Monetary incentives in Va. Rx plans displease pharmacists

Drug Store News, Feb 6, 1989

Monetary incentives in Va. Rx plans displease pharmacists

RICHMOND -- Pharmacists and state employees aren't happy with a new government health benefit for state employees that includes a monetary incentive to use a mail order prescription program.

Under the new program, active and retired state employees are required to pay a $6.00 co-pay for prescriptions ordered through the mail order program, $8.00 for prescriptions filled through participating community pharmacies and $10.00 at non-participating pharmacies.

Pharmacists are concerned because the mail order component will most likely be used to fill prescriptions of maintenence drugs. "Pharmacists are angry because the use of a mail order prescription service takes money out of the state," said Paul Galanti, executive director of the Virginia Pharmaceutical Association.

"The amount spent on long-term medications filled by mail order for the state's 110,000 active and retired employees would reach $4.26 million a year," said Galanti. "That's a loss of $3,000 per community drug store.

"We did not even get a chance to bid on the program," Galanti said. "The state advertised the contract in the Washington Post rather than in the Richmond Times Dispatch. I don't think that's fair."

Representatives from the Department of Personnel and Training's office of health benefits did not return Drug Store News' phone calls.

Pharmacists, said Galanti, are also unhappy with the reimbursement fee offered under the plan, $2.50 plus AWP. "We want at least what Medic-aid is paying. That's $3.40."

While state employees have different gripes with the program, a major one is the stipulation under the new plan which eliminates coverage of brand name drugs.

"Employees don't like the fact that they will have to pay the difference between the price of a generic and a branded drug if they opt for a branded pharmaceutical," said Joan Dent, executive director of the Virginia Government Employees Association, a lobbying group. "There are still doctors who will prescribe brand name drugs, which the state employee will then have to pay for."

Dent recalled one man with epilepsy who called to complain that generic drugs did not work as well for his condition.

"Most people I talk to are refusing to send their prescriptions away," said Becky Caudill, manager of Drug City, a Richmond pharmacy. "But for those who use maintenence drugs, they really have no choice. If they mail away, they get a three month supply for $6.00."

Community pharmacists are also concerned that patients using a mail order pharmacy may be losing opportunities for face-to-face pharmacist consultation.

"In school I was taught that there is a triangle of care for patients, with the pharmacist playing an important role in that system," said Caudill. "When you remove the pharmacist, you break down the system."

Some of those questions are going unanswered, according to one Richmond independent. "If someone calls on the phone with questions about a prescription they got through the mail order firm, I don't answer them," he said.

"That may be mean, but I entered pharmacy thinking it was a two-way street and I'm realizing that's not the case. We're losing money and they are still squeezing us. It's just not fair."