Pharmacies that have been left out of Blue Cross of Rhode Island’s and United Health-Care’s pharmacy networks are once again asking state legislators to put them in the loop. The Senate Corporations Committee heard supporters of a proposed state law that would require health insurers to allow customers to fill their prescriptions at any pharmacy that is willing to provide the service.
Those who subscribe to Blue Cross’s “Preferred Rx” pharmacy plan may fill their prescriptions at any CVS or Brooks Pharmacy. Many independents are also part of the network. The major chains that are not part of the network are Walgreens, Stop & Shop, and Ann & Hope.
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United HealthCare of New England, based in Warwick, also allows customers to fill prescriptions at CVS, Brooks, and many independent stores.
A bill nearly identical to this one was proposed last year, and the Senate Corporations Committee considered it at length, taking in hours of testimony. In the end, however, it decided not to forward the bill to the entire General Assembly for vote.
Blue Cross Spokesman Scott Fraser said three of every four pharmacies in Rhode Island are part of the pharmacy network. He told committee members March 9 that even with the pharmacy network – in which the participating pharmacies give Blue Cross a better deal in exchange for the increased business that comes with being part of a limited group of providers – Blue Cross was forced to raise premiums. Forcing the company to include all pharmacies in the network would cause costs to go up further, he said.
Like Blue Cross, United Health-Care is also fighting the legislation. Spokeswoman Kim Madden said, “When you have a network, (you’re) able to negotiate better prices – you’re getting a better deal for your members. If that’s taken away there’s no leveraging, no buying power.”
But those who support the legislation note that people often have to go right by a pharmacy that is closer to their home in order to get to one of the pharmacies in the network. Elderly people who do not drive are particularly hurt by this, supporters say.
PHARMACISTS like Richard Backer at East Side Prescription are watching closely the twists and turns of health insurance.
Further, representatives from Stop & Shop and Walgreens said they should not be denied the opportunity to do business with the thousands of people who now get their prescriptions filled through the United HealthCare and Blue Cross networks. They further argue that forcing the two health insurers to include the remaining pharmacies would not cause costs to increase significantly. According to Stop & Shop, 46 Rhode Island pharmacies are now being left out.
Fraser said Blue Cross will come up with projections on how much it would cost the company to add the remaining pharmacies.
Corporations committee members, however, nixed the bill last year, largely because of concerns that the bill would cause the cost of prescription drug coverage to rise even further. State Sen. Jonathon F. Oster, D-Dist. 34, a corporations committee member, said he expects the bill this year to meet with the same fate. After the hearing on March 9, the committee held the bill for further study. Oster supported the bill last year and said he still supports it this year.
”I’m still in favor of it. There’s got to be something we can do to open up the pharmacy system without passing on additional costs to our constituents,” Oster said. But he added: “My impression is (that) it has gained no more support this year.”
Blue Cross and United HealthCare hire pharmacy benefit management companies to set up their pharmacy networks. In the case of Blue Cross, it is the pharmacy benefit management company, PharmaCare in Lincoln, that negotiates with pharmacies and establishes reimbursement rates. Therefore, Blue Cross’s reimbursements go to PharmaCare, not the individual network pharmacies, Fraser said.
