Fed-up pharmacists are banding together to inform consumers about bills pending in the legislature that would prevent health plans from limiting their participating pharmacies.
Members of the recently formed Coalition for Pharmacy Freedom of Choice say they’re suffering financially from having been barred from pharmacy networks dominated by the state’s two largest insurers. Now they’re lobbying to get consumers on their side, and themselves back in the loop.
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The group’s members – representing Stop & Shop, Walgreens, Pharmacy Services Corporation in Ann & Hope, Rhode Island Food Dealers Association, United Food and Commercial Workers Union, and Rx Place – have accused Blue Cross & Blue Shield of Rhode Island and United HealthCare of New England of unnecessarily limiting customers’ choices.
The coalition blames the existence of exclusive pharmacy networks that dictate where and from whom more than 600,000 Rhode Island residents can buy their prescription medications. Blue Cross, the state’s largest insurer, introduced a pharmacy network at the beginning of the year. Now, its subscribers can buy prescription drugs only at CVS, Brooks and 43 independent pharmacies.
United HealthCare has always had a limited pharmacy network. It expanded last summer to include CVS. United customers can now fill prescriptions at 135 of the state’s 175 pharmacies.
Blue Cross chose to go the exclusive network route so it could continue offering prescription benefits to elderly customers who signed onto the insurer’s BlueCHiP for Medicare plan, said Brian Jordan, a Blue Cross spokesman. Restricting subscribers’ choice of drugs and pharmacies turned out to be the only way to make ends meet and keep the benefit, Jordan said.
”Medicare doesn’t have coverage for drugs. They give us so much money per beneficiary” because in the past “they’ve lost their shirts on the pharmacy benefit,” Jordan explained.
Blue Cross offers that benefit. However, “the compromise that we came up with is, in order to control our costs, we put together a limited network of pharmacies,” Jordan said. ”In exchange for volume, we get a lower rate.”
”Drug costs are the most rapidly increasing component” of health care,” he said. “This is just our effort to control it. It’s the old volume/cost argument. We promised them (participating pharmacies) volume in exchange for a cost reduction.”
Asked how much costs have dropped since the beginning of the year, Jordan said “off hand, I don’t know.”
It’s the absence of cold, hard numbers that has the coalition holding firm to the belief that limited networks do not bring better prices.
”The exclusive pharmacy networks that the health insurers have created is bad news for our workers,” George Tennian, president of a local chapter of the UFCW said in a March 3 news release announcing the coalition’s formation. “These health insurers are needlessly threatening the livelihood of our members by limiting the ability of excluded stores to grow and create new jobs.”
Legislation known as “pharmacy freedom-of-choice” bills are pending. However, their survival is questionable. The General Assembly has considered similar bills in each of the last three years. All have died in the Senate.
The House and Senate Corporations Committees, which will review the pharmacy bills in the General Assembly, have yet to hold a hearing on the legislation. Nonetheless, Blue Cross is bracing.
”There’s certainly a lot of support for it and I think there’s more of a focus on it this year than in previous years, given that the benefit effects the elderly,” Jordan said.
If the legislation were to pass, requiring Blue Cross to open its network to all, costs would rise and “we would have to review the benefit to see whether it would still be worth the while to continue offering,” Jordan said. ”It may force us to drop the benefit.”
