The Newnan Times-Herald

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Pharmacy steering detrimental to patient care

  • By The Newnan Times-Herald
  • |
  • Jun. 08, 2020 - 9:36 AM

I purchased Lee King Pharmacy because I wanted to provide world-class care for people in my community with a personal touch.

Since purchasing the pharmacy in January of this year, I have had the privilege of providing care under the most trying health care crisis this country has seen in our lifetime.

In doing so, I have seen the best this country has to offer from physicians, nurses, pharmacists and pharmacy technicians. I have also seen it from our patients and their relatives and loved ones, who are willing to go the extra mile to stay healthy and safe.

But I have also seen a darker side to America’s health care system – PATIENT STEERING. During this COVID-19 pandemic, I’ve had more than 15 patients who were steered from my pharmacy to pharmacies owned or affiliated with the patient’s insurance company or their pharmacy benefits manager.

To be clear, these are patients, who are often very sick with chronic diseases including cancer, who chose my pharmacy, who traveled to my pharmacy, who needed drugs, and who were told, at the height of the pandemic, that they had to receive their drugs from a mail order pharmacy (delaying treatment up to three weeks) or retail chain pharmacy affiliated with the insurer or PBM.

As a health care provider, there is nothing more devastating than seeing a patient who chooses to receive care from you to be forced to go elsewhere.

The good news is that the Georgia General Assembly is hard at work on these issues, with a package of pharmacy patient protection bills that look to stop patient steering and other harmful patient practices, including in Georgia’s Medicaid managed care program, where some of the managed care companies have overcharged the state to the tune of $90 million dollars more than pharmacies were reimbursed for drugs in the last two years alone, while also steering some of Georgia’s sickest patients to affiliated pharmacies.

In fighting this legislation, representatives for the insurance companies and PBMs argue that they are not the ones who steer patients, that it is their clients that want to use their pharmacies exclusively for certain drugs.

Allow me to dispel that myth. I am not only a pharmacist; I am also a small business owner, employing 10 people, and something I am very proud to do is assist with health insurance for my employees as well as myself and my family.

What has shocked me to the core is that my pharmacy’s insurer, Aetna, who is owned by CVS, is requiring that my employees get certain prescriptions from CVS mail order or retail pharmacies. Let me be clear, I did not ask Aetna for a plan requiring me and my employees and their families to use CVS pharmacies, nor was I informed this would be a required part of the plan.

That I can’t care for my own patients, neighbors and friends saddens me. That I can’t fill prescriptions for my own employees for insurance offered through my business just plain makes me mad. That insurers and PBMs engage in this practice at the height of a pandemic scares me.

The time to act to stop this practice and other harmful and wasteful practices is now. Please join me in thanking the Georgia General Assembly for taking on unscrupulous and dangerous practices by large insurers, PBMs, and Medicaid managed care companies and reach out to your state Representative and state Senator and ask for their support of Georgia House bills 918, 946, 947 and 991, as well as Georgia Senate Bill 313.

Mindy Leech