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Medicare hurts local pharmacies

Medicare hurts local pharmacies

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My interest in the health and patient care field started early. As a boy growing up in Big Sandy, I swept floors and helped behind the counter at the local pharmacy, which was owned by a family friend. When the drugstore closed its doors, my hometown was without a pharmacy for many years. These experiences shaped the values on which I have built my career and my belief in community.

Five years ago, I decided to start a community pharmacy built around patient care. Understanding the challenges of rural health care, I opened Frenchtown Drug in 2008. Today, I own stores in Frenchtown, Philipsburg, Missoula and Libby, serving thousands of Montanans. My Frenchtown and Philipsburg operations are the only pharmacies in these towns.

Today, independent pharmacy owners are faced with an impossible question: continue to provide necessary services to clients with the risk of Medicare nonpayment, or refuse access to patients, friends and neighbors, because of Washington’s poor public policy.

In 2008, the Centers for Medicare and Medicaid Services implemented a so-called “competitive” bidding program in 10 metropolitan areas with the promise to Montana’s senators that the program would never come to rural America. We know now that that promise was untrue. Under the competitive bidding program, providers were forced to bid to continue billing Medicare for products such as oxygen, power chairs and diabetic supplies. The vast majority of pharmacy patients have Medicare or are Medicare eligible. Many of these patients are diabetic, a disease that, according to the Centers for Disease Control and Prevention, is dramatically increasing in prevalence. Pharmacists like me have seen an increasing number of restrictions placed on these diabetic patients – restrictions that reduce choice and access to care.

Diabetic supplies are required for health. As a health care professional, I know that monitoring is the single best way a person with diabetes will live a safe and healthful life. As a small-business owner, I also know that diabetic testing supplies cost far less than emergency room visits and hospital stays for patients unable to monitor their health.

Pharmacies are often a patient’s primary resource for information on managing their care. In our rural state, primary care doctors may be hours away. Pharmacists see patients managing chronic conditions like diabetes on a regular basis. Pharmacists may recommend a patient test their blood sugar more often than the original doctor’s prescription if the patient is struggling with an infection or illness. Medicare is now informing pharmacies that they cannot provide necessary care items at a higher frequency than a doctor’s prescription. If they do, Medicare will not pay the claim. Moreover, Medicare is denying diabetic test strip payments (usually through impossible audits) even when the physician has clear orders for the patients to test at the desired frequency. I see this as a direct violation of a prescriber’s orders and patient care.

It is as if Medicare is trying to put us out of business. Currently, almost every test strip prescription that is filled in one of my pharmacies is audited by CMS. Claims are being denied payment for a variety of inconsequential reasons. In the past six years, I spent thousands on ensuring my pharmacies were accredited and authorized to submit Medicare claims; however, we are faced with no recourse as the government is effectively requiring our business to provide something for nothing.

I have chosen to continue providing supplies that patients require regardless of the financial loss from unpaid Medicare claims.

I have been told that our pharmacy opening in Frenchtown was more important than the local grocery store by one customer. Now, my business, the livelihood of my 24 employees, and the health of thousands of my patients is threatened by a law that was not supposed to come to rural America. That law has come to Montana and is unfairly jeopardizing patient care.

Eric Beyer, a native of Big Sandy, is the owner of Granite Pharmacy. Beyer has worked professionally in the health care field for 16 years, including for a national longterm care corporation, Indian Health Service, St. Peter’s Hospital, and now as the owner of four independent pharmacies. Beyer is on the executive board of the Montana Pharmacy Association.

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