Insurers Are Rattled Going into 2014—What Will Be the Impact on Retail Pharmacy?

December 2013, Vol 1, No 2 - Inside Healthcare
Charles E Collins, Jr, MS, MBA

In our inaugural issue, I talked about our US healthcare delivery system bracing for a sea change in 2014. Well, it turns out my column for this issue will be no different, except that more changes have now been implemented as a result of the rocky rollout of the Affordable Care Act (ACA).

As reported by the Wall Street Journal, there have been a string of 7 deadlines that have shifted since the infamous October 1, 2013, start date, all in the attempt to “jump-start” a law that no one was truly ready to implement to the fullest extent in the first place. From the insurers’ perspective, what’s the real impact of the false starts, restarts, canceled policies, reinstated policies, new federal healthcare exchange options, private exchange options, and now the offering of “catastrophic” plans, as well as numerous deadline tweaks for signing up for coverage?

Sadly, it is the need to decipher the old coverage, the new coverage, or the old-new coverage, as well as the need for validation, verification, member attrition, member retention, and processing enrollments before all of the deadlines really hit. Not to mention the fact that the foundational rock of the individual mandate, the one that requires most Americans to carry health insurance or pay a penalty, may begin to crumble. We won’t even discuss the Medicaid expansion, which is expected to initially outpace the federal exchange enrollment by 9 million versus 7 million in 2014, according to the Congressional Budget Office.

That’s how the insurance world has been rattled by the ever-changing “tweaks” to the ACA. But what’s the impact on the world of retail pharmacy? After attending a few recent industry meetings, the outlook for the pharmacy industry will be a direct result of the chaos that has been created for the insurance industry. For retail pharmacists, it is rather normal for the first 2 weeks of January of any year to have to deal with changes in insurance for many of their customers—especially Medicare recipients, who have always had the option of choosing a new drug prescription benefit plan on an annual basis.

The sea change is about to hit retail pharmacists, and it will hit hard. After several discussions with the heads of corporate retail chains, it has become unmistakably clear that this will not be the normal 2-week process to get customers converted to their new prescription benefit plans but, instead, it will more likely be a 4-month process. Given the insurance industry changes that must be dealt with coupled with the fact that individuals still have until March 31 to get health insurance for 2014, our healthcare delivery system has created the perfect storm of absolute chaos.

Besides the normal process of telling customers how their insurance plans have changed, a more prominent specter will continue to emerge that will most likely change how the pharmacist will need to “come out from behind the counter.” I am referring to the meteoric rise in high-deductible health plans, which even the federal exchange offerings could not escape. Gone are the days when you, as a retail pharmacist, would tell your customers that they owed a $10, $15, or $25 copay or even a 25% coinsurance on their prescriptions. What you will now find yourself saying more often than not will be along the lines of “that will be $132 or $254 because you have not met your deductible.”

So brace yourselves and your team, because the next 4 months—and perhaps beyond—will be filled with unpleasant conversations as we all prepare to navigate the turbulent waters of the implementation of the ACA.

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Last modified: January 15, 2014
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