Brabu Pharmacy and Wellness Center
Theodore R. Parker, R.Ph., MPH
This community pharmacy in the Northern Marianas Islands says it was left completely out. The only "preferred" pharmacy for their patients is in Hawaii, 9 hours away by plane. The pharmacy appealed to CMS and even offered to match the reimbursement rate, but was told that being in the preferred network was "by invitation only" and was denied.
Hashim Zaibak, R.Ph.
3727 W Wisconsin Ave
Milwaukee, WI 53208-3182
Serves a considerable amount of low-income Medicaid/Medicare patients. Many of them don't have cars and would certainly prefer (for example) in the harsh winter months to not have to make the public transportation trip to the pharmacy. The pharmacy does a lot of delivery, but they do a lot more than just drop off the prescriptions. They actually offer MTM services in their patient's homes
They cater to several different immigrant populations that include the Hmong (besides the Minneapolis/St. Paul area they have the highest number), Somalis, Iraqis and Spanish speakers. Their delivery drivers speak those languages and can facilitate video conferencing with staff pharmacists via tablet computers when patient questions arise or counseling is requested.
They also go to other community venues likes churches to provide disease state management education.
No national chain would go above and beyond like this to cater to their patients, who clearly lose out when preferred pharmacy plans excluded this pharmacy.
Mt. Carmel Pharmacy
705 E. 187st
The pharmacy has been in the same location for 50 years with the same ownership—passed down from father to sons.
The community landscape has changed considerably during that time period. It went from being dominated by Italians to being true melting pot of all ethnicities and races. He has pharmacists who speak Italian, Spanish and Albanian.
No other pharmacy in the immediate area offers that. And certainly the same-day home delivery they provide to approximately 60% of their Medicare Part D patients can't be replicated at a chain pharmacy. Patients are very comfortable with this pharmacy because they have been going there for years if not decades.
By breaking down the language barrier they are able to dispense what can become life-saving advice. You can't put a price on that.
A family comes from the Dominican Republic and speaks Spanish only. The father is in renal failure when they come to the pharmacy and introduce themselves. The pharmacist and staff speak Spanish from the moment they walk through the door. Their level of comfort was obvious and that was 7 years ago. The father has since qualified for Medicare part D, has been relying on our delivery service, and recently had a kidney transplant. Were it not for the comfort level, this patient might have landed in a chain pharmacy that could not meet the needs that his family relies on till this day for medication delivery, professional pharmacy advice on the specialized medicines he will be on for the remainder of his life which are explained in detail in the language that he and his family are most comfortable with. The pharmacy is truly a lifeline for this Spanish-speaking patient.
An Italian couple that moved to the pharmacy's neighborhood in the 1970s, have been patients along with their 3 children for four decades. They spoke no English then and not much more today. As the insurance world changed, the staff of Italian speaking pharmacists helped them to navigate their way into the world of Medicare part D. The family has since relocated 12 miles north of the pharmacy. They continue to service by way of delivery and offering the same Italian-speaking comfort. This couple, now in their 70's, NEEDS these services. The husband had a stroke and cannot drive. The wife never learned to drive. This pharmacy is absolutely their lifeline. When programs force patients hands, in cases like this family, into preferred networks, who will help them manage? Who or how will they get their meds by one of these preferred pharmacies?
New York City
A feature was recently done on the store in the Wall Street Journal
, and its role as a community fixture.
He is Puerto Rican, speaks Spanish, and prints labels in Spanish to cater to patients where English is a second language.
When it comes to the "any willing pharmacy" provision being added to Medicare Part D plans he is willing to accept the lower reimbursement rates and potentially onerous terms in order to compete and grow his customer base.
The New York AMMO bill doesn't necessarily apply to federal programs, so huge swaths of his customer-base can be forced into mail order. New York City, which is dominated by apartments can be problematic for mail order pharmacy. For example, the prescription packages don't always fit in the apartment building mail boxes so patients are forced to go to the post office. The need for going to the post office can also be caused by concerns about packages being stolen in certain impoverished neighborhoods where that type of criminal activity occurs.
His pharmacy has done countless emergency fills for their patients who were forced to go the mandatory mail order route. The most frequently occurs when new insurance is obtained or during a holiday season. In fact, when his pharmacy has drug take-back days mail order prescriptions figure prominently and from time to time the flood of auto-shipped prescriptions for patients who have recently passed away is a substantial contributor, since their relatives don't know what else to do.
He helped one family find a special type of syringe to help their child take a specific prescription drug, after they struck out at pharmacy after pharmacy. Unfortunately, after three months they were forced to go the mail order route. Even his own mother and father are forced to use mandatory mail order, because of requirements by the supplemental policy that comes from his father's former employer.
He has known patients for decades. That's why many patients are so apologetic when a plan forces them away from his pharmacy. Thankfully, some patients will pay more to continue using his pharmacy.
He is concerned that the move to Managed Medicaid, especially with dual eligible patients, will open the door to more private insurance pushing mandatory mail order. Because of mandatory mail order and preferred pharmacy plans his business has not grown as expected. If he hadn't diversified his revenue streams he might be in real trouble.