Pay Independent and Hospital Pharmacists Fairly & Provide Access Through Coverage

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Per a recent consumer reports study, most patients prefer independent pharmacy (Gill,2018). Unfortunately, many are not allowed to use independent pharmacist for coverage of their life-saving medications as they have been removed from the insurance networks by their competition. It appears, no one is listening to the voices of voters and patients.

For example, recently medications that were filled by a hospital pharmacy were suddenly forced away from the hospital pharmacy to the insurance company's pharmacy benefit manager's owned mail-order pharmacy. It wasn't because our pharmacy was unqualified; they fill medications for children's transplant, cancer, and many other specialty medications every single day. Although, the reply received from the insurance company for the reason for denial said the pharmacy was not appropriate to fill these medications. Many would argue they were the most qualified and appropriate.

The issue is the pharmacy benefit managers (PBM) who control access and reimbursements. There is about an 80 percent chance your PBM is Express Scripts Optum RX or CVS Caremark. Sadly, these same pharmacy benefit managers force many to their own mail-order and retail pharmacies. For my family, our only in-network pharmacy is CVS and CVS mail-order pharmacy. The PBM, of course, is CVS Caremark. Life-saving medications, like my son's transplant medications, are mandated to only be received through the mail for coverage. This issue is not unique. It's happening across America.

Recently, a news article stated that CVS paid their own pharmacy much more. "For example, CVS would have to pay Walmart and Sam’s Club almost half again as much — 46 percent more — for generic drugs if CVS were to equal the rates it was paying its own pharmacies" (2019, Candisky & Schladen)"

When looking at the reimbursements of our independent pharmacies, unfair and unequal reimbursements are found. "For a Fentanyl Patch 100, CVS pharmacies were reimbursed $400.65 while mom-and-pop pharmacies were reimbursed $75.74. For Amoxicillin, CVS pharmacies were reimbursed $35.92 while mom-and-pop pharmacies were reimbursed $12.21 (Lopez,2018)" Upon speaking to many pharmacists, these reimbursements are barely enough or not enough to cover their overhead cost along with the cost of the medications.

After these unfair reimbursements Business Insider notes, "They also didn't know that, as their local pharmacists were getting squeezed, CVS was waiting in the wings, sending out letters offering to buy the very mom-and-pop shops it was forcing out of business (Lopez,2018)."

In Ohio alone, over 160 independent pharmacies have closed. Many were bought out by CVS and many did not reopen. These closures are leaving entire communities at loss of a critical healthcare provider to help them demonstrate how to use complex medications, to inform patients that it may be cheaper to pay cash instead of using their insurance card, to prevent patients from taking the many risks of mail-order pharmacy such as delays, lost, thefts, loss of potency of medications due to lack of temperature monitoring, the risk of children and pets ingesting medications, and no one to communicate face to face with our elderly and people with chronic conditions and the list of over 100 other issues with mail-order pharmacy.

The over-performance and hard work of our independent, hospital, and community pharmacist should be greatly rewarded not overlooked and disregarded. For example, CVS often states that they are paying per performance. For example, CVS states they pay the pharmacy based on factors such as patient adherence and use of generics. They often measure adherence by medications refilled by the customer. However, for some customers who are discarding medications by the table full due to auto refills and the price gouging of taxpayers dollars when generics are filled, many patients argue that the performance reward should go to our independent, community, and hospital pharmacy who do not make us take all the risks with mail-order pharmacy.

Often, when a medication is refilled and the mail-order pharmacy has delayed the medication for days and weeks or one of many incidents that can go wrong with mail -order happens during shipment, the independent pharmacies will fill an emergency prescription. What will happen as the independent pharmacist close their businesses? Where will we go?

The insurance company's pharmacy benefit managers are hoping that we are all sleeping at the wheel. That we are not caring about the future of our pharmaceutical care. Let's unite and the PBMs and our regulators otherwise!  

YOUR SUPPORT WILL SAVE LIVES 

Thank you!

 

References, 

Candisky, Cathy, and Schladen, Marty, and . “CVS Paid Itself Far More than Some Major Competitors, Report Says.” Gatehouse Media, Gatehouse Media, 2019, gatehousenews.com/sideeffects/cvs-paid-far-major-competitors-report-says/.

Gill, Lisa L. “Consumers Still Prefer Independent Pharmacies, CR's Ratings Show.” Product Reviews and Ratings - Consumer Reports, 7 Dec. 2018, www.consumerreports.org/pharmacies/consumers-still-prefer-independent-pharmacies-consumer-reports-ratings-show/

Lopez, Linette. “What CVS Is Doing to Mom-and-Pop Pharmacies in the US Will Make Your Blood Boil.” Business Insider, Business Insider, 30 Mar. 2018, www.businessinsider.com/cvs-squeezing-us-mom-and-pop-pharmacies-out-of-business-2018-3