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5 Tips to Managing Your Insurance Coverage

March 26, 2013 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

Don’t use providers that aren’t in your network. Most plans have lowered how much they will pay for doctors or facilities not in your network, while some won’t pay for out-of-network providers at all.

Review how prescriptions are reimbursed under your coverage. Many plans are now offering reimbursement based on a percentage of the retail cost of a drug, which can add up quickly. If you pay a percentage instead of a co-pay, compare prices at different pharmacies.

Prepare for a doctor visit ahead of time if you anticipate a prescription, diagnosis or treatment plan. You should have your benefits summary with you as well as your drug formulary to know how much you’ll pay for a prescription before you leave the office. You can also pull up prices at local facilities on your tablet or phone at www.medtipster.com to discuss choices with your doctor.

Read your benefits summary carefully to know what’s in your plan, and what isn’t.

Shop for the lowest priced facility for diagnostic tests. Hospital-based services are often priced higher than independent facilities.

 

Drug Adherence Rises When Co-Pays Go Down

September 14, 2012 By: Nadia Category: HealthCare, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Reuters Health, by Amy Norton – 9.11.2012

When people with chronic health conditions have lower out-of-pocket costs for medications, they are more likely to actually fill their prescriptions, according to a new research review.

The findings, reported in the Annals of Internal Medicine, sound logical. But they lend some hard numbers to the idea that lower drug costs should improve people’s adherence to their medication regimens.

“It was striking to us,” said lead researcher Meera Viswanathan, of RTI International, a Durham, North Carolina-based research institute.

“If you help people with costs, even a little, it seems to improve adherence,” Viswanathan said in an interview.

She and her colleagues reviewed several dozen U.S. studies on various efforts to improve people’s ability to stick with their prescriptions. A few of those studies focused on insurance coverage – either giving people drug coverage or lowering their out-of-pocket costs for prescriptions.

Some looked at what happened after Medicare prescription coverage took effect in 2006; others looked at cutting out-of-pocket payments for people with private insurance.

Overall, better coverage seemed to help. In a study of nearly 6,000 heart attack patients, for example, those given full drug coverage through their insurer got more prescriptions filled over about a year.

Of patients who were on their usual insurance, 36 percent to 49 percent filled their prescriptions, depending on the medication. Those rates were four to six percentage points higher among people with full drug coverage.

Patients with full coverage also suffered a new complication, like a stroke or second heart attack, at a slightly lower rate: 11 percent, versus just under 13 percent.

But while there is some evidence of actual health benefits, not many studies have followed people long-term to see if the better drug adherence translates into a longer or healthier life.

“There were some encouraging findings,” Viswanathan said. But more research is needed to know what the long-term health effects are, she and her colleagues write.

The results do not mean that better drug coverage is the only way to get people to fill their prescriptions, according to Viswanathan.

The studies in the review found some other tactics to work, too. Education plus “behavioral support” was one.

That goes beyond telling patients about their health problem, and why a particular medication is needed, Viswanathan said. “You would also try to get through the barriers that may keep a patient from taking it,” she said.

If a patient was afraid of side effects, for example, a nurse might discuss that with him or her.

Another measure that seemed effective was “case management.” That means the health provider would try to identify patients at high risk of not using their prescriptions, then follow-up with them – with phone calls, for instance.

It’s not clear, Viswanathan said, how programs like that could be “scaled up” to be widely used in everyday practice, and not just clinical trials.

And the specific fixes might differ depending on the health problem. With high blood pressure, a fairly simple move seemed to boost patients’ adherence to their medication: Giving prescriptions in blister packs rather than bottles, so people could more easily keep track of whether they’d taken their daily dose.

With more complex measures, the question of how to work them into the real world remains. “We need to know, what does it take to implement them into clinical practice?” Viswanathan said.

Figuring out how to get people to stick with their medications is considered a key part of improving healthcare. Studies show that 20 percent to 30 percent of prescriptions are never filled, and half of medications people take for chronic ills are not taken correctly.

All of that is thought to contribute to 125,000 deaths a year, and to cost the U.S. healthcare system as much as $289 billion annually.

Tips for Traveling with Medications

December 06, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Eli Trathen 12.6.2011

Everyone looks forward to vacation, and a good deal of planning goes into most trips to make the experience as relaxing as possible. This planning may involve booking a hotel, purchasing traveler’s checks, and packing the sun block. However, one more concern that must be remembered affects millions of Americans. Namely, people need to be aware of how to travel with prescription medications, and what one should expect if the need for a prescription medication arises while away. When away from home for an extended time, it is advisable to think about your medications.

Before You Go
Prepare a list of all of your medications and a list of contact information for your doctor(s). Carry the name, location, and phone number of your pharmacy as well. If questions arise about your medications, or if you lose your prescription, you will have the needed information.

If you are flying, keep your medications in your carry-on luggage. That way, you will have access to them during your flight and will not lose them if your luggage is lost. Also, keeping your medications with you helps prevent exposure to extreme temperatures in the baggage compartment. Extreme temperatures can change the drug’s effectiveness.

If travelling with needles and syringes, carry information that proves the syringes were prescribed for a medical reason by your doctor. A copy of your prescription and a label attached to the product is sufficient proof. The American Diabetes Association recommends that people with diabetes be prepared to provide airport security with copies of prescriptions for diabetes medications and supplies, as well as complete contact information for your doctor. Make sure all prescription medications have the name of the drug, the name of your doctor, and your name on the label.

Airport security requires that medications are transported in their original, labeled containers. The labeled vial from the pharmacy that contains your pills meets this requirement. Check the Transportation Security Administration (TSA) website prior to travel for the most up-to-date information about travelling with medications. Airport security may ask you to prove that the name on your prescription bottle(s) matches your identification. According to the TSA:

  • Medications must be labeled, so they are identifiable.
  • Medications in daily dosage containers are allowed through the checkpoint once they have been screened.
  • Medication and related supplies are normally X-rayed. TSA allows you the option of requesting a visual inspection of your medication and supplies, which you must arrange before the screening process begins. The X-ray process has not been found to affect drug products.

Long Distance Travel
Consult with your doctor or pharmacist if traveling over many time zones to work out a plan to adjust the timing or dosage of your medications. He or she will also be able to determine whether a plan is necessary given the medications you are taking.

If you are visiting a foreign country, be wary of buying over-the-counter (OTC) medications. Many medicines that are available by prescription only in the United States are available OTC in other countries. Beware of these medications, as they may have been manufactured in facilities that do not meet Food and Drug Administration code. You may receive a medication with less effectiveness; or, even worse, you may receive the wrong drug. Taking these medications could put you at risk.

Extra Medications
Take along more medication than the number of days of your trip. A good rule of thumb is to have at least an additional week of medication on-hand. Unexpected delays can happen, and it will be easier for you to have one less thing to worry about should this happen. It is best to have all of your medications refilled before you travel. If it is too early to get a refill before you leave, but you will need more medication while you are gone, ask your doctor and pharmacist if they will refill early as a special circumstance. If you are not leaving the country, remember that large, national pharmacy chains allow you to refill your prescription wherever you happen to travel nationwide.

While You’re There
If you are visiting a hot, humid climate, try to keep your medications in a cool, dry place and out of direct sunlight. While many people assume bathrooms are a good place to store medications, this is not necessarily true. The heat and humidity in bathrooms can cause a drug to lose effectiveness. Be aware of medication storage requirements for the medications you take on your trip. All medications are labeled with an ideal range of temperatures for storage. Some medications require refrigeration when stored. This may be done by packing the medication in a small cooler with ice and a thermometer to ensure the temperature is kept at an appropriate level. Likewise, you may ask your hotel if a small refrigerator is available to help with your drug storage. Check with your doctor or pharmacist about the best method of travelling with these more sensitive drugs.

Another climate consideration is increased sensitivity to sunlight. Some medications can cause a rare side effect, called photosensitivity, which could cause inflammation of the skin (similar to sunburn). Products like ciprofloxacin (for infections), Bactrim and doxycycline (antibiotics), and diclofenac (for pain) have this potential. Ask your pharmacist if any of the medications you are or may take on vacation could cause photosensitivity. Try to avoid excessive sun exposure, and cover up with SPF 30 or greater sunblock.

Hopefully, using the above tips for traveling with medications will allow you the relaxation you deserve on your next vacation.

Meet Bradley Powell, R.Ph. – Medtipster.com Pharmacist

July 25, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

A few minutes with Bradley…

 

Q: What do you do for a living?
A: In additon to my responsibilities at www.medtipster.com, I am an outpatient pharmacist for LL Health. My main responsibility is to the patients that I serve and to the clinic that we’re in by helping the doctors and nurses with drug therapy for patients.
 
Q: What is a typical day like for you at the clinic?
A: typical day would include dispensing refill medications to our regular customers and new medications to people coming to us from our clinic and outside of the clinic. It also includes lots of phone calls from doctors and nurses who have questions about certain drugs or questions about patient therapy. And I’d say that the pharmacist’s main responsibility is to verify that all the prescriptions that leave the pharmacy are correct for the patient.
 
Q: What is your schedule like?
A: Our schedule can vary. I’d say most days are fairly regular and from 8:30am to 4:30pm, although some days there are 1pm-9pm shifts. As far as weekends, we usually work just one weekend day every four to five weeks.
 
Q: What do you like most about being an outpatient pharmacist for LL Health?
A: I like the staff that I work with both in the pharmacy and in the clinic. For a professional pharmacist, it’s very nice to be so close with the doctors and the nursing staff and to be able to get a hold of them when we need to.
 
Q: What motivates you most in your career?
A: I would say hearing good things from our customers is probably the most motivational aspect.
 
Q: What is the atmosphere like at the clinic?
A: The atmosphere here at the clinic is very open and friendly. All of the staff seems to get along and work together, so it makes for a really good working environment.
 
Q: What originally got you interested in the pharmacy field?
A: I originally went into pharmacy because I liked math and science in school. And after I had looked around at different careers that would involve my interests, pharmacy just seemed like a really good fit.
 
Q: What are some unique aspects of being an outpatient pharmacist at LL Health?
A: I think as an outpatient pharmacist, a lot of times you are the “first line” for many patients. So I think it’s always interesting because we see so many different things. And I think our opinion to the patients we serve really matters.
Contact Bradley or one of our pharmacists at contact@medtipster.com

Meijer’s Free Pre-Natal Vitamin Program Fills Millionth Prescription

July 06, 2011 By: Nadia Category: Free Prescriptions, HealthCare, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: prnewswire.com – 6.29.2011

Delivering a healthy dose of good news to Midwest families, Meijer announced today that its free pre-natal vitamins prescription program has filled its 1,000,000th prescription, at a cost savings of nearly $14 million to Midwest families.

The announcement, made by Hank Meijer, Co-Chairman and CEO, came as the Midwest retailer reported that its pharmacies had hit the million-mark milestone earlier this week.

Meijer gave birth to the program in May 2008 when it announced it would fill select pre-natal vitamin prescriptions at no cost to customers. The no-strings-attached program enables any customer, regardless of insurance or co-pay, to have their pre-natal prescription filled free of charge.

“Meijer has always been a strong advocate for safe and healthy families, and we’re very proud to offer a program that works to ensure the health of an expectant mother and her child,” said Meijer. “In addition, offering free pre-natal vitamins helps Midwest families cope with rising health care costs, complementing the many other ways families can save money throughout our stores.”

It has been shown that pre-natal vitamins play an important role in healthy pregnancies and healthy babies. These supplements have typically been prescribed for women who have become pregnant, however, many members of the medical community believe they also play an important role for women in the months leading up to conception.

Prior to launching its free pre-natal vitamins initiative, Meijer successfully introduced a program in October 2006 offering to fill select antibiotics at no charge. That program, still in use, covers leading oral generic antibiotics with a special focus on the prescriptions most often filled for children.

The Michigan-based retailer followed up its free pre-natal program in 2010 with a similar program providing no-cost prescriptions for metformin, the most commonly prescribed drug for type 2 diabetes.

Since its inception, the Meijer free antibiotics program has filled more than seven million prescriptions, saving families almost $120 million. The free metformin program has helped nearly 500,000 people battle diabetes, at a cost savings of more than $4 million.

“In less than five years, our free antibiotics, pre-natal and diabetes prescription programs have saved our customers nearly $140 million,” said Meijer. “In total, we have helped hundreds of thousands of people throughout the Midwest receive free prescriptions to help them, and their families, lead healthier lives.”

The Meijer free pre-natal vitamins program features several well-known brands of pre-natal vitamins, including TriAdvance, Trinatal GT, Trinatal Ultra, Vol-Nate, Vol-Plus, and Vol-Tab.

Find a qualifying Meijer Pharmacy near you at www.medtipster.com!

DAW Prescriptions May Add $7.7 Billion To Healthcare Costs

March 25, 2011 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: CVS Caremark – 3.25.2011

Approximately five percent of prescriptions submitted by Pharmacy Benefit Management (PBM) members in a 30-day period during 2009 included a “dispense as written” (DAW) designation. This practice – whereby doctors or patients demand the dispensing of a specific brand-name drug and not a generic alternative – costs the health care system up to $7.7 billion annually, according to a new study by researchers at Harvard University, Brigham and Women’s Hospital. Moreover, these requests reduce the likelihood that patients actually fill new prescriptions for essential chronic conditions.

In a study published this week in the American Journal of Medicine, the researchers demonstrate that DAW designations for prescriptions have important implications for medication adherence. They found that when starting new essential therapy, chronically ill patients with DAW prescriptions were 50 to 60 percent less likely to actually fill the more expensive brand name prescriptions than generics. “Although dispense as written requests would seem to reflect a conscious decision by patients or their physicians to use a specific agent, the increased cost sharing that results for the patient may decrease the likelihood that patients actually fill their prescriptions,” the researchers said.

“This study shows that dispense as written requests are costing the health care system billions,” said William H. Shrank, MD, MSHS, of Brigham and Women’s Hospital and Harvard, and the study’s lead author.  “The further irony is that patients with prescriptions specifying a certain brand seem less likely to fill their initial prescriptions, adding to the medication non-adherence problem.”

“Previous to this study, little was known about the frequency with which doctors and patients request dispense as written prescriptions,” said Troy A. Brennan, MD, MPH, Executive Vice President and Chief Medical Officer of CVS Caremark and a study author. “Those who advocate for dispense as written and argue that the practice provides patients and physicians with greater choice will probably be surprised to learn that the practice increases costs and exacerbates non-adherence.”

The study reviewed 5.6 million prescriptions adjudicated for two million patients from January 1 to January 31, 2009. The review found that 2.7 percent of those prescriptions were designated DAW by doctors, while another two percent were requested DAW by patients.

If existing safe and effective generic alternatives had been provided in place of those brand-specific prescriptions, patients would have saved $1.7 million and health plans would have spent $10.6 million less for the medications.  The researchers said that assuming a similar rate of DAW requests for the more than 3.6 billion prescriptions filled in the U.S. annually, patient costs could be reduced by $1.2 billion and overall health system costs could be reduced by $7.7 billion.

The study is a product of a previously announced three-year collaboration with Harvard University and Brigham and Women’s Hospital to research pharmacy claims data in order to better understand patient behavior, particularly around medication adherence.  Annual excess health care costs due to medication non-adherence in the U.S. have been estimated to be as much as $290 billion annually.

Medicine is the best medicine; help patients keep taking it

December 07, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: Boston Globe, 12.3.2010

Patients who don’t take their medications are a well-documented problem in medicine. If doctors are to spot patients who might stop complying with prescriptions, it’s vital to have a fuller understanding of why and how it happens.

As many as 40 to 60 percent of those with chronic conditions like high blood pressure, heart failure, or diabetes don’t take their medicines regularly. The reasons vary – some patients never fill their prescriptions; others feel better and stop their drug regimens; in still other cases, side effects or the burden of too many pills discourage patients from refilling their prescriptions. Whatever the motive, failing to take needed drugs leads to worse health and higher spending, as patients land in the hospital for preventable conditions that cost the health care system hundreds of millions of dollars a year.

But a new study this month in the Annals of Internal Medicine, by researchers at Brigham and Women’s Hospital and Harvard Medical School, shines the spotlight on another contributor: Patients not picking up prescriptions that have already been filled.

The analysis, funded by CVS Caremark, looked at over 10 million prescriptions filled over a 3-month span in 2008 and found that 3.3 percent were never picked up. The number seems small, but translates to 110 million abandoned prescriptions per year in the United States. It costs a pharmacy an estimated $5 to $10 to prepare, then return to the shelves, an unclaimed medication, so the authors estimate the problem could be costing more than $500 million a year. CVS Caremark has a clear interest in bringing that number down – but so do patients and doctors.

The problem could worsen as technology evolves: Prescriptions sent electronically were 65 percent more likely to be left behind, probably because they bypass the step of having the patients hand- deliver a slip to the pharmacist. As electronic prescribing continues to take hold nationwide, insurers should be vigilant that prescription fill rates may reflect compliance less accurately than with traditional prescriptions.

Not surprisingly, prescriptions with $40 to $50 copays were the most likely to be abandoned. According to William Shrank, the study’s main author, this means that during economically hard times “even insured patients are experiencing sticker shock, and walking away from the pharmacy, without filling essential medications.”

Doctors are unlikely to know their patients’ copays for drugs, but taking the time to talk about drug costs would help them identify those who might never pick up their prescriptions. Down the road, those extra minutes of chat time at the office become multiple dollars saved at the hospital bedside.

Steep Co-Pays May Cause Some to Abandon Prescriptions

November 17, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News

www.Medtipster.com Source: HealthDay, 11.15.2010 – By Serena Gordon

In these tough economic times, even people with health insurance are leaving prescription medications at the pharmacy because of high co-payments.

This costs the pharmacy between $5 and $10 in processing per prescription, and across the United States that adds up to about $500 million in additional health care costs annually, according to Dr. William Shrank, an assistant professor of medicine at Harvard Medical School and lead author of a new study.

“A little over 3 percent of prescriptions that are delivered to the pharmacy aren’t getting picked up,” said Shrank. “And, in more than half of those cases, the prescription wasn’t refilled anywhere else during the next six months.”

Results of the study are published in the Nov. 16 issue of the Annals of Internal Medicine.

Shrank and his colleagues reviewed data on the prescriptions bottled for insured patients of CVS Caremark, a pharmacy benefits manager and national retail pharmacy chain. CVS Caremark funded the study.

The study period ran from July 1, 2008 through Sept. 30, 2008. More than 10.3 million prescriptions were filled for 5.2 million patients. The patients’ average age was 47 years, and 60 percent were female, according to the study. The average family income in their neighborhoods was $61,762.

Of the more than 10 million prescriptions, 3.27 percent were abandoned.

Cost appeared to be the biggest driver in whether or not someone would leave a prescription, according to the study.

If a co-pay was $50 or over, people were 4.5 times more likely to abandon the prescription, Shrank said, adding that it’s “imperative to talk to your doctor and pharmacist to try to identify less expensive options, rather than abandoning an expensive medication and going without.”

Drugs with a co-pay of less than $10 were abandoned just 1.4 percent of the time, according to the study. People were also a lot less likely to leave generic medications at the pharmacy counter, according to Shrank.

The medications most frequently abandoned were cough, cold, allergy, asthma and skin medications, those used on an as-needed basis. Insulin prescriptions were abandoned 2.2 percent of the time, but Douglas Warda, director of pharmacy for ambulatory services at the University of Chicago Medical Center, said this might be a cost issue, but it could also be that some people are afraid to inject insulin.

The study also found that antipsychotic medications were abandoned 2.3 percent of the time.

Drugs least likely to be abandoned included opiate medications for pain, blood pressure medications, birth control pills or hormone replacement therapy, and blood-thinning medications, according to the study.

Young people between the ages of 18 and 34 were the most likely to forgo their prescriptions, and new users of medications were 2.74 times more likely to leave their drugs behind.

Prescription orders that were delivered to the pharmacy electronically — via the computer — were 64 percent more likely to be abandoned than prescriptions walked into the pharmacy.

“We’re definitely not saying that e-prescribing is bad; it’s great, but there appear to be some unintended consequences,” said Shrank.

There was no way to tell if people never tried to pick up their prescriptions, or if they went to retrieve them but chose to leave them behind because of the cost.

Warda said he believes that more patients might pick up their medications if the instructions from their physicians were clearer. For example, prescriptions for proton pump inhibitors were left at the pharmacy 2.6 percent of the time. These medications reduce the amount of acid in the stomach and can help prevent heartburn or more serious problems. “If the physician message is, ‘You need to take these medications for two to three months and it will reduce your pain and help your body heal,’ fewer people might abandon these medications,” he said.

Plus, if cost is an issue for you, bring it up with your doctor ahead of time, he added. “Don’t get blindsided at the pharmacy. Always ask your physician if there’s a generic option, or if there’s something cheaper that might work just as well. Sometimes people are embarrassed to say anything, but it’s better to ask and get a medication you can afford.

“If you get to the pharmacy, and you can’t afford the medication, follow up with your doctor or ask the pharmacist if there’s a cheaper alternative,” suggested Warda.

Excellus Blue Cross Blue Shield study estimates e-prescriptions could save money and lives

July 16, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News, Prescription Savings

www.Medtipster.com Source: The Post Standard – by Charley Hannagan – 7.14.2010

A study released Tuesday estimates that 35 deaths a year could be prevented in Upstate New York if more doctors sent prescriptions electronically to pharmacies.

Yet, less than a quarter of the doctors nationally, and in Upstate, e-prescribe.

The study by Excellus BlueCross Blue Shield shows that 24.3 percent of doctors and 20.6 percent of physicians assistants in Upstate electronically send prescriptions to pharmacies, called e-prescriptions. In Central New York, the number drops to 21.8 percent of doctors and 17.3 percent of physician assistants.

E-prescribing is important to keep patients safe, prevent prescription forgeries, save money and make the system more efficient, said Dr. Arthur Vercillo, of Excellus.

“You can try and write as neatly as possible on a prescription form, but the call-backs (from pharmacists seeking clarification) still come in,” he said.

The study estimates that if all doctors sent e-prescriptions, and acted on the alerts provided about drug interactions, it would prevent 35 deaths, 161 permanent disabilities, 391 emergency room visits and 449 hospitalizations.

If doctors followed the generic prescription recommendations that pop up when they e-prescribe just 1 percent of the time, it could cut health care spending in Upstate by $64 million, Vercillo said.

The federal government is encouraging doctors to computerize patient medical records to make the system more efficient. E-prescribing is one part of that.

The federal government offers incentives to doctors to e-prescribe.

Excellus also offers an incentive to doctors to e-prescribe as a part of a package of incentives, Vercillo said.

Yet only about 25 percent of doctors nationally e-prescribe even though 85 percent of the pharmacies nationwide can accept e-prescriptions, according to Excellus.

Among other advantages are it allows doctors to retrieve a patient’s prescription history, it prevents forgeries and patients from going to many different doctors for the same prescription and it allows doctors to see a patient’s insurance coverage for drugs.

Local pharmacies leery of Caterpillar Rx policy

July 09, 2010 By: Nadia Category: Free Prescriptions, HealthCare, Medtipster, Prescription News

www.Medtipster.com Source: Winston-Salem Journal, 7.9.2010

A group of independent local pharmacies supports Caterpillar Inc. opening a plant in Winston-Salem, but not if it costs them customers.

That’s why they are appealing to city and county officials to make equal prescription-drug access to potential Caterpillar employees a part of any incentive package with the company.

The pharmacies are concerned about a preferred prescription-drug agreement that Caterpillar has with Walgreens and Wal-Mart.

The agreement, which runs through 2011, provides for lower or no co-pays for Caterpillar employees who fill their prescriptions with Walgreens and Wal-Mart. Employees pay more if they fill their prescriptions through an online or mail-order pharmacy, other chains or independent pharmacies.

“With Caterpillar’s policy, if one of our customers gets hired by Caterpillar, we could lose them,” said Dave Marley, the president and chief executive of Marley Drug in Winston-Salem.

“This, combined with the fact that our own tax dollars were used to entice Caterpillar, and it becomes wholly unacceptable.”

Caterpillar has named Winston-Salem as one of three finalists, along with Montgomery, Ala., and Spartanburg, S.C., for a proposed $426 million manufacturing plant with 510 company and contract employees.

Last week, Winston-Salem and Forsyth County offered Caterpillar a combined $23.4 million in incentives. Caterpillar plans to make a decision in August.

Marley said that the pharmacies are “willing to accept the exact same reimbursement terms given by Walgreens and Wal-Mart.”

“We feel there is no way this would be negotiated after the fact, so if there is going to be a change in Caterpillar’s policy, it has to be raised now and discussed now,” Marley said.

Also making the request are Andrews Pharmacy, East Winston Pharmacy, Gateway Pharmacy, Jonestown Pharmacy, Lewisville Drug, Medicap Pharmacy on Liberty Street and Medicap Pharmacy on Reynolda Road.

Mayor Allen Joines said the city “will bring this concern to the company’s attention if we are lucky enough to be negotiating a contract.”

At cathealthbenefits.cat.com, Caterpillar said the “direct contracts with Wal-Mart and Walgreens use a transparent cost-plus pricing methodology that is intended to eliminate unnecessary and hidden costs in the prescription-drug supply chain.”

Caterpillar did amend its policy to allow independent pharmacies to participate at the Walgreens and Wal-Mart tier in rural areas that don’t have easy access to those stores.

A small percentage of employers have adopted similar policies regarding prescription drugs, said Steve Graybill, a senior consultant for Mercer, a human-resources consulting company.

David Howard, a spokesman for R.J. Reynolds Tobacco Co., said that in 2009, the manufacturer opened up its health-care plan to give employees access to more than 59,000 pharmacies, including national chains and many local pharmacies. Before that, Reynolds provided most medical care for its employees through company-sponsored clinics such as Winston-Salem Health Care.

The bulk of local Reynolds employees have still chosen to use Winston-Salem Health Care and its pharmacy for years, Howard said. “Employees have the option to go outside of network for health care and prescriptions, but they will have higher out-of-pocket costs,” Howard said.

Media General Inc., the parent company of the Winston-Salem Journal, has a contract with Medco, a mail-order pharmacy that provides discounts for employees, but employees can fill prescriptions elsewhere, as well.

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