Anthem change frustrates pharmacists

Posted July 09, 2009, at 9:28 p.m.

ORONO, Maine — Maine’s community drugstores are up in arms about changes in a popular prescription plan offered by the state’s largest private insurer, Anthem Blue Cross and Blue Shield.

Pharmacists say the company is pressuring policyholders to purchase medications from its own mail-order pharmacy program rather than from their local drugstores. By reducing what it pays to local pharmacies to fill three-month supplies of drugs, the pharmacists say, Anthem is crowding them out of the popular plan that gives policyholders a 30 percent out-of-pocket discount.

The matter has been referred to the office of the state’s insurance superintendent for investigation.

Anthem spokesman Chris Dugan said Thursday that the intent of the contract change is “not to harm local pharmacies in any way” but to hold down costs for Anthem policyholders, especially those who take multiple drugs for chronic conditions such as diabetes.

“The goal is to get the best possible price for our members,” Dugan said, adding that keeping drugs affordable increases patient compliance with recommended dosages.

Pharmacist Ali Aghamoosa, owner of Orono Pharmacy, said Anthem’s recent take-it-or-leave-it reimbursement reduction means a significant loss of revenue if he accepts it and a likely erosion of his local customer base if he doesn’t.

“At the same time that the drug wholesalers are raising their prices, Anthem is reducing their reimbursements,” Aghamoosa said Thursday. “We get slapped on both sides.” Accepting the reduced payment means he would go from making a small profit on each 90-day drug supply he fills for Anthem policyholders to losing about $10 on each one, he said.

Aghamoosa, a native of Iran who now lives with his family in Orono, has run the small drugstore on Mill Street for about 10 years, taking it over after it was shuttered by the Rite Aid chain.

“This is how I earn my living,” he said. “This is how I send my kids to school and pay my mortgage and my taxes.”

In a letter to its policyholders last month, Anthem’s medical director in Maine, Dr. Jeffery Holmstrom, said pharmacies that have been filling three-month supplies of medications and charging its policyholders only a two-month co-pay “may choose not to participate in this program after July 1.”

That leaves policyholders three options, the letter said:

• Continue to do business with the policyholder’s local pharmacy, specifically named in each letter, and face the possibility of paying more for prescriptions.

• Switch to Anthem’s own mail-order pharmacy service, NextRx, to continue receiving the co-pay discount, with assurances that the transition will be handled smoothly. “One call does it all,” the letter says, listing a toll-free number.

• Switch to a different local pharmacy that has accepted the new Anthem contract. A list is available by telephone or on the company’s Web site.

Chris Gauthier of the Maine Pharmacy Association said Thursday that Anthem’s new contract and the company’s “heavy-handed tactics” are a clear bid to compete with local pharmacies for the business of its policyholders.

“Obviously, if you’re paying your co-pay to them, they make more money,” he said. “Stores can either sign the contract and take a hit in the pocketbook or they can lose their customers.”

Pharmacist Bill Miller, owner of Miller Drug in Bangor, said he resisted accepting the terms of the new Anthem contract for several weeks.

“I finally signed it yesterday morning,” Miller said Wednesday, frustration in his voice. Anthem policyholders account for about 15 percent of his business, Miller said, including employee groups at the University of Maine and the Bangor School District, as well as, ironically, his own employees. Losing those customers either to NextRx or to one of the larger chain pharmacies in the area would be a severe blow to his store, which has been in his family for 60 years, Miller said.

A message on the answering machine of the Miller Drug phone line explains to customers that Miller Drug is still participating in the 90-day discount program, but that he is fighting the validity of the change “behind the scenes.” The message accuses Anthem of “trying to push [Miller’s customers] into the mail-order program.” It asks customers to express their concerns to Anthem and to their state legislators.

Reducing the reimbursement to Maine pharmacists participating in the 90-day discount program brings payments in line with Anthem’s NextRx program, Dugan said.

He said about 85 percent of Maine pharmacies were participating in the discount program before the July 1 contract change.

State Sen. Elizabeth Schneider, D-Orono, said Wednesday that she and several other lawmakers have heard from constituents who are upset about the impact of Anthem’s change on their local pharmacies. The situation has raised a number of questions, she said, including the possibility that Anthem may be engaging in “unfair practices” that “could contribute to the demise of local businesses.”

Schneider said she has asked the state Office of the Attorney General to investigate as well as the state’s insurance superintendent, Mila Koffman.

Koffman confirmed Wednesday that her office is looking into the matter. Lawmakers, Koffman said, are concerned for the health of local businesses and for Anthem policyholders who may lose access to their community pharmacist if they switch to the NextRx mail-order business.

But Anthem is a private company, and “companies do what the law allows,” Koffman said.

As of Thursday, Aghamoosa had not decided whether to sign the new contract but expressed concern that he already may have lost some loyal customers.

“I can’t blame them for wanting to save some money,” he said. “But they have to decide whether it’s worth losing the one-on-one relationship they have here in this store.”

mhaskell@bangordailynews.net

990-8291

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