New Kaiser policy requiring mail-order prescription refills stings rural pharmacies

COLFAX – A new policy by a major health insurer requiring patients to refill their prescriptions through the mail threatens independent pharmacies and presents a hardship for rural residents.

Under the policy that went into effect Jan. 1, Kaiser Permanente will refill prescriptions only through Kaiser pharmacies or through the mail. Patients are allowed an initial fill and one grace refill at a pharmacy of their choice before they must make the switch. For monthly refills, that means many patients will experience the change in March.

For rural residents in Eastern Washington, mail can be undependable and a drive to the nearest Kaiser pharmacy in Spokane can be over an hour away.

Maureen Clausen, 78, lives on a rural mail route in Whitman County where she said she was lucky to receive mail once or twice a week this winter. Driving to Spokane is “a big outing” especially in winter.

“I am very scared,” she said. “I don’t know what we are supposed to do.”

Born and raised in Whitman County, Clausen lives on farmland that belonged to her parents.

“We have to be self-sufficient to do this,” Clausen said. “So, I don’t like Big Pharmacy telling me to get drugs from them when I already have a place.”

That place is Tick Klock Drug, an independent pharmacy in Colfax, a town of about 2,800 people an hour south of Spokane, where many school and public employees use Kaiser insurance.

Nathan Johnson, a pharmacist and third-generation owner, said his concerns are quality of patient care and patient choice.

“I wouldn’t want to mandate everyone has to come to our pharmacy,” Johnson said. “I would just say, if you like the service we provide, then we are happy to serve you.”

In a statement, Kaiser called the mail order service “convenient, safe, and cost-effective” and said 97% of refill prescriptions in central and Eastern Washington are delivered within two to three days.

“Kaiser Permanente is committed to ensuring our members continue to have access to their medications. In the rare event a member’s prescription does not reach their home, a specially trained pharmacy staff member will work with the impacted member to assist with a time sensitive supply of medication at a network pharmacy.”

The policy applies to routine medications. In emergencies, members can have their prescription sent to in-network contracted pharmacies, including ones like Tick Klock Drug.

Katie Johnson, a Tick Klock pharmacist who has no relation to Nathan Johnson, said that might not be enough.

“A small independent pharmacy is not going to survive if the vast majority of prescriptions are mandated mail-order,” she said. “There are not going to be any brick-and-mortar pharmacies left.”

Katie Johnson said she worries about the level of care patients will receive without going to their local pharmacy.

Tick Klock Drug works closely with the local clinic and miscommunications are easy to resolve. Patient questions come up naturally when filling prescriptions at the counter, where it is easy to go over instructions, she said.

If patients need to call the mail-order pharmacy, there may be long wait times.

“We are very active in knowing what health conditions are going on with our patients,” Katie Johnson said.

Clausen said she values visiting her pharmacist.

“Our druggist knows us and helps keep things straight,” she said.

Mike Morgan, a teacher and a coach in Colfax, has used Tick Klock Drug for the 30 years he has lived there.

“Tick Klock Drug is part of the family,” Morgan said. “They know me personally; they know everybody in town.”

The policy affects even larger towns, like Pullman, and Moscow, Idaho, where there is no Kaiser pharmacy.

Will Edwards, who owns Sid’s Pharmacy in Pullman, estimates about 10% of his customers have Kaiser insurance.

“I feel bad for patients,” Edwards said. “Rural health care just got more rural.”

Pam Vander Zanden, 69, who lives in Moscow, said driving 1½ hours to Spokane is not an option for her. She said her maintenance medication co-pays have doubled.

“I think a lot of people are getting sick of corporate greed, and this seems to be a great example of it,” she said.

State Rep. Joe Schmick, R-Colfax, said he received many calls from constituents about the issue.

“I don’t think people realize how important the pharmacist role is in health care,” he said. “We have such few providers in rural areas. They are a vital part of it.”

Some rural residents may find mail-delivered prescriptions more convenient than driving into town for them.

“I just want people to have a choice,” Schmick said.

Many patients said Kaiser did not do a good job informing them before the policy change. Some said they would have changed plans during open enrollment, had they known.

Legislation could prevent mandatory mail-order

A pair of bills proposed in the state Legislature would prevent mail-order prescriptions from being mandatory.

Schmick, the ranking minority member of the House Health Care and Wellness Committee, co-sponsored a bill that would regulate pharmacy benefit managers, middlemen who negotiate drug prices between insurance companies and pharmacies.

Katie Johnson testified in support of a companion bill before the Senate health care committee earlier this month. If passed, the bill would go into effect in 2025.

Opponents of the bill say pharmacy benefit managers help keep drug costs affordable.

The Senate bill is scheduled for an executive session hearing Friday.

A similar bill at the federal level aims to bring transparency to pharmacy benefit managers.

U.S. Sen. Maria Cantwell, a Washington Democrat, introduced the Pharmacy Benefit Manager Transparency Act along with Republican Sen. Chuck Grassley of Iowa on Jan. 27.