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DADE CITY, Fla., Aug. 29, 2016 -- The following is a statement by Pharmacists United for Truth and Transparency (PUTT):
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Patients of Discount Pharmacy* in Dade City, Florida were surprised to receive cautionary network restriction letters from their Medicaid HMO Plan, Staywell. The letter warned that after March 31, 2016 only the approved pharmacists listed in the letter would be covered under Staywell’s Managed Care Plan. Patients quickly noticed Discount Pharmacy was nowhere to be found on the list.
A photo accompanying this announcement is available at http://www.globenewswire.com/NewsRoom/AttachmentNg/76e2027f-dc61-4ba9-99aa-dd1cb17fc81e
One of the co-founders of Discount Pharmacy describes that period as a flurry of confusion, “Since the restriction was enacted in April, we’ve lost approximately 326 prescriptions per month from 51 patients, because, and rightfully so, they don’t want to change their plans.” The co-founder did note that many patients are dismayed at the change because some of the services available through Staywell are not offered by the other Medicaid managed care plans. These services include Diabetic Educators on regular home visits to work with and counsel patients, sending a nurse to provide weekly home visits, and intensive care post surgery. 10 patients opted to stay with the pharmacy because Discount Pharmacy offers bilingual staff at all times and free delivery for those who do not own cars and live in locations where public transportation is scarce.
The story of Rx Discount Pharmacy is all too common. Despite the great value independent pharmacists provide to the economy (pharmacy small businesses represent over $81 billion annually), according to the National Community Pharmacists Association approximately 1900 independent pharmacies have closed their doors over the course of the last 10 years. This is roughly a 5% reduction in the total number of small business pharmacies. There are a number of different reasons for this, but the co-founder of Discount Pharmacy speculates many of these closures are the consequence of industry reimbursement and contract abuse. “In my opinion, when CVS Caremark contracted to be the pharmacy processor for Staywell in 2015, CVS was then able to re-channel the prescriptions and business towards their own stores. This is happening even though it’s tax money that is being utilized to fund these plans. About 90% of independents are excluded from these network approved plans.”
CVS Caremark, as well as, Optima and Express Scripts are three of the largest Pharmacy Benefit Managers (PBMs) in the United States. PBMs are third party intermediaries for prescription drug programs between pharmacies and health plan enrollees (employees of private companies and government agencies as well as welfare programs). PBMS face little to no government oversight and the lack of transparency has led to substantial discrepancies in how reimbursements are both calculated and paid out. Unexplained fees are charged to pharmacists in such extremities that independent pharmacists find themselves paying manufacturing costs and being reimbursed at only 40-60% the full cost. Independent pharmacists are increasingly being forced to send prescriptions to larger pharmacies whose bottom line is not as severely impacted.
Discount Pharmacy has already seen a $20,000 reduction in its bottom line since April. The staff is currently conducting immunizations and Medication Therapy Management in an effort to generate alternative income, however they worry that this is not sustainable in the long term.
*Name has been changed
Pharmacists United for Truth and Transparency (PUTT) exists to unify, promote and preserve independent pharmacies through education and access; to monitor PBM and other industry practices which, when identified as abusive, are exposed in various manners in the interest of improving quality, safety and cost of patient care. For more information about the negative impact of Pharmacy Benefits Management company practices on the cost and accessibility of medications, or to learn more about PUTT, visit TruthRx.org or contact Monique Whitney, (602) 359-0626
Contact info: Melissa Kiguwa [email protected] (480) 797-2281
