Alabama residents with Blue Cross and Blue Shield of Alabama insurance who have their prescriptions filled at CVS drug stores will have to pay full price for their medications or go elsewhere for their insurance to help cover the cost.
Blue Cross and Prime Therapeutics have developed new preferred pharmacy networks as of Jan. 1 that do not include CVS, according to Koko Mackin, vice president of corporate communications and community relations for Blue Cross.
“This change was made to help offset the continuous rise in prescription drug costs,” Mackin said. “The new pharmacy networks will provide the best medications for the best price.”
Blue Cross and Blue Shield of Alabama is part owner of Prime Therapeutics, which is a pharmacy benefit manager based in St. Paul, Minnesota.
Mackin said CVS is the only national chain not participating in the new networks.
“Prime was able to secure more cost-effective prescription drug prices from Walgreens and other pharmacies,” Mackin said when asked why CVS is not in the new networks.
Gary Serby, director of corporate communications for CVS in Woonsocket, Rhode Island, said it was not the company’s choice to be excluded from the Prime Therapeutics network.
The more than 2.2 million Alabama residents covered by Blue Cross likely will have to transfer their prescription medicine shopping from CVS to other drug stores.
Jessica Parker, of Decatur, learned of the change late Wednesday afternoon at the CVS on Beltline Road Southwest when Blue Cross would not cover part of the cost of her prescription.
“That makes me livid,” Parker, 35, said after leaving the drug store. “I’m supposed to take my medication today. Now, I won’t be able to.”
Parker said she has used CVS for about 10 years to fill the five prescription medications she takes. She said she did not receive any notice from Blue Cross about the change involving CVS.
She left CVS at dusk Wednesday to go to Walgreens.
“I’m going to call the insurance company on the way and give them hell,” she said.
Louise Jones, executive director of the Alabama Pharmacy Association, said the association was notified last fall of Blue Cross’ new preferred provider network. She said the association believes in freedom of choice for drug stores and the public.
“The APA supports a system that provides an open network for pharmacies that want to participate,” she said. “We think patients should be able to choose where they go to get their medications.”
The Alabama Department of Insurance has no authority over the matter, spokesman Stephen Holmes said.
Chains such as Walgreens and Wal-Mart are in the new networks, along with many local independent drug stores, Mackin said. She said consumers can find a participating drug store online at AlabamaBlue.com/pharmacy.
Any pharmacy network changes for employer plans will occur when the employer’s plan is renewed, which can be any time during the year, Mackin said.
Prime Therapeutics and Walgreens announced their alliance jointly last fall.
Blue Cross or their affiliates in 14 states own Prime Therapeutics, which is the fourth-largest pharmacy benefit management company in the country. Blue Cross in other states in the ownership group includes Florida, Texas, California, North Carolina and Minnesota.
A pharmacy benefit manager administers prescription drug programs, according to the American Pharmacists Association.
A pharmacy benefit manager develops and maintains a list of prescription drugs covered by an insurance plan, negotiates discounts and rebates with drug manufacturers, contracts with pharmacies, and processes and pays prescription drug claims, the association said.
CVS’ loss of Blue Cross business comes on the heels of being dropped from the network for TRICARE, the health insurance program for active U.S. military members and veterans, on Dec. 1.
CVS Health Corp. projects it will lose more than 40 million prescriptions in 2017 because of the new pharmacy networks that exclude CVS drug stores, according to the company’s third-quarter earnings report.
Serby said 180 of CVS’ more than 9,600 drug stores are in Alabama.
“We have no announcement on any closings,” he said.