By Emily Elconin
Clinton County Chatter Staff Reporter
Small-town pharmacies like Hometown Pharmacy located at 128 S. Bridge St. in DeWitt are facing challenges with demand from growing mail-order pharmacies and larger insurance companies.
In the process, face-to-face consultations between pharmacists and patients are being replaced with a technology-based service that eliminates any personal connections. But proponents of the change claim an ability to provide drugs at cheaper costs, something one study did not agree with.
“What I’ve been told is that it’s a claim that’s it’s cheaper for the insurance companies to go mail-order,” Patty Wagner, pharmacy manager at Hometown Pharmacy said. “It lowers our script count and we’re not going to have as much work to do. If it lowers it too much, there’s the potential of lay-offs or even the store closing.”
Corporate Communications Vice President for mail-order drug provider Express Scripts Inc., Brian Henry, says that Express Scripts are able to deliver drugs in a cost-effective way so that the employers are also paying less.
“It’s a ripple effect across the board,” Henry said. “We believe that we offer the most cost-effective way to get your medicine.”
According to a final report to the National Community Pharmacists Foundation in February of 2013, written by Norman V. Carroll, professor of Pharmacoeconomics and Health Outcome at the School of Pharmacy at Virginia Commonwealth University, states in his study that a number of health plans have implemented mandatory programs that require patients to use mail order pharmacies for maintenance prescriptions.
Results based on a large random sample of Medicare Part D patients indicated when comparing 30-day retail and 90-day mail prescriptions, plan sponsors did not realize savings by using mail order pharmacies, according to the NCPA foundation report.
Wagner says that their customers want to have a face-to-face exchange. In some cases, customers will come in if they have trouble receiving their medications from mail-order. Wagner says that there’s nothing the pharmacy can do to help their customers if their scripts are strictly mail order.
“They give them co-pays for a 90-day supply. They won’t pay for them to have them come to a retail store,” Wagner said. “They make them pay with cash for their medications and the only place they can get it cheaper is through mail order.”
Wagner also commented on how the advancement of a technology based service is troubling for the elderly who have a hard time with the computer systems and being able to call in their prescriptions.
On the other hand, Henry explains how Express Scripts Inc. offers 24/7 access to specialists who specialize in different areas. Henry says having 24/7 access to pharmacists who understand very deeply about different conditions people have is the most most effective way to help patients, especially in the privacy of your own home.
Professor of Pharmacy Administration at Ferris State University, Greg Wellman, says there are two phenomena that are happening simultaneously as you talk to pharmacy owners. Wellman says that larger chain organizations are acquiring smaller chains and smaller independent pharmacies.
Wellman explains how mail order also affects the large chains and small pharmacies.
“An overlying issue is employer insurance. When you have a health benefit plan through your primary employer then the prescription provider is a component of that,” Wellman said. “The prescription plan can direct how you get those prescriptions filled. In some cases, the plans may mandate using mail order pharmacy for your prescriptions.”
Wellman says these prescription plans are taking the decisions away from the person who have the prescriptions in their hands. Some plans have no direct requirement or the plan may provide a financial incentive to use it and decrease co-pay. Pharmacy Benefit Managers (PBMs) are trying to herd beneficiaries over to the customer because it provides the employer with a less costly option.
Wellman explains how the contracts are negotiated between employers and benefit plans themselves.
“There’s still an open question what the direction of mail order looks like,” Wellman said. ”We went through a period when it first came on board and we saw steady growth.”
DeWitt resident Laura Tagsold discussed how the younger generation may be more comfortable with mail-order because they don’t have to deal with face-to-face interactions.
Tagsold says she likes Hometown Pharmacy because they know her personally and she enjoys the positive atmosphere.
“I used mail order to order skin care medication for my daughter. It took forever to get the medication because they had to ask us a million questions,” Tagsold said. “At Hometown Pharmacy, I walk right in and they know my name.”
Tagsold said she never refilled the prescription again because it was such a negative experience.
According to an article called Pharmacy Benefit Managers: Mail Order Pharmacies 101 by the National Community Pharmacists Association, when given the option, 83 percent of customers prefer to fill their prescription at a community pharmacy rather than using a mail order pharmacy.
Deputy Director of Office of Compliance in the Center for Drug Evaluation and Research at the U.S. Food and Adminstration (FDA), Dr. Ilisa Bernstein, feels that the pharmacy industry has changed. Bernstein says that when insurance companies offer an incentive to customers to save money on their prescriptions, it is difficult for customers to turn away this option.
“Given that prescription drugs are so expensive, being given other alternatives to a regulated mail order pharmacy where a patient can save money because of their agreement with their insurance company, then that’s an option,” Bernstein said.
Bernstein says that pharmacists are required to take classes on communication, how to get to know your patients, and how to properly counsel your patients. She feels that the face-to-face interpersonal relationship between a pharmacist and customer is extremely important.
“There’s a difference between counseling your patients face-to-face and counseling your patients over the phone,” Bernstein said. “Mail order pharmacies should still have a pharmacist available to ask questions. You’re not getting that face-to-face interaction as you would when you walk into the pharmacy.”
Andy Grodman, RXM pharmacy manager at Walgreens in West Bloomfield, near Detroit, says that mail-order has taken a big chunk of the business and continues to. Grodman comments on how companies like Express Scripts Inc. are hurting local pharmacies.
Grodman explains how mail order has affected every aspect of local stores. He says that sending medication and business out using internet or mail order pharmacies means that those dollars are being sent out of the area and doesn’t help support the local community.
“Express Scripts is pulling a lot of the business away. It’s a part of the business today. When you’re sending medication and business out using internet or mail order pharmacies, you’re sending those dollars out of the area and you’re not supporting the local community,” Grodman said. “They’re taking business away from small-town pharmacies.”
Henry confirmed that Express Scripts Inc. is one of the nation’s leading full-service Pharmacy Benefit Management (“PBM”) companies. Henry also mentioned that Express Scripts Inc. serves over 80 million people everyday.
“We serve literally millions of people through home delivery pharmacies on a daily basis across the country,” Henry said.
Henry says a critical aspect is there are so many pharmacy options available to people today and that is the biggest driver of change in the pharmacy landscape.
“There’s a lot of competition for pharmacies and pharmacists do have to face that.” Henry said.”We want to make medicine affordable. We are able to work with clients and make sure patients have access to pharmacy options.”