Categories
Personal Pharmaceutical Benefits Management Rant

The Pharmaceutical Desert grows…

So, I’ve been getting messages from Bi-Mart over the past few days, telling me that they are withdrawing from the pharmacy business, and transferring all of their pharmacy works to Walgreens.

Yes. The folks at the corner of We’re Seriously Overworked and We’re Going To Make A Critical Mistake.

As the title alludes, this is a problem, as it increases the size of an already growing pharmaceutical desert, caused in part by employer health plans funneling through a pharmaceutical benefits manager that mandates the use of a specific pharmacy chain.

As example, I’m only allowed to use either mail order pharmacy, which has its own set of woes I’ve touched on, or Walgreens for any of my maintenance medicines. When I last truly dug in on it, I didn’t own a car: I was dependent on public transportation, either by city bus, taxi or ride hailing, or booking a paratransit trip to and from, which leads to its own set of problems, or cycling to and from the pharmacy when the weather was decent and I felt good enough to handle the trek. Sometimes, a housemate would also be going to the pharmacy, and I could catch a ride with them.

The current pandemic has dug its hooks in deep, changing the overall landscape of everything around us.

Those of us who are trying to follow the plausible rules of distancing, wearing some type of useful face cover that mitigates aerosolization of our own saliva, keeping our hands clean and out of our faces, and staying the f🌕k at home like the book suggests?

It’s becoming harder, as we have to choose between queuing at the local pharmacy with others, or wondering if our damn insulin or testing supplies might make it in today’s mail.

To remove an entire chain of pharmacies during a pandemic smacks of a lack of social responsibility to others, but also feels like it was caused by the continued erosion of a client base by the dumpster fires of pharmaceutical benefit management companies.

It does not help that employers go into their PBM use seemingly blinded by the “Hey, this works, and we’ll save money, right?” approach, missing the blackcurrants for the giant forest fire raging around them.

Let’s talk about the difficulty of getting a blood glucometer on my insurance benefit that I just had to go through:

For once, I am less angry at Express Scripts than I am at Walgreens: the folks I spoke with at E-S were professional, on point, and were very quick to confirm that yes, I can certainly have a finger stick glucometer in addition to my current CGM, because treatment decisions for a low or a high should be meted against blood, not interstitial fluid.

My doctor’s office could and should have asked me which pharmacy to send the glucometer request to (and should’ve listened to the entirety of the data I provided, another story), but they sent it to Walgreens.

I went to pick that up right after work when it was requested and I was notified it was ready.

I parked the car after negotiating garbage tier traffic through a busy segment at 5 pm to get there. As I approach the doors to the Walgreens, there’s a sign on the door indicating that they are only distributing prescriptions through the drive-through, and that the counter to walk up is closed.

I don’t like this one bit, so I get back into the car, and go to drive around to the drive-thru.

A view of the drive-thru at Walgreens.

This is what greeted me, though there was actually one more vehicle here prior to my photo. The queue is poorly designed, forcing me to sit back at a stop sign to allow folks to get out of the drive-thru; there are two other cars not pictured at this juncture on the forward side, and the queue grew by three cars behind me while I waited for this mass to actually not move for ten minutes.

I got frustrated enough that I left, drove over to the sanity-saving FredMeyer because it was about six in the evening, and bought a glucometer out of pocket solely because I really needed one, and I wasn’t willing to spend an hour in line in my car alternating between the clutch and the brake. I just wanted to check my blood sugar, get something to eat, and call it an evening.

Imagine my surprise when I get to FredMeyer, and there’s one person in line at the pharmacy, waiting. Me. Because the only other person getting pharmaceuticals was already being taken care of, and the glucometers are sitting out where any diabetic in need can pick one up.

In appropriate fashion, as I’m being checked out, I thanked the pharmacy tech for being there.

The line at your competition is so long that it would benefit me to buy a glucometer out of pocket so I can check my numbers. I’ve got a wonky sensor and need to check. Thank you for being here and so quick.

– Jayel

They had been hearing the horror stories all day, it seems.

Here’s a food for thought moment as I wrap back to an earlier statement: What if I didn’t have a car and needed to pick up prescriptions? What the hell is that pharmacy doing in those situations? Are they footing the bill for a person to call a cab or hail a rideshare and sit in the drive-thru just to get something they needed to take?

“But Xial, Walgreens delivers prescriptions, too,” I can hear someone arguing in the most nasal of tones.

No, Walgreens does not deliver, if you’re looking for something to be done in a timely manner. I tried to have their home delivery bring me my meds, none of which are controlled substances: they’re my injectables for maintaining my blood glucose. I wasn’t out at time of order — two weeks’ worth on hand, minimum. 10 days after ordering showed no order movement, so the mail order tech basically tells me I should go in to a store for my meds.

It’s all madness and turtles, all the way down.

So, once more, for the crowd in the back:

PBMs cause neighborhood damage by funneling clients away from smaller pharmacies, to large national chains. This often takes away those jobs and livelihoods, containerizing money into the hands of an elite few, who are already buddies with the elite few of the PBM. They sail yachts together.

As the funneling continues, we start to see growth of the pharmaceutical desert, growing to be on par with the already existing food deserts.

I would wonder if someone has done the research to see how much of the pharmaceutical desert affects populations of minorities: how often are their local pharmacies disappearing, forcing them to travel miles and miles away just to get their medicines, or hope they’ll arrive this week in the mail?

That’s food for thought.