New UPMC policy causing concern for patients, pharmacies

A new UPMC policy is causing concern for a lot of patients and pharmacies.

UPMC, along with its pharmacy benefits manager Express Scripts, sent a letter to patients in UPMC’s essential pharmacy network notifying them that they had to change pharmacies at the beginning of 2023.

This impacts companies with up to 50 employees and individuals who have insurance through Pennie — the online insurance marketplace in Pennsylvania.

Many patients like Dana Barone are very upset. Now, she can’t go to the pharmacy she’s been using for more than 40 years.

“It’s part of our community. We know we can count on them. I panicked,” Barone said. “Because it is so convenient. We’re right down over the hill. My parents are here, so it’s convenient for them as well.”

She is one of many patients who now has more limited access to get her medication. She has to travel farther to a different pharmacy, such as Walmart, Sam’s club, Giant Eagle or Rite Aid.

“The tragedy of it is, I, as the owner of the store, I’m also in that network. So I got a letter saying that I can no longer get prescriptions filled at my own pharmacy,” said Kevin Evancic, the owner of Pleasant Hills Apothecary. “That’s how crazy it is that UPMC has carved out and given nobody a choice.”

Patrick Lavella, the president of the Pennsylvania Pharmacists Association and owner of Hilltop Pharmacy in Allentown, said this change impacts hundreds of independent pharmacies plus CVS, Walgreens and Costco’s across the state.

He said they will lose customers and explained why this hurts hundreds of thousands of patients who are being pushed to use primarily big chain pharmacies.

“We know these patients. We know what the issues are. We know what their health problems are,” Lavella said. “Many times, we are the only medical professional that they see multiple times a month.”

UPMC said, “UPMC Health Plan has heard from its members that affordability is key, and we modify our plans when we find opportunities to save costs for our members. The Essential Network has a balance of chain and independent pharmacies while also adding a value and quality component that combines both drug reimbursement and several clinical outcomes measures.”

Lavella said they plan to talk with UPMC about this issue later this month.

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