War on druggists?
Pharmacy owner bemoans loss of customers under state prescription
rule
By Ed Jacovino Journal Inquirer
Published: Tuesday, December 27, 2011 11:59 AM
EST
SOMERS — David Guerette
and his wife, Kari Ann, are counting the customers who’ve stopped getting
prescriptions filled at the couple’s Somers Pharmacy because of a change in
state policy.
The customers started leaving in October, when the new rules took effect.
Through mid-December, the list totaled 122 customers. They’ll continue for
about another month, Guerette suspects.
“I don’t really known when we’re going to stop
bleeding here,” he says.
The change is part of the labor concession agreement for state employees that
took effect in October. It mandates that all state employees and retirees under
65 use a mail-order program for “maintenance” drugs, such as those for
diabetes, asthma, and high blood pressure. The change is expected to save the
state $20 million yearly.
The patients can pick up the drugs at a CVS or any other
pharmacy that can match CVS’s rates, or else get them
delivered at their doorstep. CVS holds the contract to distribute drugs under
the state’s insurance plan.
Somers Pharmacy is an example of how the new rules are affecting the bottom
lines of smaller, independent drugstores across the state. The Guerettes bought the business outright last year. David
runs the store’s general operations, while Kari Ann is the pharmacist. They
have 11 employees, including themselves.
And because they can’t match the CVS rates, they’ve had to tell longtime
customers who are covered by the state’s insurance to go elsewhere.
Pharmacists and their lobbying groups have been railing against the deal since
the spring, when they learned it was part of the concession agreement. At
first, the mail-order program was limited to CVS Caremark, which holds the
contract with the state to deliver prescription drugs. Pharmacists claimed a
small victory when they were allowed in — as long as they agreed to a contract
with CVS Caremark.
But that quickly turned sour, when many realized they’d lose money on the deal.
The issue came up during a legislative hearing in November, when lawmakers from
both parties urged Gov. Dannel P. Malloy’s budget
director, Benjamin Barnes, to find a way to help the independent pharmacies.
However, Barnes has said the change saves the state money. He cautioned
lawmakers against using state money or policies to prop up one industry,
although he said he’d look into it.
Guerette keeps his report on every state employee and
retiree who has left in a folder labeled “transfers out due to state employee
insurance.” Its cover is decorated with a frowning face, red tears dripping
from its eyes.
On some of the files, he’s kept track of where they’re going — most are to one
of the CVS outlets in Enfield
or the Big Y in Ellington, he says.
Part of the Guerettes’ concern is that when a state
employee takes his business elsewhere, their store also loses the business of
the other family members on his insurance plan. And they’re also not there to
buy greeting cards, toys, or over-the-counter drugs.
David Guerette estimates between 10 and 15 percent of
his business comes from state employees and retirees, many of them employed at
the state’s prisons in Enfield
and Somers.
And less business means less profit, and less money to give back to the
community, Guerette says.
“We’re not going out of business, but Somers Pharmacy probably is not going to
be able to support the community as it has in the past,” he says. The pharmacy
has sponsored local youth sports teams, the Lions Club, as well as the Boy
Scouts and Girl Scouts.
Guerette
himself played for a Somers Pharmacy-sponsored Little League team while growing
up.
The problem, he says, is that the independent pharmacies just can’t compete.
CVS buys its pills directly from the manufacturers. Independent pharmacies work
through wholesalers, and have less buying power, he adds.
Guerette looked at the CVS Caremark rates. He’s
hesitant to talk because a condition of seeing those figures was signing a
nondisclosure agreement.
“We decided that obviously we weren’t in the business to lose money,” he says.
“You’re almost better off letting the customers go.”
The state keeps a list of the pharmacies that are on the plan. Other than CVS,
many are connected to regional supermarket chains and national big-box stores.
Only a handful of independents, among them Hebron Pharmacy, have signed on with CVS.
But the independent pharmacies have started making their case.
Somers Pharmacy is part of the Northeast Pharmacy Service Corp., a trade group
for independent pharmacies that’s started lobbying the issue. The group has
hired a lawyer to work on the issue during the upcoming legislative session,
according to Guerette, who keeps the talking points
it’s provided on hand.
The group is pushing the state to look more at savings tied to major drugs
being available in generic form. The group estimates about $30 million in
savings can be achieved that way in 2012 and as much as $50 million in 2013. A
generic version of Lipitor, an expensive
cholesterol-lowering drug, is one of them.
State officials, meanwhile, predict $1.5 million in savings in 2012 and $12
million in 2013 from drugs going generic.
The Guerettes also have a poster on the wall next to
the prescription pickup counter explaining the change, asking customers to call
their legislators and Malloy.
They’re also making their case from a public health perspective, pointing to
studies that found forcing patients away from their pharmacy of choice and
forcing them to use mail-order services makes those patients less likely to
take their medicine as directed.
Kari Ann Guerette says she’s concerned about
interactions between medicines.
Most customers who have switched to a CVS or mail-delivery drugs are still
going to Somers Pharmacy for their regular prescriptions, such as antibiotics,
she says.
The computer programs provided by insurance companies show what other drugs a
patient is on, she says. But there are delays in the system, and the effects of
a drug sometimes last longer than the prescription. It’s unsafe for people to
be getting different drugs from different pharmacies, she says.
As for the state employees who had to stop getting prescriptions filled at
Somers Pharmacy, Kari Ann Guerette says some are
returning to her with complaints.
“They’re mad; they’re angry,” she says. “The customers themselves, they’re
really not happy using mail-order.”