Mail-order medicines worry local pharmacies
Local pharmacists are concerned about the quality of mail-order prescriptions despite their popularity – and one worries it could force him out of business.The industry has taken off in recent years because mail-order businesses often offer discounts to consumers. Rodney Diffendaffer, who owns and operates Rodney’s Pharmacy on Main Street, said it’s common for people to get three months’ worth of a prescription through mail order for the price of one month at a local pharmacy. And he says that leaves little incentive for people on a budget to shop locally.”The way the system is going, it’s going to ruin any independent pharmacist,” Diffendaffer said. He also is concerned that he is losing business from employees of Pitkin County and the city of Aspen because their insurance plans offer discounts on mail order. Consumers like the affordability and convenience of delivery right to their door. But some pharmacists worry that delivery problems and a lack of face-to-face contact with a medical professional could make the mail-order business less of a bargain.Organizations called pharmacy benefit managers, or PBMs, contract between insurance companies and pharmacists on how much to pay pharmacists for prescriptions. However, retail pharmacies can’t negotiate on that price. “A lot of these contracts are below pharmacy cost,” said Tad Anderson, who owns and operates the Basalt Pharmacy with his wife, Heidi. That’s why his pharmacy can’t accept every insurance plan – he would lose money on some contracts.Many PBMs own the mail-order companies, which is why mail-order prescriptions are sometimes cheaper. Mail-order companies can also get rebates from drug manufacturers, allowing them to drop the prices of certain drugs.There has been increasing political pressure in recent years for the U.S. Congress to change that system, and there are bills in both the House and the Senate that would allow retail pharmacists to negotiate their PBM contracts.Plus, while PBMs often are part of lobbying groups like the Pharmaceutical Care Management Association, retail pharmacists say there is no mechanism for them to lobby politicians in the same way. Although Diffendaffer is worried mail-order companies could price him out of the market, Anderson wasn’t worried about losing too much business. Carl’s Pharmacy manager Jerry Pearce also said he has been busy, though he attributes some of that to several Aspen pharmacies closing. Now there isn’t as much competition, and Pearce said he definitely picks up some of the slack.”There’s just not that much competition anymore,” Pearce said. He also said he tries to keep people coming by providing good service people can’t get through the mail. But that means paying several pharmacy technicians – and high overhead.”Don’t know what we can do about it, because the insurance companies are making the rules,” Pearce said.Anderson was more worried about patients losing personal interaction through mail order, which he sees as instrumental to the business. Diffendaffer expressed similar concerns. They worried that mail-order companies might not be able to catch a harmful drug interaction, or notice that someone is taking two different drugs that do the same thing.”I just feel that mail-order is not the safest way to get your meds,” Anderson said.It’s also common for deliveries to be delayed in the mail. Diffendaffer, Anderson and Pearce all said they frequently have to fill short, temporary prescriptions to tide customers over until the delivery arrives. But insurance usually doesn’t cover that, so customers end up paying full price. It’s sometimes enough that it offsets any money they might have saved by going mail order.”It’s not as much of a bargain as they thought it would be,” Anderson said.Diffendaffer said many of his customers – some of whom work for the city and county – complain that they can’t buy from him because they don’t get the same discounts as mail order. He said he thought local government could do more to encourage people to purchase locally.Pitkin County human resources specialist Connie Overton said she hasn’t heard people complain about the county insurance plan in regard to prescriptions. She also said a survey was e-mailed to all employees asking about the quality of the plan. Fifty percent responded, and Overton described the responses as overwhelmingly positive.City human resources director Rebecca Doane said although the city’s insurance plan covers local pharmacies, many people choose to go mail order.”It’s the most convenient way for people who are on maintenance drugs” for conditions like high blood pressure, Doane said. “You can get a three-month supply, and it is much cheaper. Clearly, it’s an advantage to our employees.”She acknowledged criticisms that mail order keeps money away from local business but said her first objective is to provide affordable, quality health care for her employees. Mail order is an attractive option because of skyrocketing medical costs, she said.”Medical prices are outpricing income,” Doane said. “If we don’t cover our prescription drugs, we’ve got employees who won’t take them. It’s a complex issue, and we’re doing the best we can.”Diffendaffer said he hopes people take notice and mobilize to change the existing system. Anderson also said the government could do more to regulate, but that won’t happen unless people talk to their representatives in Congress.Greg Schreier’s e-mail address is email@example.com
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