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The Dose

True-Life Tales from the PBM Storybook

by Jayne Cannon | Feb 06, 2018

We talk a lot about PBM abuses, but there's no better way to illustrate the real-life impact of PBMs than hearing examples of what goes on in community pharmacies across the nation every day. In the coming weeks, we'll feature some of these stories from NCPA members who've told us how PBMs mislead and mistreat patients and pharmacies. If you have a true-life tale to tell, send us a note today.

"Our Patients Are Being Misled"

Just before Christmas, a patient came in to the pharmacy with a new insurance card from her Medicare Part D plan. The staff ran her prescriptions through and when they told her the copay amount, she was confused. The copay was much higher than she expected, she said.

The pharmacy staff explained that they had no control over the copay amounts that the insurance company gives back to them. The patient decided not to get her medications and told them she was going home to call her insurance company.

A little later, she returned to the pharmacy and told them she was told that she had to switch all of her prescriptions to a large chain because the insurance company said they are preferred. The pharmacist explained to the patient that his pharmacy was also preferred, and that there should be no difference in price.

After talking with his patient, the pharmacist realized that the insurance company may not have told his elderly patient specifically that his pharmacy is NOT preferred, but they did tell her that the chain store IS preferred, and they didn't bother to mention that his pharmacy is preferred too. The call confused her. And that's why she got the impression that she had to use the big-box store to get the lowest copays.

The pharmacist didn't leave it at that. He sat down at his computer, logged on to medicare.gov to compare the plan pharmacy to pharmacy, and showed his patient that the prices were identical and there was no need to change pharmacies.

She was relieved. And so was the staff of the pharmacy who had served her for years.

But there's a bigger issue here than just one patient. The pharmacy was able to retain this patient, but how many patients are independent pharmacies across the country losing because of misleading information? These are elderly people who trust professionals to tell them the truth, and that isn't happening. Rather than flat out saying that the independent pharmacy and the chain were both preferred, they definitely led this patient to believe that she had to leave a pharmacy she knew and trusted as well as her established routines just to get the lowest copays offered.

NCPA continues to fight for passage of S. 1044/H.R. 1939, the Ensuring Seniors Access to Local Pharmacies Act. Voice your support here.

Pharmacists find that a lot of their patients are confused, and this is one reason why. Has this happened in your pharmacy?