Prescription medication capsules and tablets
HOPKINS, Minn. - Some pharmacists in Minnesota are concerned about the indirect impact of some parts of the Affordable Care Act. The possibility of pharmacies being left "out-of-network" in plans for the newly insured is a bitter pill for some drug stores to swallow.
Pharmacies left "out-of-network" have to expect their customers to pay higher out-of-pocket costs for prescriptions. As a result, some customers choose to go elsewhere, to an "in-network" provider, for their medicinal needs.
Hopkins Center Drug owner Josh Lemm said he makes every effort to be "in-network" for all insurance plans, but sometimes it is not possible. He said he has lost some loyal customers through the years because of the higher "out-of-network" costs.
Lemm is concerned that customers may choose plans under the Affordable Care Act (ACA) that do not include his store in their networks.
University of Minnesota Professor and Health care expert Steve Parente, Ph.D. calls it a "huge problem."
Another potential issue for pharmacists on this Halloween weekend is reimbursements. Reimbursements are the payments that pharmacists receive from insurance plans for the drugs they dispense.
"Currently, we are hearing estimates of a 30% decrease in pharmacy reimbursements for prescription medicines," said Lemm. "We are already operating at a pretty low reimbursement rate. So, that is our biggest concern. The unknown is whether we are going to be able to continue to operate at that lesser reimbursement rate."
Lemm said many members of the Hopkins community rely on government programs, like Medicare, for their health coverage. "We have a largely aged community," he said. "We are quite interested and curious and worried, honestly, how [ACA] is going to affect us."
He also said private insurers normally follow the government leads. "Much like in 2006, when Medicare Part D first arrived, commercial plans followed suit on that. "
Lemm said the timing of the reimbursement details is troubling. "Sounds like we really will not understand all their particulars until after the first of the year when the plans release solid information."
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