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is the way prescriptions are handled.  No, I am not talking about Medicare Part D and the donut hole, or the ban against negotiation of prices or of reimportation, all of which are important issues.

I am talking about the tilting of the playing field against independent pharmacies.

This is from personal experience, twice in recent months, first with my wife and then with me.

Under her federal employee health insurance we have full coverage on prescriptions, which given some of our medications and the official prices is critical.

We first encountered it with one of the medicines for her cancer.

This week I encountered it with one of the medicines from my psoriasis.

Our independent local pharmacy cannot get them.   The prescription plan for the federal employees is managed by CAREMARK which is CVS and the only place we can obtain those prescriptions apparently is CVS.  The wholesaler for our wonderful local independent is not given access.

Please keep reading.

There is no logical reason for this to occur, other than it becomes a cash cow for some major drug chains / distributors.  I was told by one local pharmacist that they even in some case pay kickbacks in order to obtain exclusives.

Yes, there is a desire to control costs.

But there is no reason that ongoing medications should therefore have to be routed through large chains without the kind of ties to the local community, which oh by the way also tend not to pay their employees as well.

We have seen big box stores destroying local mom and pop stores for years.

I can remember when we first got prescription coverage with a local government employer that we were told all maintenance prescriptions had to be through one mail-order company (which btw is a good reason to maintain Saturday mail delivery, particularly in communities where the package delivery companies do not go).

In the case of my wife's medication, there is supposed to be special care taken in handling it, and she must appear, show ID and sign for it.  But the special handling is that the overnight package delivery sits at the pharmacist's station unopened until we show up, and then the paperwork is executed by a clerk.

We already have too much of what we have to deal with being centralized in large corporations.  This is true in banking, in health insurance, in so many other areas.  

Given the importance that independent business have played in American communities, one would hope that the Congress might address this issue so that small businesses are not so disadvantaged.

Just saying.

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Comment Preferences

  •  Tip Jar (29+ / 0-)

    "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

    by teacherken on Sat May 18, 2013 at 03:52:09 PM PDT

  •  I Think There's an Active Program to Shut (12+ / 0-)

    down local pharmacies altogether. I know our plans are increasingly pressuring us to buy everything mail order.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sat May 18, 2013 at 03:59:50 PM PDT

  •  It's even worse than you think. (13+ / 0-)

    The last 3-4 years have seen a brutal shakeout in the pharmacy/pharmaceutical benefits business. The large companies managing prescription drug benefits for commercial insurers went through multiple rounds of engulf-and-devour consolidation, until now there are basically two Goliath corporations controlling 80% of the market.

    Naturally this is not to the benefit of the individual patient. By limiting vendors to two, it reduces inefficiencies in billing and management for insurers like Aetna/Humana etc. while simultaneously eliminating any need for these companies to actually compete on quality of service. Which now can suck full strength.

    As a physician I find these Goliath companies utterly unresponsive on any level. Attempts to communicate with them for things like prior authorization are basically a complete waste of time. My nurse can easily spend 45 minutes trying to reach the right department to get a patient's medication approved, only to be told "Oh, you need to speak to the supervisor of this other department. She won't be in until next Tuesday.

    Lather, rinse, repeat....

    •  intentional DDD (1+ / 0-)
      Recommended by:
      Regina in a Sears Kit House

      delay deny & discourage
      Doesn't cost them much and improves their bottom line by getting insured subscribers and their doctors to give up.  The best answer is single payer but short of that there needs to be regulations to penalize this behavior.  I deal with it by carrying high deductible insurance and buying my meds for cash internationally, sometimes for a fraction of US cost. Never had trouble with bad product.

  •  American enterprise has always relied on (9+ / 0-)

    susidies and monopoly situations guaranteed by our public corporations to thrive. The whole "government should stay out of business" is a crock because from patent protections to copyright law to free access to natural resources, American business expects to suckle at the public teat.
    Recall that airlines used to have designated routes and dedicated terminals (regulated monopolies), as did interstate trucking companies. The Reagan Republicans argued that de-regulation would force enterprise to compete and welcome new entrants. Instead, both airlines and bus companies abandoned middle America and people have to operate private cars or stay home.
    Individual mobility is irksome to the bureaucracy. One of the goals of the prescription drug program to be administered by pharmacies was that the elderly would be "encouraged" to stay close to their druggists and stop wandering around the country, as the managed care program had not succeeded in doing. If patients want to patronize a new pharmacy, they have to get a new prescription from the doctor because the pharmacies won't transfer the prescriptions. The costs associated with health care are decried, but the plaint is much like Aunt Myrtle's arthritis -- an excuse to complain about something.
    That the patients' time is wasted is unconscionable. Whatever health care costs is cheap compared to the bombs we dropped on Iraq. We destroyed the cradle of civilization and that can never be replaced.

    We organize governments to deliver services and prevent abuse.

    by hannah on Sat May 18, 2013 at 04:37:07 PM PDT

  •  We have no local pharmacies - none for 50 miles (2+ / 0-)
    Recommended by:
    Lujane, greengemini

    In my small town, we have a Rite Aid.  That's all there has been for decades.  Within 20 miles there are a few more stores representing pharmacy chains.  To my knowledge, the nearest independent pharmacy is about 50 miles away.  It's too late to preserve that local business model here in rural Northern New England.

  •  Today, I noticed something odd with one of my (6+ / 0-)

    scrips, too. I've been taking methotrexate for a few years now. It's the same drug that was in critically short supply for kids with leukemia a while back, but that's not what I use it for, and I'd guess their dosage is quite different from mine. I haven't looked at the price for quite some time because my Part D coverage, for which I pay about $30/mo, covers all of it, no deductible.

    For a couple of years, before I turned 65 a year ago, I paid cash for all my prescriptions, and this one ran about $30/mo with a $25/year discount card from the pharmacy. No big deal.

    This morning, for some reason, when I picked up this month's supply, I looked at the paperwork that came with it. It informed me that my Part D coverage for this drug saved me $87! I never paid anything like that. It makes me wonder WTF is going on. Is someone (the pharmacy? the drug manufacturer?) charging Medicare $87/mo. for that drug? I can't believe it's gone up that much in one year.

  •  I'm sure it's just an oversight on Congress' part (6+ / 0-)

    ..and they'll get right on it.

    After the 1001st vote to repeal Obamacare - of course.

    Suspend disbelief. It's gonna get confusing as hell soon enough.

    by Anthony Page aka SecondComing on Sat May 18, 2013 at 07:21:09 PM PDT

  •  TK you are so right. I'm surprised ANY are (3+ / 0-)
    Recommended by:
    Lujane, greengemini, wilderness voice

    still in business. There are only 3 types of retail commercial construction projects left in America: fast food, banks and chain drugstores. I've talked t a few independents, it's very hard to stay afloat and drug dispensary companies like Caremark will only play fair with large chains.

    There is only one thing wrong with American medical care: it is big business. The last place I'd look for help is Congress, I'm sad to say.

    Even if I knew that tomorrow the world would go to pieces, I would still plant my apple tree. -Martin Luther

    by the fan man on Sat May 18, 2013 at 08:10:19 PM PDT

  •  remedy: socialized health care....ZOMG /nt (1+ / 0-)
    Recommended by:
    wilderness voice

    Warning - some snark may be above‽ (-9.50; -7.03)‽ eState4Column5©2013 "I’m not the strapping young Muslim socialist that I used to be" - Barack Obama 04/27/2013

    by annieli on Sat May 18, 2013 at 09:27:55 PM PDT

  •  I almost died because I delayed care. (2+ / 0-)

    Not to derail the conversation...

    We're getting deeper and deeper in debt.  So when I heard that I needed gall bladder surgery, I put it off.  What could it hurt?  So a year and an appendectomy later, I had a gall bladder attack so bad that I couldn't imagine a worse pain.  I went to the ER and they couldn't figure out what was wrong.  The mnext weekend I had another.  I was pretty sure that I was having gall bladder problems again, so I started that provess withy PCP.

    I had the gall bladder out two weeks ago. This Friday the doc tolde I had 'acute gangrenous choleocystis.  In other words, I had a dead gall bladder insidee that could have given me toxic shock, peritonitis, or worse.  All because I wanted to save some money.

    I'm to the pint of saying F it to capitalism, or at least the cirremt jealth care system.  I'm even deeper in debt than I was before, but my health and hubby's health are more important than money.

    I see you drivin' 'round town with the girl I love / And I'm like / Please proceed, Governor. - Dave Itzkoff

    by Jensequitur on Sat May 18, 2013 at 11:03:58 PM PDT

  •  not exactly on topic but (0+ / 0-)

    even for those places with no independent pharmacy, the push for mail-in prescriptions also deprives businesses like rite aid  who at least provide jobs in the local community. Like shopping on the internet, this process may eventually change the face of our communities drastically. Still, the cost savings are enormous according to their price structure.

  •  The reimbursement system by Medicare part D is als (1+ / 0-)
    Recommended by:
    JamieG from Md

    Responsible for putting independent pharmacies out of business, as the wait for money can be at least 3 months after filing a claim. To carry the inventory and wait for reimbursement is costly and put 3 independent pharmacies out of business in our area. The remaining pharmacy is a part time antique store and they deliver to shut ins so they diversified.
    As Ralphsog said, refills authorization is extremely expensive for physicians.

  •  Not still because we don't have a system for any (0+ / 0-)

    Thing. We have fixed markets to deliver more money to the evil money hoarders. We have to keep fighting for more "fairness".

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