Caremark Corp. oppose the bill and say the mail-order requirement makes prescription drugs more affordable.
"This legislation takes away the ability of plan sponsors to design a cost-effective pharmacy benefit plan that best suits their needs and the needs of their beneficiaries and employees," wrote Lauren Rowley, vice president of government affairs at CVS Caremark Corp., in testimony to Hawaii lawmakers.
Mark Oto, director of government relations at HMSA, agrees. He testified that health plans shouldn't be denied the flexibility to control costs.
State Insurance Commissioner Gordon Ito also had concerns about the bill. He said the insurance commission doesn't have jurisdiction to enforce it and is also worried about rising costs.
Some advocates of the measure say there isn't enough evidence to show that fees will increase.
And the issue isn't just about consumer choice. The bill could help local pharmacies compete with huge corporations like CVS Caremark Corp., a multibillion-dollar company based in Rhode Island. Hawaii pharmacists say that their business has suffered as a result of the state's move to mandatory mail order for maintenance drugs like diabetes or allergy medication a few years ago.
Kimberly Svetin from Molokai Drugs, the only pharmacy on an island of 6,000 people, said her pharmacy's prescription count has fallen since the shift. She said the drop in business forced her to turn away two prospective hires, both of whom are now on government assistance programs.
Les Krenk has felt a similar effect on Maui, where he has worked as a pharmacist for decades. Krenk says that because of the decrease in business, he was forced to lay off five people.
"It was the hardest thing I have ever done," he said.
But both Svetin and Krenk say the importance of the bill lies in improving patient health.
While mail order is convenient for many people, not everyone has internet access or a mailbox at home, Svetin said. She says sometimes insulin will sit in the post office, heating up far above the recommended temperature. Kauai pharmacist Lianne Malapit said the same thing happens in Kauai.
Jennifer Hawkins from Molokai knows the issue all too well. She has had several problems receiving her husband's medication on time or at the right temperature.
Once, the medication never arrived and Hawkins was told she could get it from Longs Drugs on Maui. She took the boat there during the weekend, but the store clerks couldn't reach Rhode Island to confirm that Hawkins could pick it up.
Hawkins returned to Molokai empty-handed.
That wouldn't have happened if Hawkins could have called a local pharmacist. Krenk and others say they don't hesitate to deliver medication to patients at night or over the weekend when it's needed.
"That's how local pharmacies think about their people: We think about them as part of the community," Krenk said. "Mail order doesn't think like that."