NYT,pg1: Drugstores Fret as Insurers Demand Pills by Mail

[DeepModem Mom]

Drugstores Fret as Insurers Demand Pills by Mail
By MILT FREUDENHEIM

Published: January 1, 2005


Employer health plans across the country are forcing millions of consumers to change their drug-buying habits. And one side effect could be the decline of the neighborhood drugstore.

Instead of picking up their medicines at a local pharmacy, growing numbers of consumers will be required - starting this month when new health plans take effect - to buy dozens of widely used drugs, like insulin for diabetes or Lipitor to lower cholesterol, by mail order.

Employers and the companies that manage prescription drug insurance coverage favor mail-order pharmacies because they can get lucrative rebates and deep discounts from drug makers when they buy in volume. Those savings, which are said to amount to hundreds of millions of dollars a year, can then be shared with employers and health plans.

Distributing drugs by mail order also gives the drug-insurance managers - known as pharmacy-benefit managers - more control over which drugs are used, because they can ask doctors to change prescriptions before the drugs are delivered....


http://www.nytimes.com/2005/01/01/business/01drugstore.html

[yorkiemommie1]

1. re: 'control over which drugs are used'

hmmmph... just happened to me last week. although, it was ok this time because i had asked the dr. to change my next prescription anyway.

[Danmel]

16. That happened to my husband

His plan went to mail order and when the medication arrived it was a different pill. He called his doctor and was told that the plan wouldn't cover the prescribed meds so the doc changed the scrip. Bean counters telling the docs what meds they can prescribe. Another reason to move to Canada.

[proud2BlibKansan]

2. We have had mail order drugs available for many years now

Three different companies have had the contract and each one has managed to fuck up in one way or another.

They routinely send the wrong drugs or put the wrong directions on the label.

It takes 3+ weeks to fill prescriptions, which frequently leads to lapses in administering daily meds. If we do run out of meds before the mail order comes, we can't call in an emergency prescription to our local pharmacy because the mail order firm has already told the computer that they have filled the script!

We finally gave up on the mail order idea when a pharmacist called to ask us to check our most recent delivery to see if she had accidentally put someone else's prescription in our package.

So even thought it costs 3X as much, we now get all our scripts filled at our local neighborhood pharmacy.

[Sporadicus]

3. It's Significant That I Can Obtain a 3-Month Supply

of a medication from a mail-order place for the same health insurance copayment as a 1-month supply from a pharmacy. The corner drugstore, owned & operated by an entrepreneuristic pharmacist, is a relic of the past. The chain pharmacies face lots of obstacles in the face of competition from mail-order outfits. Most apparent among these: each pharmacy - even though part of a corporate franchise - must bear the financial burden of fixed expenses associated with running a business from a brick-and-mortar store. Another factor: pharmacies must carry an entire line of sundries & services to maximize profits. Consumers are turning to discount stores for better prices on these items; it's rare that I find a price enticing enough to lure me into a pharmacy.

This isn't related to the story directly, but I wonder how the demise of brick-and-mortar pharmacies will affect the availability of birth-control pills & 'morning after pills' at these establishments. As we know, laws allow individual pharmacists to exercise discretion in dispensing these medications based on their religious convictions. Will increased competition among pharmacists for positions available in remaining pharmacies become more or less likely to dispense these formulations?

[amazona]

5. yes this is how our insurer got us to switch

I travel! I don't have time to fill a script every month, by switching to their mail order company, I can get three months at once. So far no worries.

[DBoon]

4. Customers fret as medications are stolen from delivery

Yeah right, nobody is home, the meds are dropped off, someone decides to walk off with them.

Then you have no medications and have to spend hours with the insurance company convincing them to resend without charging you twice.

[OutsourceBush]

6. My insurer bugged me about this multiple times

They monitor the drugs you use and charge to them, then they call you and twist your arm to get you to get the drugs by mail instead.

I kept saying NO!

This is bad for consumers and I hope it does not become totally mandatory. I can immagine people waiting for days or weeks to get something via mail. Many medical conditions should not be treated in that manner. When you need the drugs you need them NOW.

Say NO if they ever offer you the choice.

[happynewyear]

12. I have no choice

It is either bite the bullet and go with the mail order or pay 3X the amount. If you check costs, you'll often find that it might be cheaper to get your RX's filled at Costco and to hell with the insurance.

I have Caremark. God do they ever suck. Do a search on caremark jeb bush and see what pops up.

They are very corrupt (steaming off labels and sending out old drugs!!!)! I sent 3 RX's to them 3 weeks ago and have yet to hear a word. One of the RX's is for HIGH BLOOD PRESSURE medication. Maybe they are hoping I'll drop dead before I get the medications perhaps?

Wishful thinking Caremark. I am not going anywhere!

:grr:

[Liberal Veteran]

7. Well, in truth this is a bit skewed...

Mail-order is not going to replace the drug store for non-maintenance drugs. If you need an antibiotic, or prescription cough syrup, or steroid anti-inflammatory for an injury, or pain killer for a dental procedure, or anti-fungal for that yeast infection, etc....you are not going to be required to mail order them.

This is not uncommon nor is it necessarily bad for the consumer to get maintenance medication via mail-order.

I've been getting my antivirals by mail-order for the better part of 5 years. I actually LIKE getting a three month supply at one time and it is cheaper for the insurance company and me to do it that way since chain drug stores generally charge more because they are running a store front.

Yes, there are downsides. I think the first month of prescriptions should ALWAYS be filled at drug store, if nothing else for the sake of counseling, but if you are going to be on a drug for a extended period of time, running to the drug store every month is kind of a pain in the ass.

[sally343434]

8. Drugstores have brought this on themselves

We get our medications all by mail now. While there have been rare delays in starting a new prescription, we've never received the wrong drug and nothing has ever "disappeared."

We used to always use the neighborhood drugstore. But their prices are sometimes 50% higher than the mail-order outfit. But that isn't why we switched.

One time we had a prescription for a single pill, and they charged us $10 for it. We had been going to this drugstore for many years, and we asked why it was $10 for a single pill that should have cost about 50 cents. We were told that it was their "minimum charge." I asked them if our future business was worth that $10. They insisted on that $10, and we've never been back. So, in exchange for making their $10, they lost a steady stream of about $250 per month.

It's price gouging like this, probably to finance the owner's lavish lifestyle, that has brought this on. I don't fault insurance companies for wanting to avoid this wholesale price gouging. They get it enough with the obscene markups on the drugs themselves, let alone the added overhead of the greedy drugstores.

[oneighty]

21. One time

I could not afford the full script. I asked the pharmacy clerk to give me "Half now and half next payday." When I picked up the script there was sure enough half the script at full price for the full script.

The pharmacist explained; "We cannot do half scripts"

"Gee" I say "If you cannot do half scripts then at least give me all the pills since you are charging me for them anyway." He was highly offended.

He did not last long there. (Rite Aid)

180

[jmowreader]

9. I can see good and bad in this

The good is that your maintenance drugs could get cheaper. If you're with an HMO, that organization already has a formulary and it costs big bucks to go outside it. So if Lipitor is on your HMO's formulary, why not get it from a mail-order place?

The bad is if someone steals your drugs out of your mailbox. This could lead to a new drug black market--not heroin or pot, but Prozac and Dilantin. If you can get your blood pressure medicine cheaper from Mary down the street than you can from Canada, who would you buy it from?

Mail delays would be bad too.

If this gets really popular, I expect some of your larger HMOs to open their own dispensing businesses. If it's cheaper to buy drugs on an individual prescription basis from a mail-order pharmacy, it's got to be cheaper still to hire a few pharmacists and buy the drugs by the skid directly from the manufacturers.

[oscar111]

11. NATIONALIZE big pill,and every corner of healthcare

i am sick of reading of some new twist in some corner of healthcare that will jack up profits by putting the sick's lives in danger or gutting their life savings, .. either gutting all at once.. million dollar surgieries.. or over time.. five, ten dollar pills. Not for the one pill mentioned above, but ten dollars per pill for entire bottles full of them.

Elderly going without food, to pay for pills.. horrid.

time to take the profit out of healthcare, every part of it.

VA has state owned liquor stores.. called ABC stores.. why not state RX stores replacing current drugstores?

[jmowreader]

22. NC has state-run liquor stores too

They aren't nonprofit exercises; in some counties the ABC profits have negated the reason to set up profitmaking police roadblocks. (Unfortunately, Cumberland isn't one of these counties; the fucking cops set up a fucking roadblock on my street at least twice a week. Claimed reason: enforce the speeding laws. Real reason: an unbuckled seat belt is worth $125 and 2 points, and an expired safety inspection is worth $100. They come to my street, stop every car driving down it, write 20 tickets and leave--I sat there one day and watched. They can't be "enforcing the speeding laws" because they bring six cars and put six cops in the middle of the street--twenty to thirty feet from their cars and, of course, their radars.)

If we nationalized healthcare with the village idiot in office, healthcare costs would not go down, quality of care would not go up and your taxes would not be reduced to compensate for the extra revenues generated. The fuckers would send all that money straight to Iraq or to one of Dubya's friends.

With a Democrat in office, you could nationalize healthcare and feel good about the results. A Republican would figure out how to make it make him rich.

[reprobate]

26. You're not talking about the current Dem leadership, are you?

They are just as much a part of the sytem as the repugs are now.

We *truly* need a new grassroots movement to change the leadrship before you cant tell them from the repugs.

[jmowreader]

33. I said a DEMOCRAT, dammit!

You know, a JFK/FDR-style no-shit Liberal Democrat!

Not a DLC puke.

[reprobate]

36. Thank you. I wholeheartedly argree.

[heidler1]

19. My HMO keeps trying to get me on mail order, but

I live in AZ and during the summer it gets so hot in side of the mail box I wonder if the drugs are affected by the heat.

Another problem is the fact that the co-pay is the same no matter where you buy the drugs. At least half of the savings realized by the HMO for the user's shopping for lower co-pay and lower total cost should go to the person who does the shopping, thus creating a motive for the drug stores to compete by advertising their co-pay advantage. I ask a druggist about this and he said it's a Federal law that all co-pays be the same. This is another way to prevent price competition between drug stores. If HMO's publicized this it might force competition to raise it's lovely head.

[msgadget]

10. With premiums at an all-time high, insureds should have a choice

about how they want to receive their medication.

[oscar111]

13. I've seen PO carriers steal mail: and read of UPS drivers stealing guns fr

from shipments.. must have been shipments to gun stores, as one cannot mailorder guns IIRC.

So be careful about mail order. I have also read of thieves stealing from home mailboxes.. and of thieves following UPS trucks and then going to porches to steal.

Tell ups to leavethings on your back porch or block the view of your front porch. Also , block the view of your mailbox, so stuffed box wont tempt thieves. Cardboard inside your screen door will block view of a door mounted mailbox.

We need area RX stores for true safety, with delivery boys.

Any RX stores inyour are still deliver? none hereabouts do. NONE.

[happynewyear]

14. Caremark delivers bulk rate

No tracking #'s no nothing. Good luck finding out what happened to YOUR RX! :grr: :grr: :grr:

[msgadget]

15. There's only one drug store that delivers

in my area. Those are really good ideas for safeguarding the delivery, I hadn't even considered theft.

I just don't like mail order for prescriptions with the requisite 'review' by another company. Whatever happened to the doctor-patient relationship? Diagnosis is by committee these days, with the insurer exercising the final say.

We who pay these outrageous premiums should receive 'premium' care but instead have to settle for what they'll allow us. I don't see politicians doing more than tsk over the high cost because providing HONEST alternatives might weaken their insurance company contributors.

Don't get sick.

[BamaGirl]

34. Our local pharmacy will still deliver

No idea what they charge for it.

[w4rma]

17. Squeezing small buisnesses out of the picture some more. (nt)

[OutsourceBush]

18. Yup, drug stores.... another outsource victim

[ally_sc]

20. yeah and you had til midnite

to qualify for the money from medicare. never heard about the deadline except once on tv that is...

[Neshanic]

23. Every corner in Phoenix for sale....cheap, with building.

[Dem2theMax]

24. Check your prices BEFORE agreeing to any mail program.

My parents and I are both on the same health plan. They learned the hard way and I learned through them, don't believe what the insurance companies are saying.

Both my Mom and Dad bought medications through the insurance mail plan. And they found out that ALL but one of the meds they got through the mail were more expensive than going through their local pharmacy.

I am constantly being hounded by the insurance company to join their mail plan. NO freaking way.

[Cymbaline68]

25. Fun times with mail order

Every three months I have a panic attack while waiting for my daughter's injectable to arrive. That is IF they even call me to tell me it is on the way.
It must be kept cold, but there was one time when the one little ice pack was hot to the touch. Now, if you are shipping an injectable to Texas in June, don't you think it needs more than one dinky ice pack??
They have to 'review' her case for eligibility every year. Her syndrome ain't going away, and neither is her need for the injectable.

[NNN0LHI]

27. My employer forced me into a by-mail prescription drug plan January 1, 2004

I am glad they did too. I really like it. Between my wife and it saves us quite a bit of money every year. Hundreds of dollars a year saved. And I only have to order our drugs 4 times a year instead of 12 times a year which was almost like a full time job itself. Saves me a lot of time. If my company wouldn't have forced me into it I would have never switched to the identical optional by-mail prescription drug plan that they have been offering for 10 years or more. Wish I would have switched a long time ago. Could have saved thousands of dollars by now if I had.

Don

[Ilsa]

28. I have a problem keeping up with the once-every-three-months

ordering, and it can take up to two weeks to get the Rx. My son's scripts were expired (I don't know why, they weren't a year old), so I ended up having his doctor (a long distance doc) call it in to the pharmacy around the corner, a locally owned place.

Besides that, my son's meds undergo readjustment every few months. I pay more, but sometimes I do better stress-wise going through the local guys. If we get his meds set for awhile, I go through the mail ordering system to help save my money and also for the insurance co.

[d.l.Green]

29. Looking forward to less drugstores

Hopefully this'll be one chain box style that'll go out with mail order. In small historic towns like mine they have built these ugly insipid boxes, thanks to the small mindset of local officials of letting any development do whatever they want, in the name of some strange impression of public service. Our council just approved handing over parkland(!!!!) to build a drugstore whose chain has already had some major financial problems. To top it all off they amended their approval at the behest of the real estate development agent to be able to build ANYTHING on this land if the drug store ends up not being built or successful enough to stay in business. On parkland! I say good riddance to stores whose sole purpose is for drugs...

[American Tragedy]

30. I take Schedule II medication, so I guess that wouldn't work for me.

I have to pick up the prescription directly from the doctor each month.

[Princess Turandot]

31. I seem to be an exception here..I've been happy with the mail-order..

system. I was nervous abt it, and even gave my internist a crib sheet on certain skin related drugs, in case they called him, since I was concerned that the derm who originally diagnosed me wasn't going to write the scripts as I needed them, since it cuts back on her visit fees. I sent in my order my Fedex to have a record of delivery, because I was worried. But they approved 11 scripts at one time on my first submission, and shipped them to me by Fedex. They required a signature, so no one left a box at my door to be stolen. They don't even ID themselves on the box for that reason. I take a few meds for chronic conditions and need to use others intermittently for a skin problem. I figured out that the retail value of what they sent me was in excess of $3,000 for the 3 months, because 2 of the skin meds are very expensive and they did not bat an eye at the quantities ordered by my MD.(Too bad Vitamin D3 doesn't have a street value lol.) I have nearly a month to order a refill and got the drugs promptly. They have 7 day a week customer service phone lines, which they answer. When I had a detailed ? for abt a med, they switched me to a physician assistant.
It also was cheaper in terms of the copays.

I have had just horrible experiences at the pharmacy at the local branch of the national chain that I used. The only competent person was the guy behind the cashier, who had worked in pharmacies for a long time. If my doc wrote a script for me for 240 ml of a liquid topical which came in 120 ml sizes, the druggist would invariably only give me one bottle, when what she was supposed to do was give me 2 bottles. She made that decision w/o calling either me or my physician. (This was not the type of drug where that quantity was over the amount the doc could legally prescribe.) The same thing happened to me four more times in one year. Then I had the moment when the pharmacy tech at the store took processed a script for one of the benzos. The computer alerted him that I had received a script for a different benzo 3 weeks earlier. First he gave me a hard time, so I told him to put the script thru their computer system and see what the insurer said. Big surprise: they approved it since an MD can always order a different medication for someone. The kicker came when this 20-something tech said to me 'so like, are these the same kind of drugs or something'.

That was the final straw, so when my COBRA ran out and I switched to the HMO from the same insurance company, I decided to give the mail order a shot, and I've been very happy about it. (As far as I know, usng the mail order isn't mandatory.) I was able to renew the drugs on line, and they shipped them promptly.I now use a different pharmacy for the one shot type of scripts, which don't pay to send in. I would have to imagine that these plans must have some sort of exception for a person to get a drug at a pharmacy if they need it immediately.Don't get me wrong: having worked on the provider side of healthcare organizations and as an insured individual, I don't have much love for insurance companies. But the mail order drug process has worked well for me.

[booksenkatz]

32. I have several concerns about this

1. I can't afford to buy in bulk, no matter how great the overall savings. I can only afford to buy what we need by the week. (That's what happens when your company shuts down and you lose your job; we rely solely on my husband's income now.)

2. I would be very concerned about scripts sitting in extreme heat or extreme cold.

3. My son's ped writes out a script for Ora-Pred for occasional asthma/croup attacks and I hang onto that script until it's needed. Invariably, when my son has an attack, it's the middle of the night. I have to run out at midnight to get the script filled -- can't do that by mail order. No, I can't keep a bottle on hand, because my son's asthma is rare. Buying a bottle that is not needed is something I can't afford.

4. I have asthma myself, and recently my pharmacist was of great help to me when Glaxo suddenly changed inhalers without my knowledge and I could not get the new version anywhere. He went out of his way to get me one and to get the paperwork taken care of. Would a mail order house do that for me? I prefer having personal service when I need it.

5. What if I needed emergency birth control pills? Can't do that by mail order.

6. I'm old enough to remember when drugstores delivered, and I miss it!

I think that this type of thing should be optional. It's sad that we're running out of CHOICES in this country -- the corporations tell us what to buy and how to live. THAT is the greatest shame of this entire thread.

[BamaGirl]

35. I'll stick to my locally owned

pharmacy. We have to pay the same co-pay anyway, and since our deductible is so high I've compared prices at all the local chains. The local guys are cheaper. Also, they still deliver and they go out of their way to help when we have a problem.