A Greenville man I know recently learned his local pharmacy was no longer ‘in network,’ and that he’d have to choose a new one. He was steered to a limited list of mostly big-box chain pharmacies, which would be a huge change for this man, who has several complex medical conditions and is thus very invested in his close relationship with his local independent pharmacist.
This is not an unusual story for North Carolinians. As we approach the end of the year and patients and employers are finalizing health plan decisions for 2021, many state residents have received this sort of notification; many are steered to chain pharmacies; others to home-delivery mail order companies based far from home.
Health plans contract with, or own, pharmacy benefit managers, which administer the pharmacy benefit portion of a patient’s health insurance. But North Carolinians would be surprised to learn how little say they have in which benefit manager they have to deal with, which often determines the pharmacies they can go to, and even the specific drugs covered by their insurance plans.
All pharmacists, whether outpatient, chain or independent, work hard and go to great lengths to care for their patients, but patients should be allowed to choose their pharmacy; and benefit managers, which are large, profit-oriented, and mostly non-regulated healthcare monopolies, should not be allowed to marginalize and decimate our state’s locally owned pharmacies.
The letter the man in Greenville received is referred to as “steering,” in which the benefits manager significantly limits choice, and channels prescriptions to its own affiliate retail, mail-order, or specialty pharmacies. Although the patient would prefer to use his local independent pharmacy, it becomes more difficult to do so since at least two major health plans doing business in our state no longer have any independent pharmacies in their 2021 networks. Steering, and other such practices, are continually eroding patient choice, and chipping away at the viability of our local independent community pharmacies.
During the 2019-2020 legislative session, the North Carolina Association of Pharmacists introduced a bill (HB534/SB632) that would require pharmacy benefit managers doing business in our state to register with the NC Department of Insurance, provide greater transparency, and eliminate practices such as “steering.” Unfortunately, the bill had to take a back seat to the state’s COVID-19 priorities.
In 2021, our organization will push, again, for more transparency in how these benefit managers operate. Many other states have already enacted legislation requiring this; North Carolina needs to follow suit to protect patient well-being, restore choice, protect our state’s small, independent pharmacies and support our local economies.
Penny Shelton is the Executive Director of the North Carolina Association of Pharmacists.