One result of switching many state employees' mail-order prescriptions to Florida is that Paradise Pharmacy will close today after 20 years in business in Pukalani.
Owner Larry Land says the change in the reimbursed drug plan by the Employer-Union Trust Fund was not the only reason he sold his business to Longs. But it was the last in a long run of difficulties that have driven all but two independent pharmacies on Maui to close.
Land said last week, "We spent from October 1 to the end of November an average of three to six hours a day working with InformedRx problems." InformedRx has the contract to fulfill insured prescription drugs, and it will not reimburse for maintenance drugs unless they are sent from its warehouse in Florida.
The Maui News MATTHEW THAYER photo
Paradise Pharmacy owner Larry Land fills a prescription for a customer Friday. He has sold his business, and it will close today. Falling reimbursements for insurance coverage and loss of business to a mail-order pharmacy made it impossible to carry on.
At Molokai Drugs Inc., President Kimberly Svetin says the switch to InformedRx has cost her father, the pharmacist, at least 10 percent of his business.
"Hawaii is a tough place to do business," she says, "we cannot afford to lose one prescription, to lose one customer on an island of 7,000."
Two complaints about the way InformedRx does business have been filed, one with the Board of Pharmacy and the other with the state insurance commissioner. And state Sen. Josh Green, the only physician in the Legislature, has been working on a bill that would address the complaints.
"My first approach in drafting a bill is to make it optional for people to opt out of mail prescriptions," he said recently. "I have had many, many complaints."
The complaints cover service, reimbursement, quality and access to professional advice. Svetin offered a photograph of pills received by one of her customers. Of 90 pills, 12 were broken. "We get broken bottles sometimes," she says, but Molokai Drug would never hand them out to customers. "We take the loss."
Denise Cohen, a nursing professor at Maui Community College, filed a complaint with the Board of Pharmacy. "If you look at the Pharmacy Providers Act, it clearly states a patient has a right to see a diploma and talk to a pharmacist. InformedRx has clearly violated this state law," she says.
She described how she attempted to reach a pharmacist on the InformedRx help line, only to discover, after some time on the telephone, that he was not a pharmacist and said he had had only three weeks training.
The board, which does not have its own investigator, forwarded Cohen's complaint to the Regulated Industries Complaints Office, which asked her if she wanted to file a formal RICO complaint. "I did file," she said.
"When I called, I had no idea whether I was talking to a pharmacist or to someone they just hired."
Cohen, who is on the state Board of Nursing, which also sends complaints to RICO for investigation, said she was satisfied with the actions taken so far. "The boards are not staffed for investigations," she said.
Les Krenk, owner of Wailuku Clinic Pharmacy, said, "They have been paying us so poorly that quite often they pay me below my cost. The state of Hawaii, in the Prepaid Health Care Act, says no insurance company can force me to pay below my cost. If they are not a health care plan, if they are just paying bills, then there's the Unfair Competition Code that prevents me from dispensing prescription drugs below cost. I plan to file a complaint with the insurance commissioner."
In an earlier round of protests against the EUTF-InformedRx contract, Krenk made a different complaint under the insurance regulations, but state Insurance Commissioner J.P. Schmidt turned that one down.
Like Cohen, Krenk says InformedRx is not, as required by its contract, making registered pharmacists available. "We called them. They don't care. If I tell them my costs are higher than on the Mainland, they don't care.
"I haven't gotten anything in writing. When we ask to speak to a supervisor, we've been unable to get to anyone. I have never spoken to a pharmacist."
Cohen has a personal story about trying to obtain a desperately needed prescription drug from InformedRx, when it was operating under a different name (see related story).
Green, who works as an emergency room physician at Hawi on the Big Island, also has stories about patients having difficulty obtaining medication. It is not all laid at the feet of EUTF cost-cutting. The acute shortage of physicians in rural areas of Hawaii County has also been a serious problem.
He says, "The first weekend, multiple people presented at the emergency room to come and get medicine that hadn't been shipped to them. It was totally unnecessary and very expensive, an emergency room visit is $300, $400, to get a handful of pills."
Svetin says Molokai residents have had similar experiences and even bigger ER bills. "People are desperate. If they go to the emergency room, it is $600 or $700 a visit, and the insurance companies are dealing with that cost."
The frustration may even be causing some insured state workers or retirees to start needing medication. An unsigned e-mail to The Maui News said, "I have panic attacks for a long time which is controlled by Zanax and Lexapro. It is making my condition worse, fearing that I possibly won't get my meds on time."
While that complaint could not be authenticated, Krenk and Cohen said they had encountered similar ones.
"Yes, that's very credible," said Krenk. "We have a 75-year-old customer who says he may have to go on tranquilizers he's so concerned. I would believe that e-mail."
Cohen says, because she spoke out about the contract, she has been asked for advice by several colleagues at MCC, and "there is lots of anger."
Krenk says, "I met with a big provider of Blue Cross/Blue Shield coverage, I'm on their pharmacy advisory committee, and they have learned not to be in the mail-order business."
Green says he understands that the EUTF trustees were concerned to hold down expenses for drug coverage, which have soared. However, "when they did their calculations, I don't think they considered this.
"It's hard enough to get people to take their medicine, and any additional burden, a language barrier, that's a recipe for compliance to go down, and in my view, that is a big mistake."
Green says that, "In some rural parts of the state, the pharmacy is the only health care provide people have access to," especially on weekends. Svetin agrees that can be true on Molokai after 4:30 p.m.
Green says that forcing small pharmacies out of business "is a major disservice to other people. People could suffer major hospitalizations, major conditions."
He adds, "My general philosophy is, there is no shortcut (to cutting medical costs). Who are we kidding if we think we are getting a shortcut from a corporation on the Mainland?"
Svetin estimates that over the life of the contract, InformedRx will suck $100 million out of Hawaii.
"We should stand up for our pharmacists and say, 'We value you,' " says Green.
InformedRx has declined to discuss its contract or its service. EUTF Administrator Jim Williams could not be reached for comment.
* Harry Eagar can be reached at firstname.lastname@example.org.