Seniors find themselves torn when choosing their pharmacy
The issue: Loyalty versus lower costs
Retirees Ron and Luida Shearer of Rayne, Indiana County, stopped by Gatti Pharmacy in Indiana Borough on Wednesday to pick up prescriptions for Mr. Shearer’s diabetes and effects from an earlier stroke.
The four bubble-wrapped sheets each held a week’s worth of medications, with the daily doses in tear away strips — a handy feature when the Shearers recently vacationed in Florida.
“It just makes life so much easier,” said Ms. Shearer, 75. “This is a thousand times easier” than managing a bottle of loose pills.
Gatti pharmacist Stephanie Smith Cooney said the special packaging done at the shop is meant as both as a convenience for customers and a safeguard against missed doses.
The pharmacy also tracks late and missed refills, checking with customers to make sure they’re taking their medications, she said. For those who can’t make it to the Philadelphia Street store, the staff will deliver for free. In 2017, they made close to 3,000 home deliveries.
Despite these extra steps, which often can’t be found at chain store pharmacies, Gatti is not listed as a preferred pharmacy provider for either UPMC Health Plan or Highmark, the area’s two largest Medicare Advantage plans.
Preferred networks — pharmacies and other health providers designated by an insurance plan that will offer lower cost or even free services — are now firmly embedded in the health care landscape. With pharmacies, the intent is to keep the insurer’s drug costs in check by securing discounts in exchange for increased customer traffic.
Those plans have increased dramatically, too: The drugchannels.net website has reported that 99 percent of the 2018 Medicare Part D regional prescription drug plans include a preferred network, compared with 7 percent in 2011.
But having to choose can be hard on seniors, said physician Robert P. Roca, chair of the American Psychiatric Association’s Council on Geriatric Psychiatry and chief medical officer for Sheppard Pratt Health System in Baltimore.
“All of the plans that direct patients to a particular provider — be they a physician or a pharmacist — do put people in a bit of a spot on whether they continue to patronize a provider,” he said. “People often have a trust in their pharmacists, who know them well and who give them advice about how to use medications.” Dr. Roca added that pharmacists tend to be more accessible than other health providers, something Ms. Smith Cooney noted as well: Where physicians may see a patient once or twice a year, pharmacists will see them once or twice a month and may recognize a medical issue in its early stages, particularly if it is a longtime customer.
The Shearers say they pay $300 more a year at Gatti’s for their medications than if they filled prescriptions at one of the preferred pharmacies down the street. But they have no plans to switch to another pharmacy, where they say they’ll likely face long lines and less personal service.
“We prefer to deal with our local businesses as opposed to giant chains,” said Mr. Shearer, 79. “They are putting money into the local economy.”
“When you’re older, you like to go where the people know you and you feel like they’re welcoming you in,” Ms. Shearer said.
But sometimes the math wins out.
Another customer, Shirley
Moore of Indiana Township, 79, says she really likes Gatti’s, but she still changed pharmacies once she learned she could get her generic medications for free at a nearby preferred pharmacy.
She figured she is saving $100 a year for her four medications.
“I’m on a fixed income and every penny counts,” Ms. Moore said. “It’s been to my advantage saving that kind of money every month.”
This year, Gatti Pharmacy has lost four or five customers who moved to one of the other pharmacies in town that was part of a preferred network. While not an immediate threat to her business, Ms. Smith Cooney said, “not having access [to a preferred pharmacy designation] is a real big concern for me going forward.”
Over the past several weeks, the Pittsburgh PostGazette spoke with nine seniors referred by area independent pharmacists about their prescription plans after being offered a “preferred pharmacy” option. Each said they didn’t want to change, but a few felt compelled to financially.
“We’re talking about quite a lot of money,” said Sue Mohney of Hawthorn, Clarion County, who left her local independent Klingensmith’s Drug Store and now gets her seven medications at a preferred Rite Aid, saving about $100 yearly.
“I have the money to pay it, but I’m not going to throw money away,” Ms. Mohney said.
Ms. Smith Cooney sympathizes with her customers who struggle to pay for their medications — and she said the Gatti staff will help them track down coupons, or alternative plans, to save them money.
But she believes insurers are being short-sighted when they designate preferred status to certain pharmacies based on a promisedupfront discount, rather than giving greater consideration for the pharmacy’s performance.
The compliance packaging and medication monitoring, for example, means customers with diabetes or other chronic condition will better manage their disease, Ms. Smith Cooney said. That in turn lowers the risk of complications or hospitalization, lowering the health plans’ costs.
“There’s so much opportunity for innovation in this model, but nobody is doing this,” she said.