A.G. Schneiderman Announces $375,000 Settlement With Specialty Pharmacy Over Failure To Provide Basic Services

Accredo Health Group, Inc Agrees to Address Delivery Delays for Life-Sustaining Medication, Insufficient Non-English Language Services, Mishandling of Consumer Complaints, and Other Key Service Issues; Company to Pay $375,000

A.G. Schneiderman Encourages New Yorkers to Call Health Care Helpline - 800-428-9071 – or File Complaint Online For Help Resolving Health Care Issues

Attorney General Eric T. Schneiderman recently announced a settlement with specialty pharmacy Accredo Health Group, Inc. (“Accredo”), following an investigation that revealed, among other issues, that Accredo failed to timely deliver life-sustaining medications; timely respond to after-hour calls; and provide adequate language access for non-English speaking consumers. The investigation also showed that Accredo was not adequately tracking consumer complaints that were directed to the company –so it could not determine whether the complaints were handled adequately - and that counselors for New York consumers lacked proper New York licensure.

“Specialty pharmacies like Accredo are responsible for managing lifesaving drugs for chronically ill patients. They must be held to account when basic services fall short, especially the timely delivery of life-sustaining medication and access to representatives in the consumer’s language,” said Attorney General Schneiderman. “My office will continue to fight to ensure New Yorkers are getting the care and coverage they deserve, and I encourage any New Yorkers who need assistance dealing with their health care issues to contact my office.”

As a specialty mail-order pharmacy, Accredo purports to provide services that are not typically available at retail pharmacies, such as a 24-hour hotline for consumers and an array of disease management services. The Attorney General’s office initiated an investigation after the Health Care Bureau Helpline received dozens of health care consumer communications complaining about Accredo’s services. The complainants often suffered from serious and sometimes debilitating diseases like cancer, rheumatoid arthritis, and HIV. Among their complaints were allegations of delays in mail-order deliveries of life-sustaining medication, privacy concerns with respect to deliveries, prescription errors, billing errors resulting in medication delays, lack of language access for non-English speakers, and long telephone wait times when calling Accredo for assistance.

Accredo, through its parent company, Express Scripts, one of the largest pharmacy benefit managers in the country, adheres to Express Scripts’ formulary for “specialty drugs.” Accredo describes these specialty drugs as (i) requiring some form of “special handling” – e.g., frequent dosing adjustments or intensive clinical monitoring – or (ii) costing in excess of $500 each month. In either case, Accredo delivers these “specialty” drugs directly to consumers. As part of the settlement, Accredo will implement a plan of action to improve various aspects of its specialty pharmacy services and pay $375,000 to the State of New York.

Under the terms of the settlement, Accredo agrees to improve its services by:

• Dispensing an urgent prescription on the day required or facilitating the dispensing of the prescription from a retail pharmacy;
• Adopting the “New York Pharmacy Customer Bill of Rights for Language Services” (to include training and monitoring of pharmacy staff) and a “Language Assistance Policy;”
• Informing patients of their right to free language assistance services;
• Recording all after-hour calls and ensuring that patients who are referred to a pharmacist receive call-backs within two hours;
• Ensuring that RN and LPN counselors are licensed in New York State;
• Recording all patient complaints/queries and auditing resolutions;
• Disclosing to plans, patients, and providers on its website that all patients may not require Accredo “specialty” services;
• Undergoing an independent audit covering the relief specified in the agreement.

While Accredo asserts that it provides an array of “special services” for its specialty drugs customers, the investigation revealed that almost 75 percent of New York consumers whose health plans contract with Accredo for “specialty” drugs do not require any special service – e.g., the drugs are taken by mouth and do not generally require any kind of additional assistance like infusion support or injection assistance. While New York insurance law (the “Anti-Mandatory Mail Order Law”) requires that plans afford consumers the choice of obtaining drugs at a retail brick and mortar store instead of via delivery, that law only provides that choice to consumers if the retail store offers prescriptions on the same terms and conditions as the mail order company. Because Accredo offers special services that brick and mortar pharmacies usually do not (e.g., 24 hour telephone assistance), consumers may not always be able to avail themselves of the New York law.

Consumers who have concerns that their privacy may be compromised if drugs are delivered – or perhaps feel that expensive drugs are at risk of theft if delivered – and would prefer to purchase the drug at their brick and mortar store, may be eligible for a “hardship” exception through their health plan. The Attorney General’s Office has negotiated hardship exemption policies with seven health plans that allow consumers to obtain the specialty drug though their neighborhood brick and mortar store. Consumers who don’t know if their health plan maintains a “hardship exemption policy” or have any other health care related complaints can reach the Health Care Bureau Helpline at 800-428-9071 or file a complaint online.

The matter was handled by Health Care Bureau Assistant Attorney General Dorothea Caldwell-Brown, former Volunteer Assistant Attorney General Laura Puhala, and Civil Rights Bureau Assistant Attorney General, Anjana Samant, with the assistance of the Department of Research & Analytics; former Director Lacey Keller; former Researcher Emma Eastwood-Paticcio, and Meredith McCarron, Data Scientist. Bureau Chief Lisa Landau leads the Health Care Bureau, which is part of the Social Justice Division, led by Executive Deputy Matthew Colangelo.