Phoenixville Pharmacists Headed to Harrisburg

It’s buzzing on Tuesday morning, with customers popping in to fill prescriptions, chat with pharmacists and browse through the aisles. Along with prescriptions and advice, Gateway Pharmacy in Phoenixville is passing something else across the pharmacy counter.

The community pharmacy is asking customers to add signatures to a petition that supports two bills, one in the senate and one in the house, that would outlaw mandated mail-order prescriptions. The response to the petition has been good, and Mark Szilagyi, who’s owned the pharmacy since 1982, said approximately 100 people signed by Tuesday morning, and petition has been available since Monday.

“They jump right on it,” Szilagyi said. “I had a guy this morning, came in at 8 o’clock, and he signed it right away because one of his medications was required to be filled through mail order.”

The bills, House Bill 511 and Senate Bill 201, in part would prevent insurance companies from mandating that patients use mail-order services through pharmacy benefits managers (PBMs).

Years ago, insurance companies hired PBMs to take care of the prescription plan portion of health insurance. The PBMs created mail-order prescription services, giving patients the option of using either those or community pharmacies.

Then, PBMs began offering financial incentives for patients to use mail-order services. When some patients continued to choose community pharmacies for their prescription needs, insurance companies moved to mandate mail-order use through the prescription plans, Szilagyi, who sits on the Pennsylvania Pharmacists Association (PPA) legislative committee, explained.

The two bills mentioned above would prohibit those mandates and any financial incentives. That, as Szilagyi noted, would help level the playing field. The bills are supported by the PPA, and next Tuesday, six Gateway Pharmacy representatives will head to Harrisburg to talk to local a local representative and possibly a local senator. In addition, they’ll attend a rally in support of the bills.

Szilagyi said 500 to 1,000 attendees may show up at the rally, and some pharmacy schools may send students. One pharmacy in Boyertown is shutting down completely for the day, Szilagyi said, and sending all of its employees to the support the bills in Harrisburg.

While the argument for mandated mail-order service is cost savings, Szilagyi noted that the system often leads to waste. There’s an incentive for ordering 90-day supplies of medicines, and if a treatment plan changes, those go to waste.

Szilagyi’s daughter Jenn works as a pharmacist at Gateway and said the pharmacy has a take-back program for prescription drugs.

“Probably half the prescriptions that we take back are things that they filled through mail order because they don’t need them anymore,” Jenn Szilagyi said.

Other concerns with mail-order drugs include exposure to extreme temperatures or delays in delivery. Mark Szilagyi sees customers coming in and requesting three or four days’ worth of pills to tide them over until the mail-order drugs arrive. The pharmacy can help them with that, he said, but he expressed concern that others might not reach out for help.

“For every person that comes in here, five or six don’t,” Mark Szilagyi said. “They go without.”

He pointed to another issue if mail-order mandates become commonplace: jobs. Since some companies started mandating mail-order use, Mark Szilagyi said he hasn’t hired one person. The pharmacy is a big employer in the borough, and through the years, Mark Szilagyi said he’s had employees who started out taking out trash go through pharmacy school to serve as pharmacists.

“Allow the person to choose,” Mark Szilagyi said. “We would definitely be busier. More independent pharmacies would be busier. I’d be hiring more people. We’d be doing more business. We’d be paying more taxes, and it would be in Pennsylvania.”

He noted that many of the mail-order companies are outside of the state, and one large company handling mail-order prescriptions just moved out of Pennsylvania.

Pennsylvania is not alone in looking into legislation banning mail-order mandates. The New York Times recently reported on a similar effort in New York state, and community pharmacists there rallied in support of the bills.

At the Gateway counter, there’s little hesitation when customers are asked to sign the petition, Jenn Szilagyi explained.

“They love the Gateway, so they’re definitely willing to sign a piece of paper just to do a little something,” Jenn Szilagyi said.