Despite being mentioned in a congressional hearing, one aspect of Medicare D(isaster) that has been overlooked by many is the impact that it has been having on independent pharmacies. According to Sen. Blanche Lincoln, D-Ark.,
pharmacists in her state have had to take out loans because they could not get reimbursed quickly enough for drugs dispensed to customers who had no means to pay them.
This is not limited to Arkansas, though. In Mississippi,it has been reported that pharmacy owner Bob Lomenick has dispensed
$200,000 worth of drugs but has received only a $25,000 in payments from insurers.
In Wisconsin,Jeff Seabloom, owner of the Elcho Pharmacy stated
“We are handing out tablets to these people out of our own pocket, not knowing when we are going to get reimbursed. We are kind of subsidizing the program right now.”
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And in California
Beatle Tran now keeps his West Sacramento pharmacy open an extra day each week. He has to. He’s trying to make up for what he says the federal government’s new Medicare drug plan is costing him.
chantedor’s diary, stated that
Many of the insurance companies have not been paying the pharmacies for the drugs they’ve provided–even though the insurance companies approved these people’s prescriptions and have been collecting payments from the insured.
At least one pharmacy has already become so far in the hole because of this nonpayment that it has been forced to shut its doors. Others are owed tens of thousands of dollars, some over $100,000, and they have no idea when they will ever get paid by the insurers for prescriptions they have dispensed.
Some of them, especially the smaller local pharmacies, are worried that they won’t be able to stay open much longer.
In Ohio, pharmacist John Coler is concerned that his business may go bankrupt, as his expenses are, in addition to overhead, a bank payment, a loan payment, and a wholesaler bill every 2 weeks. Coler’s opinion of Medicare D(isaster)is that it
“has created an environment where you can’t practice pharmacy. We spend so much time being insurance representatives that it’s taking away from patient counseling…The questions we’re asked are not 5- to 10-second responses. We can spend 10 to 20 minutes per patient…I have had patients tell me to keep [the medication] because they can’t afford it“
Another pharmacist, Randy Shrivers stated,
“The federal government and pharmacy benefit managers [PBMs] weren’t set for January 1. We’re not in the business to put insurance plans into place.”
He further describes the cash flow problem that many independent pharmacies are facing.
“We’re not getting paid by these people [insurance companies and PBMs]. For some reason, the federal government and legislature think pharmacies are plush with money. As a result, there’s going to be pharmacies that go out of business.”
Another cause for concern is the Medicaid cuts. The House of Representatives voted on February 1, 2006, to cut $3.6 billion from Medicaid for generic drugs.
A 2005 University of Texas study found that the current average state Medicaid pharmacist dispensing fee is $4.15, whereas the average cost for a pharmacist to dispense a prescription is $9.62.
The difficulties of maintaining a small business/pharmacy have not been limited to the pharmacies in the states metioned above. According to the National Community Pharmacist Association (NCPA)
“Implementation of Medicare Part D has been beset with serious problems, including incomplete or unavailable eligibility information and significant challenges with claims processing. Although the source of these problems comes from many elements of this complex new benefit program, it is the nation’s community pharmacists who are bearing the brunt, along with their patients.”
Yet the actual impact of Medcare D(isaster) on small businesses has not been adequately addressed. Another fact worth noting,
The nation’s independent pharmacies, independent pharmacy franchises, and independent chains represent an $84 billion marketplace, dispensing nearly half of the nation’s retail prescription medicines.
This concern was about the maintaining a business and providing good customer service re: rx’s was echoed by Bob Lomenick, when discussing what the future may hold.
“I may have to shut it down completely…You’re going to have an access problem. The Wal-Marts and Walgreens of the world aren’t going to put a pharmacy in Potts Camp, Mississippi.”