Community pharmacists say they are getting squeezed by plans that restrict where customers can buy medications.
Years ago insurance companies hired pharmacy benefit mangers (PBMs) to administer prescription drug plans. Then PBMs began steering patients to order medications from their own mail order pharmacies by either charging higher co-payments if patients didn’t order from mail order, or by allowing them to order 90-day supplies from mail orders but only 30-day supplies from community pharmacies.
“We want a level playing field,” John Jacob, of the Berlin and Yough Valley pharmacies, said. “People should be able to freely choose their pharmacy.”
One insurance company implemented a passive strategy this year. After the third refill, the company automatically rejects the prescription and tells the patient that it must be filled through mail order.
“They don’t tell the customer that they can opt out of mail order and we’re not allowed to tell them that because of a clause in our contract,” Jacob said. “This is an unfair practice.”
Mike Fapore, of The Medicine Shoppe, Somerset, said when prescriptions are billed through insurance, pharmacists can track them for possible drug interactions regardless of where they are filled. The problems occur when people get low-cost or free prescriptions that are not billed through insurance or use over-the-counter drugs or supplements for which they pay cash.
“The way the system is set up it’s a disaster waiting to happen,” he said.
He can’t estimate the amount of business that his pharmacy has lost because of people thinking that they have to use mail order, but he knows of some people who have some of their prescriptions filled in the pharmacy and other prescriptions filled by mail order. If there isn’t a change in the way prescriptions are handled, some community pharmacies may go out of business.
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