Only a short time after starting this petition, I realized I would need more than stopping the forcing mail order pharmacy to ensure safe pharmacy access for patients like my son.
Last week, I sadly faced this reality again as I listened to legislators in Louisiana.
The alarming reality is that if this petition is successful at ending the ability for insurance to force their own mail order pharmacies, the insurance companies and their mail order and retail pharmacies are a step ahead.
In some states, such as Louisiana, laws have been written to protect patients against certain health insurance plans forcing them to their own retail and mail order pharmacies. However, insurance companies found brilliant ways to ensure that patients would still lose.
Mail order pharmacies and insurance companies merged with pharmacy benefit managers or PBMs. You've most likely heard of the three largest Optum RX, CVS Caremark, and Express Scripts which control 80-90% of medications covered through insurance across our country. Each has merged with a major health plan.
These three companies oversee the networks or the list of pharmacies that insurance companies cover and also handle the reimbursements for these pharmacies.
After states attempted to act laws to prevent insurance companies and their pharmacy benefit managers from steering to their own mail and retail pharmacies, guess what they did? They began forcing competitor pharmacies out of business by reimbursing them below their costs. Thus, they are pushing them out of network and for many, out of existence.
Why would they do this?
Independent pharmacies are often locally owned. These pharmacists fought hard to be able to remove gag clauses in contracts, so they could inform patients that the cash price would be lower than the cost of their copay.
Have you ever noticed that if you call to ask the cash price of a medication at a large retail pharmacy such as CVS or Walgreens, you will be told the full retail price for many medications? Their pharmacists' hands are often tied to the corporate red tape that may prevent them from telling you how much the real cash price could be.
Patients who call a smaller and often locally owned independent pharmacy will most likely receive a much lower cash price. Now, this will mostly only work with generic medications. Brand-name drug manufacturers don't give great deals to independent pharmacies as generic manufacturers. This needs to change.
The system is designed to ensure that those that profit the most from the high costs of America's medications win as patients and pharmacists are trapped. Pharmacists who work at pharmacy chains are so tired of the understaffing and abusive treatment that they leave the profession and refuse to work at these pharmacies. Patients have few options to take their business elsewhere when the pharmacy their insurance company forces is a one-star rated mail order pharmacy or a retail pharmacy that is often closed due to understaffing.
America's pharmacy and medication access are in trouble. Please your voice and contact your legislators to try to save pharmacy.
Thank you for your support,
Loretta Boesing