Buffalo, N.Y. (WBEN) - Some long standing, local independent pharmacies are losing business.
Some Western New York seniors have signed up with health insurance companies like WellCare Health for their Medicare plans and, as a result, have received letters from the company stating that they can no longer use their local independent pharmacy to fill prescriptions, according to a report from WKBW.
Don Arthur of Black Rock and Brighton Eggert Pharmacies explains that this all starts with the pharmacy benefit manager CVS Caremark, the largest in the county, which is the manager that WellCare operates with.
"Unfortunately, for independent community pharmacies, CVS Caremark is a very, very difficult insurance plan for us to work with," Arthur said. "We had consultants take a look at the CVS Caremark contracts offered to independent community pharmacies and the auditors looked at it, our costs and they looked at our patients that had this particular plan. They said that the reduction in payments from CVS Caremark to my my two pharmacies, were going to take us into a loss, so we had a very difficult decision to make."
Arthur clarifies, "When they decide not to participate in the plan, they're really not turning their backs on the plan, they're turning their backs on the senior citizen patients that have selected that plan and none of this is communicated to our senior citizens in Western New York, they have no idea.
After Jan. 1st, Patients started coming in to the pharmacy with their new insurance plan. In my case, we've had patients that have been coming to our pharmacy for over 30 years and they provided us with their new insurance cards. We went to process their claims, and it said 'Out of Network,' so we had to tell them that we were no longer a provider in their network."
With very little premiums and out of pocket costs that are associated with Medicare Part D, Arthur explains that seniors weren't necessarily making a financial savings decision, they made their decision based on the advertisement they saw on TV.
"The full implications of their decisions are not being clearly communicated to them," Arthur said. "If they had any idea that they would not be able to use the pharmacy that they had been going to for 10, 20, 30 plus years, that I'm sure they would make have made a different decision."
When Arthur was made fully aware of the situation that was going on, he took the proactive approach. In December, he contacted 35 of his patients who had changed their plan. By the end of the day, all of them spoke with Independent Health and had their plans changed so they could go back to their local pharmacy.
"Fortunately, you know, there are solutions," said Arthur. "These senior citizens, they're not trapped, for the most part in staying with plans like WellCare. Who really didn't communicate the implications of switching, as well as I feel they should have. The federal government has created what we call a special enrollment period, January 1st to March 31st. They can re-enroll even though they're they've quickly enrolled in a particular plan, and they've only been with the plan as little as 30 days, they have that opportunity to change and that we're actively doing that, you know, we're talking to those patients."
Even though Arthur has been educating the public and his patients on this issue, he says he is going to lose 5-7% of his patients at the Black Rock Pharmacy. Some of the companies these senior citizens once worked for, are switching their plans to WellCare. He can't necessarily help those people.
Arthur recommends that if any senior citizen has questions regarding their health insurance, they should talk to the red shirts at Independent Health.
"They're extremely helpful. They're extremely knowledgeable. They will answer those questions, they will not only, enroll those senior citizens into their own program, they'll answer all questions. If their programs aren't what's best for those particular senior citizens, they will counsel them, and they will help them even if there's a better alternative for those patients that doesn't involve Independent Health."