Many Alaskans will no longer be allowed to visit Fred Meyer pharmacies in January to pick up prescriptions.
This is due to the announcement of the termination of a pharmacy arrangement between Express Scripts, Kroger, Fred Meyer’s parent company. Express Scripts acts as a pharmacy benefits manager. This company facilitates reimbursements between local pharmacies and major insurance companies.
This split will affect thousands of Alaskans with health insurance through companies that work closely with Express Scripts such as TRICARE and Cigna, Premera Blue Cross Blue Shield of Alaska, and many others.
The affected are all Alaskans who have signed up for insurance through the Affordable Health Act Marketplace, military personnel and their families, federal employees, and all Anchorage municipal employees.
Experts believe it will be difficult to predict the full effect of the Alaskan agreement being terminated. However, it is possible that the companies could reach a last-minute agreement before year’s end.
Lori Wing-Heier (director of the Alaska Division of Insurance) stated in an email that “it is not uncommon for there to be pretension between the two parties as the negotiate,” She stated that no contract termination has been filed with the state.
However, pharmacists interviewed for this article worry that if there is no agreement, Alaska could suffer, particularly in small communities where pharmacies are limited or understaffed. This could lead to long waits and even patients being turned down in certain cases.
According to the pharmacists, they expect confusion and long waiting times due to the transfer of thousands of prescriptions from Fred Meyer to local pharmacies.
“This will definitely have ripple effects throughout community,” stated Dan Nelson, a Tanana Chiefs Conference pharmacy manager.
Nelson and other pharmacists who reached out to Nelson for this story say that a merger between Kroger (the company that owns Safeway) and Albertsons could worsen the problem. The potential loss of Safeway pharmacies and Carrs could also mean that many Alaskans will not have access to the same pharmacy options.
Access questions
Kroger Family Medicine has 13 Fred Meyer pharmacies in Alaska. This is just 8% of all pharmacies in the state.
Express Scripts spokesperson said that she could not disclose the number of Alaskans served by the company.
Express Scripts spokeswoman Justine Sessions said that “with this change, most of our customers Alaska will be able continue to fill their prescriptions in their pharmacy.”
Alaskans serving in the military are covered under TRICARE, the health insurance provider for uniformed service personnel. Express Scripts is used to prescribe.
We believe that there will be little impact, other than the inconvenience of having to transfer the prescription to another pharmacy. Kroger has decided to not be part of the Tricare Network. However, beneficiaries have other options,” Brandy Ostanik Thornton, public affairs officer at U.S Army Alaska, stated in an email.
She also included a link that military personnel and their families could use to locate a nearby pharmacy.
Premera Blue Cross Blue Shield of Alaska (one of the largest state-owned health insurances) also sent out a letter to its members about the split. It advised them of next steps.
Amanda Lansford, Premera spokesperson, stated that the company was not involved in negotiations but is committed to “ensuring our members have in-network pharmacy access.”
Lansford stated that Fred Meyer is only 8% of Alaska’s pharmacies. Each city with a Fred Meyer Pharmacy also has one in-network pharmacy Premera members may use.
Sessions stated that Alaskans will have several other options for pharmacies than Fred Meyer, but smaller communities could still be affected by the separation.
Navigating the Changes
The potential for a reduction in pharmacy options for patients could lead to staffing problems and long waiting times for prescriptions. This is due to an already existing Alaska pharmacist shortage.
According to Nelson, who helps coordinate medication delivery to the tribal consortium of 42 Interior Alaska villages which make up Tanana Chiefs Conference, Fairbanks’ Fred Meyers are the busiest pharmacies in Fairbanks.
He said that about 25% of Fairbanks residents had health insurance that was contracted with Express Scripts, and that they relied on Fred Meyer for their prescriptions.
Nelson outlined what would happen to Alaskans who buy prescriptions at Fred Meyer after January 1. First, they will be charged the cash price of their medication rather than the price their insurance covers.
He said, “Then they’re likely to have a heart attack and will need to pay the full cost upfront.” They would then have to submit a reimbursement request to their insurance company. This would likely be lower than they expected.
Nelson predicts that Fairbanks’ workload will increase by 25% over the next year, leading to backlogs in prescription transfer which can lead to delayed wait times for patients.
Alaskans can switch pharmacies by calling the pharmacy they want and stating that they have a Fred Meyer prescription they wish to transfer. Nelson agreed.
To avoid long delays in prescriptions, he advised that you not wait until January to switch pharmacies. Instead, be proactive and change it immediately.
Most likely, affected Alaskans received a letter from the company informing them of the change. Brandy Seignemartin is the executive director of Alaska Pharmacists Association and encourages anyone unsure to call the number listed on their card and ask any questions.
She stated that her main priority in the coming weeks is to help Alaskans navigate the possible changes and get care quickly.
Seignemartin stated that patients losing their pharmacies can have a negative impact on patient health outcomes. To ensure continuity of care, it is crucial that we provide support to patients so they can access their medication as soon as possible.
Lang-standing problems that require imperfect solutions
Many Alaskans were offered the option of switching to Express Scripts’ online pharmacy at a slightly lower cost by the insurance companies and Express Scripts. This was to offset the loss in access.
Alaska pharmacists who spoke with us about this story expressed concern that online orders wouldn’t work in Alaska like they do elsewhere due to long distances, extreme temperatures, and other difficulties related to Alaska’s remoteness as well as large areas of unconnected communities.
Justin Ruffridge, Soldotna-based pharmacist, stated that access is his biggest concern.
Ruffridge stated that it was not good for health care to have people lose access to their pharmacy. It’s not healthy for people to ask if their prescription has arrived in the mail and if it will be okay sitting in a cold mailbox for four hours.
Ruffridge and others claim that the practices of Express Scripts pharmacy benefit managers, especially at dismally low reimbursement rates, have resulted in the closing of many independent pharmacies.
Seignemartin stated that there is a limit to the amount of reimbursement you will accept before you are unable to staff your pharmacies safely.
Ruffridge sees Kroger’s decision in the same light as other pharmacy benefit managers.
“The more these practices continue, the more difficult it will be for pharmacies in local communities to operate.” He said that you will end up with basically a pharmacy via mail.”
Nelson, Tanana Chiefs Conference’s pharmacy manager, said he has seen firsthand the difficulties that can arise when groups don’t have experience shipping medications to rural Alaska from Lower 48 warehouses.
He receives weekly reports from patients whose medication has not arrived on time or is frozen.
He said that he believes there is a lack in understanding.
The Anchorage Daily News originally published this story. It is republished with permission.
