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CANBY -- In the town of Canby, population 1,800, there is only one pharmacy. Canby Drug & Gift is connected with the Sanford Hospital in Canby. The hospital is in contract with the Blue Connect or Network E insurance program Blue Cross Blue Shield (BCBS) rolled out this fall, but the pharmacy is not.
In spite of being contracted for the other 95 to 97 percent of the BCBS programs, pharmacy owner Mark Whittier said that he had not been invited to contract with BCBS on the new program for 2017. Furthermore, the network has been filled and will not consider more contractors, according to sources Whittier has contacted.
What this means is that individuals who have independent policies through BCBS, such as farmers and other self-employed individuals, will have to drive a minimum of a 46- to 50-mile round trip to get their prescriptions filled, according to Whittier and Southwest Insurance Services agent Kari Harding.
"This is a tremendous disservice to our rural population," Harding said in a recent email. "We would like to be able to sell BCBS products that people aren't inconvenienced by."
BCBS and its branch Prime Therapeutics have refused to give Whittier a reasonable explanation as to why he wasn't invited and why he cannot be added.
Unfortunately, Blue Connect is all the agents in the area have to offer anymore since Medica has maxed out its 70,000 new applicant quota this fall.
"My main concern is that rural access to pharmacy services and medication monitoring is (curtailed)," Whittier said.
After making several attempts at contacting Prime Therapeutics in Eagan, Whittier found out it is "really hard to get hold of." He finally received a letter stating that it was a restricted or "preferred" network by invitation only.
"I'd called early on and was told by their help desk that I was on all their lists, but I was ill-informed," he said. "I've written to legislators and they've said these companies are unregulated, so there's no law against them doing pharmacy benefit regulation. I don't think its a cost issue because it wouldn't cost them a dime more to have me in the system."
Of course, with a number of customers having to go out of town for their prescriptions, the independent pharmacies will lose their business. This will affect the community in more ways than one. These customers will have to drive to Clear Lake, S.D., to Marshall, Hendricks or Dawson to get prescriptions even though there is a Sanford-related pharmacy just two blocks from the hospital they may have just left.
Canby is not the only one affected.
Randy's Family Pharmacy in Sleepy Eye is in the same situation. Both Randy Armbruster and Whittier say that area insurance agents are the ones that are notifying them that they are not in the new network. They are both describing the same runaround they get when trying to contact BCBS and Prime Therapeutics.
In fact, there is such a disconnect between their help desks and their policy writers that Armbruster was told that the BCBS help desk had no way to contact the policy writers.
"If you call them up, you can't even talk to anybody," Armbruster said. "No access, no reasons."
This insurance program reduces access to the people who need it the most, both pharmacists said. At the same time, the customers are being drawn away from their local pharmacy, reducing the pharmacy's volume. With the low profit margin on the prescriptions, a reduction in customers will eventually drain the life out of a business.
Armbruster was disturbed by the inconsistencies in the few answers he did get. First, Blue Connect was called two other names depending on your perspective. It was known as Network E to pharmacies and Blueprint Plan to consumers (later identified on website as for Twin Cities metro area), he said, which was still different than the Blue Connect (later identified on the website as for western Minnesota residents with Sanford Health network) that the insurance agent called it. Armbruster was also told that the plan in question was only available in South Dakota, North Dakota, Iowa and Wisconsin. However, when he went online to check out the coverage, he found out that the pharmacy chains that were members have locations all across the country.
The two pharmacists are concerned that most people electing for this policy don't even know they are being restricted as to which pharmacies are in network.
Both Whittier and Armbruster said they planned to continue to correspond with BCBS and Prime Therapeutics to see if the companies' stand on the contract membership would change if the company realizes that their program is detrimental to the customers as well as to the local pharmacies.
The Independent was unable to reach anyone from BCBS and Prime Therapeutics.