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Independent druggists to lose under State Health Plan proposal

The tough economy has the State Health Plan in desperate need of money, and pending legislation would require getting long-term prescriptions through an in-network pharmacist or by mail order.

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RALEIGH, N.C. — One cost-saving measure being considered for the State Health Plan would require some employees to get prescriptions for chronic conditions such as diabetes and high blood pressure through an in-network pharmacist or by mail order, possibly boxing out independent druggists.

That's in legislation filed in the state Senate.

Independent pharmacies in small towns will lose business due to the mail-order provision and can't make a profit on the in-network reimbursement rates, said Mike James, a lobbyist for the Association of Community Pharmacists.

Retired state worker Barbara Currie is among those whom Senate Bill 287 would affect.

"I take a prescription for osteoporosis,” Currie said. For drug refills, she shops around for the best bargain at area pharmacies.

"I end up paying $30, instead of $50,” Currie said, but her own bargain-hunting would be replaced my mandatory savings under the bill. 

"If they choose to go to a pharmacy that is not part of that program, then they will, in fact, have to pay 50 percent of the cost of medication, in addition to their co-pay," James said.

Currie would have to use an in-network pharmacist or mail-order company to get full health plan benefits.

"It actually gives an additional benefit to the state employee because the state employee will only pay 2.5 co-pays for [a] 90-day supply,” said Sen. Tony Rand, D-Cumberland, sponsor of the bill.

Rand agreed that the bill would be hard on small pharmacies.

"It will reduce their profit margin, there is no question,” Rand said.

He said tough measures must be made to bridge the state budget gap, however. The State Health Plan is running out of money at the end of this month, and the bill could save the state $90 million, Rand said.

"This is a terrible situation in which we find ourselves,” Rand said.

A $250 million cash injection is under consideration for the health insurance program. The money is attached to Senate Bill 287 and includes premium increases for families, financial incentives to stop smoking and lose weight and the new prescription drug program.

James argues that money that would have gone to North Carolina pharmacies will now go to other states where the mail-order drug companies are located.

"We believe there is a lot of money that is about to leave the state,” James said. "I have never believed that mail-order is good medicine."

There are 54,000 pharmacy-related jobs in the state, James said. He estimated the bill would cause the loss of at least 10 percent of those jobs.

The Senate is to take up the bill next week.


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