New, local health care plans are excluding most pharmacies

Growing up in a small town, Becky Sargent believes in shopping local.

“I know what it’s like to, you know, get your living or your Christmas money or whatever it is from, you know, just one person buying from you, ” Sargent recalls.

That’s one of the reasons she chose to buy her prescriptions from Center Pharmacy in Cape Coral.

“You’re a real person to them other than, you know, just another number in the slot,” Sargent said.

But when she went to pick her prescriptions up in January, it wasn’t business as usual. Sargent’s medications rang up at $250 instead of her normal co-pay.

“I was a little bit shocked and didn’t have the money to pay that,” Sargent said.

It turns out her new Lee County Marketplace plan, Florida Blue’s myBlue Value Script RX plan, has a closed pharmacy network. Members can only get their drugs at Walgreens or through certain mail-order options.

“I don’t want to see someone get pushed out of business or pushed out of their job because I have to take my business to a bigger place.

Jewelry artist Rebecca Hagarty also switched to a myBlue plan because of plan price hikes.

“I’m working with teeny tiny beads right now, and it’s really hard,” Hagarty said.

It’s hard because one of her prescription​s from Walgreens makes her hands shake.
Hagarty said when Cypress Pharmacy in South Fort Myers filled her prescriptions, she could choose from a variety of manufacturers.

“When I went to Walgreens, I said, look, this is a company I need you to order it from, and they wouldn’t do it” Hagarty said.

While customers can still shop local, they’ll have to pay the cash price which can mean a lot more money even with coupons like those from GoodRX.

Ben Levene, the manager at Center Pharmacy, says staff gets an error message when myBlue plan members try to buy from them.

“A lot of them (customers) rely on some of the services that we provide; you can’t get it from some of the big chains. Free delivery, compounding,” Levene said.

And lost business means lost revenue.

Center Pharmacy and Cypress Pharmacy estimate they’ve lost up to 50 clients since January and at least $15,000 in sales a month each because of people switching to the lower-priced Marketplace plans.

Healthcare billing expert and Athos Health CEO Jon Hess said while closed pharmacy networks are not necessarily common right now, it’s something to be aware of.

“Prescriptions are a major driver of cost any more,” Hess said.

If you’re switching plans, Hess said to make sure your doctors are in-network, that your specific drugs are covered and that your pharmacy is in-network if it’s important to you.

Switching Plans

Should someone want to change their health insurance plan, special enrollment is taking place right now. WINK News is told that people making a change should do so after April 1st, when more subsidies become available.

Company Responses

In an email, Florida Blue told us:

“We launched our myBlue health plans in Lee County in 2021. These plans feature a limited provider network in order to offer a more affordable option for individuals and families who are not able to get health insurance through their employers. Since our myBlue plans were launched, Walgreens has been our retail pharmacy partner for these plans in addition to mail-order options.

“We have other health plans available in Lee County for individuals and families to purchase that offer a broader provider network that may include more pharmacies. These plans traditionally have a higher premium than the myBlue plans.

“If a member switched plans for 2021, they may have a different provider network this year. The good news is, the federal government recently opened a special enrollment period for persons with Affordable Care Act plans. If a member would like to switch to a plan with a broader provider network, they can call our Florida Blue Center in Estero for personal support in walking them through their options and see what financial assistance may be available to lower their payments.”

In an email, a Walgreens representative told us:

“My understanding after looking into this is that the particular dose needed is not currently available to order from the manufacturer,” and that any further questions about the availability should be directed to the manufacturer.