The New Humana Addendum Exhibit C: I Moved to Independent to Get Away from this Shit!

Well, going through my Monday, which started out like any typical Monday, I begin fulfilling my PIC duties.  Such as reading the new Humana Retail Contract Addendum I received on August 7th.  Yes, I really read these things.  You never know when they are going to stick two sentences in these "addendums" (I call them "Audit Set-Ups") that will result in your pharmacy losing thousands at an audit.  And being an Independent store, I no longer have the legal eagles at the chains to keep me informed of these assinine little changes...I do miss that aspect of working for a chain.

Have any of you have read the addendum?  Specifically, Attachment 1, Exhibit C????  I suggest  you review it.  My blood pressure shot up about a gazillion points when I did.  As a matter of fact, I haven't even finished reading.  That's how high my BP is right now.  I'm about to hyperventilate.  I left the chains to get away from metric bullshit like this.  One of the main reasons I left.  Other than an older gentleman pharmacist getting harrassed by the Zoot Suits (my name for the Security Suits) for having his water back in the pharmacy without stickers on all of the bottles (the man did go through the bottled water).  The man has the keys to the narcotic cabinet, but they are apparently worried he is going to steal a case of water.  Gah!

They regularly harrassed me, but whatever.  Never made much difference, and I'd come right back at them if I felt justified.  Petty, stupid stuff.  And when my stores performed, as they always did, harrasment tapered off and I was left alone to be successful, the way it should be done (from 10% to 20% profitability increase, within six months at the helm - at five different employers, by the way, kinda a pattern for me - is hard to argue with, even when it isn't done the "corporate way").  And regardless of whether or not they are trying to coerce someone to quit, that kind of game was not allowed in my store - DO NOT MESS WITH MY STAFF - employers or impatient patients, back off!  Just man up and fire him....ah, but there's the rub.  If that happens, they have to pay a severence package.  And I called the Zoot Suit on it and pissed him off.  But they started finally leaving him alone...at my store, anyway.  And for those who might care, he eventually did bow down to the pressure.  They quit putting him at my store where I could stick up for him.

But, I digress (yes, that is my favorite phrase).

Back to the addendum...

Humana is introducing "Participating Pharmacy Service Standards."  Maybe it's been in the contracts for a while, and my being a lazy corporate RPh, didn't realize it.  But here it is. 

They are now telling me how quickly they expect me to fill prescriptions.  WTF???  I quote:  "If the prescription cannot be filled within twenty (20) minutes, the Member must be informed when the prescription will be available."

It takes at least 20 minutes for the electronically prescribed Rx to arrive in my computer system.  Being in a small town, even when the clinic informs patients it will be 45 minutes before the pharmacy will have their rx ready, they still show up over here in 10 minutes or less.  In bigger cities, the electronic script services may save time, but here, they could individually walk the rxs over faster.  I hate e-scripts, by the way.  Errors, and expense.  Again, I digress...

And here's this one -

"Participating Pharmacies' personnel shall not make any negative comments with regard to an individual's insurance company, prescription drug benefit, physician, or other persons associated with providing the individual's health care."

I'm sorry, when they are in here complaining about mail order, and I'm GIVING them medication to tide them over, I'm not gonna keep my mouth shut about temperature extremes not being good for medication, missing doses not being good for the patient, etc.  Sorry.  I guess I'll have to refine how I present the information...but wait, that would be playing their game.  Hmm...quandry...

Of course, on a normal day, my Rxs are ready in minutes.  Which is one reason people stay here.  But there are days, and certain times of each day, where things take longer.  Who are you to dictate best practices to me?  I can bet I have been in this industry longer than the people who came up with this crap.

They are also dictating the length of time it will take to order a drug for stock.  One business day. 

That's not the issue...here comes the issue, and I take exception to the wording:

"...the prescription will be transferred to another Participating Pharmacy that is able to timely dispense the medication as required."

They are also requiring the pharmacy to provide a 48 to 72 hour supply of medication, apparently at their own expense, in the event the eligibility of the indivudual or the coverage of the product cannot be obtained..."subject to Pharmacist's professional judgement."  Nice caveat there, thanks.

They are now requiring access to an on-call Pharmacist telephone support 24 hours per day, 7 days a week, with the pharmacist to return calls within 30 minutes of notification!!!!!  I am the only pharmacist in an extremely rural area, the only pharmacist for 35 miles in one direction, and over 50 in the other.  Am I to be on-call for my entire life?  Oh, hell no.  Might be different if I had a partner here, but I don't.  And to deny their patient members access to a quality pharmacy simply because they cannot comply with this measure is illegal at best.

They require the pharmacy to report any serious adverse event to the FDA or the pharmaceutical manufacturer within 24 hours of patient report or notification.

I am also now required to have a back-order monitoring system that can track and provide ADVANCE NOTIFICATION for potential stock shortages or outages for products.  Um, much of the time, the only "advance notice" I receive is not getting it in the order. 

We then must also be able to provide a report containing a list of all impacted drugs, at the NDC level, the manufacturer's distribution status and the manufacturer's target release date.  We must also have an inventory system to track its daily on-hand product balance. 

This type of addendum is yet another tool to chip away at the independent drug stores' ability to provide services to its community, and to direct business to their mail-order companies.  This is such a huge conflict of interest issue.  I do not know how they can get away with this, except that WE SIGN IT AND TAKE IT.

I am going to appeal the on-call portion.  I thought I had a rural contract, and perhaps I do.  But even in smaller non-rural areas, this provision will kill a pharmacy, even a chain store.  Wouldn't you rather your members have access to 40 hours of care, rather than none at all?

How did we allow this to get this far?

I don't so much have an issue with any of these policies (ok, I have a MAJOR issue with the on-call crap).  My policies are as strict or stricter (and I can't remember a month when I didn't come up to the store after hours, sometimes several times, with no requirement).  My issue is for an insurance company being allowed to dictate to me how to run my business.  I am (was?) an autonomous professional, with awesome, mad, business skills in addition to my pharmacy knowledge.  On a level playing field, capitalism works.  On a level playing field.  The people will chose what is right for their lives and lifestyle, and if the competition doesn't keep up, their businesses will suffer.  On a level playing field. 

But the deck is stacked against the independent retail pharmacy.  Has been for some time, and the stack just gets taller and taller.  The playing field is broken, rough, un-navigable ground.  I hate legislation, but I see no alternative.

GIVE ME THE SAME RULES AND OPPORTUNITY, AND I WILL SUCEED OVER YOUR MAIL-ORDER, CHAIN-STORE FACTORIES EACH AND EVERY TIME, WITHOUT FAIL.

We've done it with the odds being stacked against us, so they damn well know we can do it, which is why they stack the deck. 

Question is, when are we going to level the playing field?  How are we going to level it?  We must take a hard, hard look at these two questions, and implement the answers soon, or pharmacy, even as we unfortuanetly know it today, will disappear forever.

And that, my friends, makes me sad and tired.  As a child, there was nothing great about being sick, except missing school and the visit to the pharmacist, who always made me feel special, and gave me a sucker.  I eventually went to work for this man, and he set me on my current path.  I aspired to be him, only to find a totally different world of pharmacy awaiting by the time I graduated.  I've been sad, sad to my core, since I graduated from pharmacy school.  It's been a long career.  Something must change soon.  But I feel as if I won't last to see that change, because as soon as the opportunity presents itself, I will soon be in a position to escape.

Thanks for listening.

Have any of you seen this addendum?  How do you plan to manage? Any ideas on how to take this raging bull by the horns and turn our profession around?

I'd love to hear some ideas!

    -- T.Ph.RPh.

P.S.  There's more!  I forgot I marked some other important issues in this addendum.  This is an important addendum, and I am worried that many independents, especially those in buying groups or that participate in contract plans will miss these important additions/changes.

For those owned by Boards, or multiple partners:


All managers, officers, and directors responsible for the administration or delivery of Part D benefits are now required "to sign an conflict of interest statemnet, attestation, or certification at the time of hire and annually thereafter certifying that the manager, officer, or director is free from any conflict of interest in administering or delivering Medicare Part D benefits or services, and adopt and follow a code of conduct particular to its organization that reflects a commitment to detercting, correcting, and preventing fraud, waste, and abuse in the administration or delivery of Medicare Part D benefits."  This would include Board members and managing officers if the pharmacy is not owned by an individual pharmacist, and would also include any managers they may have hired, along with high level staff.

This one is important to me, as we serve a very wide, rural area, and were about to branch out into a nearby (i.e. almost 30 miles away) town with no pharmacy for 30+ miles in any direction, plus we mail to some of our elderly who live in the country, especially in the wintertime, as they have a hard time making into town on the ice:

Home Delivery does not include mail order delivery through the USPS, FedEx, or UPS, or other mail service carrier.  Mail order is strictly prohibited under this Agreement.  Provider agrees that neither Humana nor Member shall be charged any additional fees or delivery charges for Home Delivery.  Provider agrees that Home Delivery greater than 30% of total prescriptions to Members is prohibited.
Oh, but it's ok for them to not only mail things, but to have a huge mail-order business, and then prohibit anyone else from using the mail.

Here's something that is exactly backwards from what I was taught in Pharmacy Law:

In the event of a conflict between federal and state law, the parties agree that federal law shall govern in terms of Medicare lines of business and for Members who are beneficiaries in employer sponsered emplyee welfare benefit plans.

I was taught that the stricter of two laws was the law to apply.  This states otherwise.  I can understand, partly, the Medicare, as it is a federal program, but the employer sponsered employee welfare benefit plans?  Is the welfare system not state-run?  Or am I missing something here?

THIS IS AN IMPORTANT ADDENDUM.  PLEASE DO NOT OVERLOOK THIS!