Using insurance at our pharmacy
Patients at our pharmacy can either use health insurance or pay out of pocket through our Cost Plus self-pay program to cover the cost of their prescriptions. See below for more information about using insurance at our pharmacy and how the industry impacts our work.
Were you impacted by the
ChangeHealthcare ransomware attack?
In the wake of the ransomware attack upon ChangeHealthcare (a subsidiary of UnitedHealth Group (UHG), which owns UnitedHealthcare insurance company) in February of 2024, UHG is offering free credit monitoring and identity theft protections for two years to anyone impacted. Their call center also offers access to clinicians trained to provide emotional support services.
Click here to be led to the ChangeHealthcare Cyberattack Support page
or give them a call at 1 (866) 262-5324
Circa 2015 | Owner and Pharmacist John Hoeschen’s daughter, Ruby, enjoying a malt at our late old-fashioned soda fountain
Is my insurance accepted at
St. Paul Corner Drug?
The only health insurance plan we outright DO NOT accept at our pharmacy is Humana. For all other insurers, please check directly with your plan either by calling the member services number on your insurance card or using their online portal, if they have one. Medicare enrollees can click here for more information about the plans we’re accepting in 2024.
Note that certain insurance plans DO NOT cover the cost of vaccination administration at local pharmacies. These plans will cover the cost of the vaccine itself (i.e., the medicine in the vial or syringe), but do not include an administration fee that is supposed to cover the cost of the time and training of vaccination personnel and the supplies we use. If your insurance plan doesn't cover the administration of vaccinations, we charge an additional administration fee of $35 per patient per visit, which can be paid using cash, a credit or debit card, or check.
Medicare patients!
Like other independent pharmacies across the nation, we’re becoming increasingly limited in our ability to accept Medicare drug coverage at our pharmacy.
Open Enrollment for 2025 plans is happening now through December 7th. For more information, visit our Medicare page, which now features details about the plans we’ll be in-network with in 2025. We also recommend subscribing to our emailed news bulletin, the DOSE, and considering attending our new Medicare 101 class.
The problem with
coupon cards…
Discount or coupon cards for prescription medications that are NOT from the drug’s manufacturer—GoodRx is a common example—can actually make your prescription more expensive (don’t believe us? We’ll show you how). And, even if they do save you money, they often lead to a lower reimbursement for the pharmacy filling your prescription, contributing to the erosion of pharmacy providers in our nation. Additionally, these companies have also been known to sell patients’ private health information for profit. For these reasons, we caution our patients about using them.
Click here to watch a video by our friend and fellow pharmacy advocate, Luke Slindee, about how GoodRx is an example of illegal algorithmic price fixing.
How the insurance industry impacts our work filling your prescriptions
Pharmacies like us that bill and fill prescriptions using patients’ health insurance plans are required to hold contracts with Pharmacy Benefit Managers (PBMs). PBMs are “companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers” (The Commonwealth Fund, 2019). In other words, they serve as the middlemen between providers (us) and payers (insurance companies, federal and state governments, private employers), and are responsible for the automated electronic processing of prescription claims, in addition to:
Creating the "formulary" (list) of covered drugs for payers
Negotiating rebates with drug manufacturers
Creating pharmacy networks
Reviewing drug utilization
Managing mail order and specialty pharmacies
Have you heard of…?
CVS Caremark (owned by CVS Health)
Express Scripts (owned by Cigna)
Humana
MedImpact (affiliated with BCBS, HealthPartners)
OptumRx (owned by UnitedHealthcare)
Prime Therapeutics (affiliated with BCBS)
Above are the names of the primary PBMs operating in today’s American pharmaceutical and insurance industries. It’s more than likely that, if you have health insurance with prescription drug coverage, one of these names is listed somewhere on your insurance card(s). Every single one is a multi-billion dollar company (in some cases, hundreds of billions of dollars).
Unfortunately, while these entities were intended to streamline the prescription filling and billing process and make prescription medications more affordable to patients, they’ve done anything but. Over the decades since their inception in the 1980’s, they’ve grown exorbitantly, along with the ways in which they abuse our nation’s healthcare system and the patients and providers within it. Put simply, PBMs are the reason that independent pharmacies have been and are continuing to struggle to survive. This is due to the both to the fact that they:
Reimburse pharmacies at inappropriately low rates (or not at all) for the cost of dispensing prescription medications and
Retroactively reclaimed monies already paid to pharmacies under the guise of DIR fees on Medicare claims (colloquially known as “clawbacks”) through December 31st, 2024.*
Additionally, they exhibit a number of other ethically questionable or illegal practices, including:
Requiring pharmacies to participate in abusive, one-sided contracts with gag clauses that limit how much information we can disclose to patients
"Patient steering," which refers to the practice of forcing patients to use pharmacies that they own or are affiliated with (e.g., requiring that a patient with a health insurance plan that uses CVS/Caremark as their PBM, to fill their prescriptions at a CVS retail pharmacy)
Forcing patients to take expensive brand-name medications when there is a more affordable generic alternative
Purchasing / merging with health systems and insurance companies
Operating with little to no transparency
*While this practice is now technically illegal, we and other independent pharmacies can promise you that PBMs are still reclaiming funds (i.e., stealing), just in new ways that subvert the law.
If any of the above has happened to you and you’d like to file a complaint with the appropriate entity and/or share your story to contribute to the insurance reform movement, click here.
To learn more about current issues in pharmacy and how you can help,
visit our Advocacy page.
How PBM abuse impacts you
and your community
PBM abuse (an umbrella term referring to the collection of abusive practices mentioned above)
is something that harms everyone in our nation, whether or not you’re healthy or
interacting with the healthcare system.
Patients suffer…
When their prescriptions are unaffordable. When they’re forced to take a certain medication that they can’t afford or isn’t the best fit for them. When they’re forced to fill their prescriptions at a particular pharmacy or use a mail order service when they’d prefer to receive their pharmacy care elsewhere. When their care providers, including physicians and pharmacies, close or stop taking health insurance because they can no longer afford to do so, and therefore become less accessible.
Providers suffer…
When they’re unable to prescribe patients the medications they need because of financial barriers or insurance hurdles. When they’re required to waste precious time dealing with the logistics of interacting with insurance companies. When they can no longer afford to stay open, or must do so without being able to accept health insurance as a form of payment. When the burnout that accumulates from dealing with these challenges makes them leave practice permanently.
Payers suffer…
When they’re overspending on patients’ healthcare costs. When the PBM they’re contracted with keeps most of what they pay out to cover the cost of patients’ pharmacy care for themselves, thereby eroding provider networks.
To make matters worse, every tax-payer in our nation contributes to the funding of Medicaid and Medicare programs, so when these particular payers are being taken advantage of financially, it’s bad for… pretty much everyone.
How you can help
Because PBM abuse impacts all of us, it’s important to make your voice heard!
Educate yourself. The vast majority of Americans don’t even know what a PBM is and, therefore, aren’t aware that this issue is happening. Our Get Educated page features a wealth of growing resources for learning more about PBM abuse. If you have further questions or would like our Nurse to come speak to your community about PBM abuse, please email hildie@stpaulcornerdrug.com.
Talk about it. Once you’re educated on this issue, talk about it with friends, family, coworkers, your healthcare providers… As stated above, it’s likely they don’t know about the widespread, negative impacts of the PBM industry or, even if they do, how they can help positively impact this issue. We’re doing our best to educate patients and patrons where we can, but it takes time, and time is limited and of the essence these days. As a small business with a staff that’s busier than ever, we’re not going to be able to reach everyone. Feel free to forward issues of our news bulletin, the DOSE, to friends and family; send others to our website; or share our social media posts (we’re on Facebook, Instagram, and X (formerly Twitter)) on your own accounts.
Contact your legislative and congressional representatives. Currently, there are a number of bills being debated in the US Congress that, if passed, would directly address the issue of PBM abuse. Independent pharmacies like us NEED at least some of this legislation to pass in order for us to survive even the next few years; unfortunately, a landmark Medicaid Carveout bill that was expected to pass in our home state of Minnesota ended up being removed from the Omnibus Bill just minutes before our legislature’s final vote for this year’s session, so we’re currently depending on a number of federal bills that are up for debate in the US Congress. For more information please visit our Advocacy page, which includes details on bills of interest, who to contact about them, and what to say (we even have sample scripts and templates you can use if you’re low on time or are new to the world of legislative advocacy!).
Spend your money and choose your health plan wisely. Even if you’re not filling prescriptions at your local independent pharmacy, you can still support them financially by purchasing over-the-counter products and accessing other services, such as vaccination. You can also be intentional when selecting your health insurance plan—if you choose a plan because it’s very low-cost, know that it’s likely that plan is not adequately paying the care providers who care for you, including your pharmacy (i.e., if it seems too good to be true, it probably is!).