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The Dose

It's Almost Like the Elderly are Being Preyed Upon …

by Jayne Cannon | Feb 13, 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.

While I was out of the pharmacy on Dec. 21, one of my patients came in and asked my relief pharmacist to transfer all of her medications to a big-box chain two towns away. When I came back to my store on Dec. 26, I called the patient to ask why she had transferred after almost five years with us. She told me that her insurance broker told her that she could save over $200 by switching from our pharmacy and using a new plan at the big box. So, based on her broker's recommendation, she switched plans.

But the problem is that the insurance broker failed to mention the patient actually could save more than $50 a year over the big box store by staying with our pharmacy and using the new plan. I did my own investigation and research on, and printed a list of the patient's drugs and how much she would pay at the big-box chain versus our pharmacy. After showing the patient she could save even more money by continuing to use our pharmacy, she was thrilled to be able to switch everything back.

On Dec. 28, I called the chain pharmacy and transferred back all of the prescriptions we transferred to them a week earlier, plus all of her new prescriptions. The pharmacist at the chain was confused because they just transferred everything from us a few days ago. Along with causing confusion, we wasted a lot of time with both our staffs transferring prescriptions. It's a process that takes time, and it had to be done twice, for no reason.

I did a little more research and was told that brokerage compensation is consistent across all plans per rules set by the Centers for Medicare and Medicaid Services. In an email exchange with one of the big three wholesalers, I was told plans have employees that enroll patients and that some plans/chains have strong affiliations, so there could be some bias there. I am all for the free market and competition improving care and driving down costs, but what I am against is the idea that some pharmacies and Medicare plans can control the market by misleading/preventing patients from making decisions in their best interest. Money is tight for this patient and she chose the new plan to save a good chunk of money, but she saves more money by choosing that new plan and continuing to use my pharmacy.

The big issue here is that the insurance broker was technically correct in what he did say, but what he did NOT say bothers me. Why fail to tell the patient the whole truth? Why didn't he tell her that she'd save money with a new plan at my pharmacy? This caused confusion and waste with all the transferring, investigation, and transferring. If all of the facts and information were presented in an honest and straightforward way, there would have been no confusion and there would not have been any waste in labor hours. It is almost like the elderly are being preyed upon because of their trust that others will help them make choices in their best interest.

- Jayne Cannon