Two pharmacies in Eureka Springs were recently left out of a list of preferred networks for Medicare Part D SilverScript, a supplemental drug insurance program by the private insurance company, CVS. The Eureka customers now have to travel 13 miles to Walmart or Economy Drug in Berryville if they want to get their prescriptions from a preferred network pharmacy where costs are lower.
The Eureka pharmacies don’t think that is fair. They feel the deal benefits the largest retailer in the world and other selected pharmacies at the expense of small, locally owned pharmacies and the people – some who can no longer drive or don’t have reliable transportation – who rely on them for medications.
“In the past, we had always been in the SilverScript’s preferred network and were able to serve our customers with zero co-pay for generic drugs,” said Danny Smith, pharmacist, Smith Drug Company, Eureka Springs. “This year, we weren’t allowed to.”
“It looks like SilverScript just wants people to go to a chain,” said Beth McCullough, owner of Medical Park Pharmacy, Eureka Springs. “They want them to go to Walmart. For people who come to my drug store, their co-pay is no longer going to be zero. It is wrong. It is not fair. It discriminates against local pharmacies.”
Interestingly enough, Economy Drug in Berryville is also a locally owned, independent pharmacy, and it is on the SilverScript’s list. But Economy Drug doesn’t like the preferred network program, either.
“We think preferred networks in general are bad for the American public, and they typically only benefit big box stores,” said Gabe Roy, one of the pharmacists at Economy Drug. “The American people should be free to go where they want and get the same co pay. These networks are out there, and we realize they are unfair. But if we don’t affiliate with any networks, we won’t have any business.”
Economy Drug was recently left out of another closed-door preferred network deal involving Walmart and Harps in Green Forest. Economy Drug is now no longer a preferred network pharmacy for the insurance program for Tyson’s, which is the largest private employer in the county.
“The whole network system is a farce,” said Robert Woolsey, a pharmacist with Medi-Quik, Ozark. “It is definitely not fair to my customers, nor myself. It is just a tactic by big business to drive the customer population to their pharmacy. It has nothing to do with what is good for the patient or the healthcare system. All independent pharmacists are asking for is a level playing field. We are not asking for more reimbursement. We are not asking for any more payments than a preferred pharmacy.”
Woolsey said at some point this inequity will be exposed and when it is, it will be a national news story.
“Driving business to one store or another using Medicare dollars should not be allowed,” he said. “It is not fair. It is an attempt to stifle competition. If customers are given a level playing field, they will choose their local pharmacist every time over mail order or chain pharmacies. Study after study shows they will go to where they get better service. Let the consumer make the decision about who wins and loses business.”
Preferred networks are a big problem all over the country, said Mark Riley, PharmD, president of the National Community Pharmacists Association (NCPA) and executive vice president and CEO of Arkansas Pharmacists Association. It is a particular issue in rural states like Arkansas. Arkansas is one of only a handful of states that have more independent pharmacies than chain stores.
“In my opinion, preferred networks are wrong,” said Riley, “It creates an unlevel playing field not only for pharmacies, but for patients who are locked out of going to their local drug store. I personally feel it is a violation of Medicare’s own policies regarding not allowing any inducements to move a person from one provider to another. It is inconsistent with its policy.”
The Center for Medicare & Medicaid Services (CMS) had determined that the government is not saving any money with the preferred network programs, and had proposed doing away with it. But heavy lobbying in Congress earlier this year overturned that proposed reform.
“What is particularly disturbing right now is CMS has finally come to understand preferred networks are not providing the savings they thought,” Riley said. “We worked three years on educating them, and they were going to do away with the preferred networking allowing any pharmacy in the network if it met the terms of payment.
“It is disturbing that CMS got it, put out a notice about a rule change eliminating the networks, and there was a fire storm against it in Congress pushed by the big drug store companies and brand name drug manufacturers. The heat got to be too much for CMS.”
Riley said large chain pharmacies want preferred networks because they are usually the ones chosen. He said it is frustrating that CMS had the gumption to make the changes, and got politically slammed.
NCPA has written a letter to lawmakers asking the Senate and House Small Business Committees to hold a hearing looking into the unintended consequences for patients and independent community pharmacies that have resulted from Medicare Part D “preferred pharmacy” prescription drug plans. NCPA said a patient choice proposal received support from dozens of members of Congress from both parties, but was set aside by CMS March 10 largely as a result of political opposition to other, unrelated provisions contained in the agency's broader proposed rule.
“Over the last several years we have heard increasing concern from our small business owner members in regards to being excluded from participating in Medicare Part D preferred pharmacy networks,” NCPA CEO B. Douglas Hoey, RPh, MBA wrote in the letter. “Many of our members are suffering due to unintended consequences. Small business community pharmacies across the country are losing patients due to their inadvertent exclusion from these preferred networks.”
CVS Caremark spokeswoman Christine Kramer said SilverScript meets all of the CMS access standards for Medicare Part D. She said CVS Caremart referred pharmacies are pharmacies in their network where they have negotiated lower cost sharing on covered prescription drugs for members of the plan.
Walmart did not respond to requests for comment.