Saturday, July 13

Smaller Pharmacy Networks Benefit Pharmacy Chains, Study Shows

How can pharmacies play a role in reducing prescription drug abuse? It may be as simple as limiting which pharmacies a patient has access to, according to a new study. But will it hurt patients’ medical care — and the success of smaller pharmacies — in the process?

The jury still seems to be out.

This was the question asked by a study, focused on CVS Pharmacies, that was recently published in the academic journal JAMA Internal Medicine by Dr. William Shrank, a senior vice president and chief scientific officer of CVS Health. The primary finding was that if insurance companies shrink their pharmacy networks — thereby making it more difficult for patients to access a pharmacy that accepts their insurance plan — the number of prescriptions actually filled by patients drops dramatically.

As Fox News and Business Insurance reported, the study looked at 200,000 patients receiving medications for chronic medical conditions like high cholesterol, high blood pressure, diabetes, and depression. Approximately 68,000 patients were part of a narrower pharmacy network plan, while 150,000 were not.

The research team analyzed these patients for a 12-month period in 2012 and 2013. Specifically, the researchers looked at how many pills were provided to each patient in one prescription, compared to when patients received refills, and then calculated a medication-possession ratio (MPR) for each patient.

Of the patients enrolled in smaller pharmacy networks, the MPR was significantly smaller, meaning that the patients adhered to their medication prescriptions more closely in a controlled pharmacy environment.

As Benefits Pro stated, narrow networks tend to benefit larger chain pharmacies, like CVS and Walgreens, which often work with insurance companies to strike a deal where one retail store is able to have “preferred provider” status.

With hundreds of locations across the country, and often multiple locations within the same zip code, these companies are able to work with insurance providers easily and ensure that patients will still have adequate access to the medications they need.

“I believe the insurance providers narrowing their networks is causing great harm to patients that can not be served by chain pharmacies,” says Mike Gross, VP Sales & Marketing, Retail Management Solutions. “Furthermore, limiting where a patient can get prescription drugs is monopolistic in my opinion. Patients need choice, whether that is from their doctor or where they get their medicines. Regarding the need for controlling prescription drug abuse, the technology is available to independent pharmacies to assure customer’s aren’t exceeding their daily or monthly limits.”

As many medical experts will note, any time a patient makes a purchase in his or her pharmacy, that information is recorded in the store’s POS system and sent to the patient’s insurance company, thereby reducing the risk of providing more medication than what’s needed and — ideally — reducing the risk of abuse.

So are smaller pharmacy networks actually beneficial, or are they just another way for pharmacy chains to extend their control over the industry?

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