COMMUNITY PRACTICE

Medicare Rx cards giving pharmacy headaches

Things have gotten so bad with the Medicare drug discount card program in North Dakota that pharmacists have sicced the state attorney general and insurance commissioner on sponsors they feel tried to bully them into accepting their cards and mislead beneficiaries into signing up.

The North Dakota insurance commissioner has accused pharmacy benefit manager Prime Therapeutics of trying to strong-arm pharmacies into accepting its Medicare Rx card. According to Commissioner Jim Poolman, Prime Therapeutics, which is the PBM for Blue Cross Blue Shield North Dakota, warned some pharmacies that if they didn't honor its Medicare card, they would be shut out of contracts with the Blues, which control 82% of the state's health insurance market. Such tactics could violate the state's antitrust and fair-trade laws, he warned.

Poolman warned in a letter to the Blues' CEO that certain aspects of consumer advertising for the Prime Therapeutics card are "incorrect and potentially misleading," causing confusion. "Pharmacists have reported multiple customers who believed that they were required to purchase the card or else lose their Blue Cross Blue Shield coverage," he added.

"It's so disheartening to see the state's largest health insurer participate in practices we did not think were appropriate," Poolman told Drug Topics. "They've got to be good corporate citizens. We are going to continue to be aggressive because we think consumers are being misled."

Following the commissioner's letter, the six pharmacists who had complained received apologetic phone calls from Prime Therapeutics, reported Patricia Hill, North Dakota Pharmacists Association executive VP. "They said it was all a misunderstanding," she said. "We don't believe we misunderstood. Our members were intimidated and concerned that their livelihood was put in jeopardy. The Centers for Medicare & Medicaid Services regional director was furious about the intimidation."

Medco Health Solutions was also on the receiving end of a Poolman missive alleging that the PBM solicited Medicare beneficiaries for its discount card by telephone. He told the giant PBM to cease and desist from such phone solicitations.

"We did receive a phone call from Medco stating that they have legal counsel working on a response to our letter," Poolman said. "They were literally calling people at home and harassing them to buy their card. That just flat out violates the spirit of the Medicare law. Our concern is that

we have had folks marketing fake discount cards. It's very hard for people to differentiate over the phone between a card that is CMS-approved and one that is not."

Machinations by discount card sponsors discourage participation in the Medicare program, said Hill, who is anxious to get more cards in the hands of seniors. "These incidents are really not a good place for any of us to spend our time," she said. "There are pretty serious implications from seniors not signing up for the Medicare cards. We need to fix that."

Another North Dakota pharmacy highlighted a different Medicare Rx card headache: inaccurate pharmacy information posted on the agency's Web site. The Web site reported that the Rexall drugstore in Langdon accepts six Medicare card programs. The only problem is that the store has been closed for at least three years.

Tipped off by independent pharmacies, U.S. Representatives Henry Waxman (D, Calif.) and Louise Slaughter (D, N.Y.) wrote a letter to the secretary of Health & Human Services. The legislators charged that the Medicare Web site "is inaccurate and riddled with errors" because it lists numerous pharmacies as members of drug card networks in which they do not participate.

"Seniors who go to the Web site and chose a drug card because they believe their local pharmacy is a participant may find that this is not the case," wrote Waxman and Slaughter. "As a result, the card they choose could leave them without access to their local pharmacy."

The problem stems from the way Rx card sponsors developed their networks. Many sponsors required pharmacies to take action to opt out of their Medicare Rx card programs. If no notification was received from a pharmacy, it was automatically included in the sponsor's network.

Carol Ukens

Carol Ukens. Medicare Rx cards giving pharmacy headaches.

Drug Topics

Aug. 9, 2004;148:23.