Pharmacies continue to fight unequal treatment with Medicare Part D

Customer tells of issue with mail-order prescriptions

Staff writer

Dick McLinden of Marion was shocked when he went to pay for his monthly prescriptions in January and found his bill to be more than $100. Previously the co-pay for his wife’s and his 10 prescriptions was around $20 after signing up for a Medicare Part D plan in July. That was, until Jan. 1 when his policy no longer accepted Marion Health Mart as a local preferred prescription provider.

McLinden said Health Mart owner Marlin Buchholz was just as shocked as he was to see the increased charges.

“My co-pay was so low that I never thought anything of it before,” McLinden said. “I could call in a prescription 24/7 and if the store was open the next day 99 out of 100 times I could pick them up the next morning. Marlin was fantastic to work with.”

In January, McLinden noticed an increased co-pay charge on the tickets he would receive with his prescriptions.

“I had a charge account and our prescriptions had to be refilled at so many different times that I would just pay for them all at the end of the month,” he said. “I noticed the huge co-pay and assumed that since my other Medicare plans have a deductible that the Part D plan must too and that’s where I ran into trouble.”

When McLinden’s January bill was significantly higher than normal, he did some research on his policy.

“I got a mailer from Medicare explaining the changes to my Part D policy,” he said. “I found out that it wasn’t a policy with a deductible.”

McLinden returned to Health Mart to figure out why his prescriptions were so high. After a half hour teleconference between McLinden, Buchholz, and Medicare, it was discovered that Health Mart pharmacies were removed from the preferred list of providers, with the status only remaining with major nationwide chain pharmacies such as Wal-Mart and Walgreens.

“Marlin didn’t even know the pharmacy had been removed from our policy or removed from preferred status,” McLinden said. “I called a Medicare policy agent and discussed what it would cost to not pay any insurance.

“The cost would about balance out between the costs of our prescriptions and the policy premium, but if we needed any more medication due to illness or something, we would be sunk.”

McLinden said Buchholz remained very helpful by helping them enroll with a mail order service, to save the drive to Newton or McPherson.

“That turned into a disaster,” McLinden said. “It took 30 days for them to send the prescriptions and we would have ran out of pills before they could be filled, but again Marlin was very helpful and helped me get pills so I had enough without missing a day.”

Buchholz bent over backward to help him get the medication he needed even after being jerked around by the insurance company, McLinden said.

“Marlin did everything he possibly could and I could not thank him enough,” McLinden said. “I hate that he’s losing money over this.”

Buchholz said he and his staff work hard before and during Medicare enrollment time to educate customers on plans that will allow them to use local pharmacies and he has hope the preferred clause will be removed from Part D plans in the near future.

A bill, H.R. 4160, was proposed and set to be voted on by Congress two weeks ago. It would have eliminated the preferred/non-preferred clause.

“It was presented and it looked like senators were going to vote in favor of it, but at the last minute, no vote was called,” Buchholz said.

Buchholz said he has sent letters and spoken to state and federal representatives about the importance of eliminating the preferred statutes. He has also gotten a lot of response from customers about the issue now that it has become more public.

Eric Diggers, owner of Greenhaw Pharmacy of Hillsboro, said he would be surprised if the bill was brought back for a vote.

“I think there are some big money behind the other side,” he said. “I think that will be hard to overcome.”

Diggers also believes that senators were given false information about the bill.

“I think that they thought that this would increase the costs for Medicare, which it won’t, and was linked to Obamacare, but that’s not the case. I think some representatives are afraid to vote for anything that might be linked to Obamacare because of the backlash.”

While the bill’s lifespan might be at an end, Diggers said the fight to eliminate the preferred status and make the system equal for big and small pharmacies alike is not over, and he will continue to put pressure on state and federal representatives as well as informing his customers.

Sarah Little, a spokesperson for Sen. Pat Roberts’ office, said he would not vote in favor of a bill to eliminate the preferred status because it would cause millions of Part D beneficiaries to lose their plans, but did not elaborate further.

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