I don’t know about you, but the amount of actual postal mail I receive today is significantly diminished from a decade ago. But unlike land lines (phones that were attached to your house, for those that grew up in the cellular phone era), the mailbox isn’t going anywhere soon. Electronic mail may be good for a lot of things (I must get back to that Nigerian Prince one of these days…), but official correspondence, while uncommon, needs a landing strip.
When you receive certified mail, you know something important just arrived. Postal mail has a certain gravitas: even if you refuse delivery of certified mail, the contents are considered “served” from a legal perspective. If something appears in your mailbox from your insurance company, it is probably significant.
As a pharmacy owner, I am regularly approached by patients, some not even my own customers, asking about mail they received from their insurance company or PBM. They correctly assume that the document may contain important information, and the message is not always clear or easily comprehended. A great example are letters from PBMs informing their customer that their pharmacy won’t be in network starting at some point in the future.
From a consumer standpoint, this is confusing. Many consumers consider their choice of a pharmacy as a given freedom. Being told you must change providers creates confusion, anger, and even fear. This is why I see so many of these letters every year. They are disruptive to the patient.
From a pharmacy owner’s perspective, these letters are often unfair. The letters, while factually accurate, do not convey all the ramifications and alternatives available to the patient. For example, around the end of the year, when open enrollment is approaching, a lot of these letters go out when a pharmacy opts out of a bad contract for the next year. The letter tells patients that they must change pharmacies. What it doesn’t tell them is that they could also elect to change plans. That is an important part of the equation, but because it isn’t in the plan’s best interest, they omit this information!
These letters are a fact of life. Sometimes a patient will have alternatives like switching plans. Other times, when an employer elects a plan change that excludes local pharmacies, there isn’t an obvious way for the patient to maintain their pharmacy choice. The important part, for both patients and pharmacy owners, is to be proactive.
As a pharmacy owner, you need to have your finger on the pulse of your community. This usually means inculcating loyalty with a few dozen community members. Let them know you want to hear about anything they encounter that might impact pharmacy and healthcare. When one of their friends mentions a letter they received from their insurance impacting their pharmacy choice, YOU want to know about it because you cannot plan if you are not aware that change is afoot.
As a member of the community, and a consumer of local healthcare, it is important to share plan changes with your local providers. If your local providers are excluded from any plan, their long-term viability as a local provider becomes questionable. Healthcare is a local service. Proximity to care, be it physicians, clinics, or pharmacies, is important, and often it is only after a clinic or pharmacy closes you recognize the impact of the loss.
Changes being made by healthcare plans impact accessibility. It doesn’t take long in today’s economic environment to be left with one or no options in your area. Healthcare plans might tell you that fewer providers creates efficiency. While this is true to a degree, it also eliminates competition and choice. What happens when the remaining options are also squeezed out, and the next closest option is in the next town, city or state?
On the consumer side, it is about maintaining access to your local providers. On the provider side, it is about maintaining access to your patients. Health plans and PBMs are not necessarily concerned with the patient or the provider. They are concerned with their own bottom lines. To them, it boils down to dollars in their pocket. To the local community, it is far more important.
For consumers, if you receive mail regarding changes to your care plans that might impact your providers, share it with them! Take time to ask questions. There may be options available to you to continue to use your providers of choice.
