Independent community pharmacies face tough competition and setbacks every day. But what happens when you take a stand? Can one person really make a difference?
One business-savvy pharmacy owner did.
When Mary Jasinski Caldwell, owner, vice president and general manager of City Pharmacy of Elkton, an independent community pharmacy located in Elkton, Md., discovered that her pharmacy would no longer be in-network for her patients enrolled in Maryland’s Medicaid program through United Healthcare, she took initiative and stood up for her business.
Jasinski Caldwell talked with us about how she became an activist, and why it’s important to speak up for your patients and your independent community pharmacy.
How did you find out about United Healthcare’s plan change?
One of my customers came in at the beginning of March and told me she had received a letter stating she would no longer be able to come to my store after April 1. I looked at the letter and it did indeed say that City Pharmacy would no longer be in the plan’s network of pharmacies. The letter suggested she use K-Mart®, and it also named another independent that had just opened in the area.
Why did you decide to challenge the plan’s change?
I questioned the legality of the plan’s change. Contractually, I was supposed to have 60 days’ notice if there were to be a change in contract.
What’s the first step you took to challenge this change?
I immediately got on the phone and called my third party contracting provider, and they knew nothing about it. So, then I called the state of Maryland. The state of Maryland Medicaid program also informed me that they weren’t seeing any changes, so I then called OptumRx. After making numerous phone calls, I still wasn’t getting any answers.
When did you finally get a clear answer of what was happening?
After calling OptumRx, I was told that, yes, indeed, my pharmacy would no longer be included as a part of United Healthcare’s network.
How did you take initiative to fight this change?
I called everyone at the state level that I could think of. I called my patients. I sent out letters. I put information on social media urging patients to contact both the state and OptumRx. Because of everything I had put out to the public, the local newspaper contacted me and launched a full-blown story. A lot of people were upset, not only because they couldn’t come to my pharmacy, but there were other independents in the area that were going to be affected by this, too. I was then contacted by my state senator and state delegate, and I was asked ifI would be interested in attending and speaking at a session with the Eastern Shore Contingency, United Healthcare and the state regarding this issue.
Did advocating for your pharmacy work out for you?
After speaking at the contingency, I received a phone call from OptumRx. They told me I would need to fill out some paperwork and I would once again be one of their providers. My patients were very grateful. Many of them have come in here for years. They have a relationship with us, and they didn’t want to have to switch. I’m glad I was able to keep my patients here.
What made you decide to take initiative and be an advocate?
I’ve been an advocate for many years. I call myself a “pharmacy brat” because I’ve been involved in retail pharmacy ever since I can remember. I saw things back in the late 80s that gave me pause. I saw control of the business side of retail pharmacy starting to slip away, so I started getting involved at that point.
Why is it important for those in independent pharmacy to take on an advocacy role?
It’s the only way that we are going to see a change. And it’s the only way we are going to affect any change because no one knows our businesses and our circumstances better than we do. We cannot ring our hands and complain. We have to be active, and there’s no one better than us to stand up for us.
What advocacy advice do you have for independent pharmacy owners?
You have to understand the issues. You have to be able to inform your customers about how this is going to affect them. Get to know your elected officials; they can be such an ally. Independents should also know and understand their state laws in regards to pharmacy benefit managers (PBMs), audits and everything of that nature. If you know the law, you can use that as a shield.
Mary Jasinski Caldwell is the owner, vice president and general manager of City Pharmacy of Elkton, an independent community pharmacy located in Elkton, Md. She graduated from Loyola University Maryland and Goldey-Beacom College with degrees in Business Administration and Accounting. She’s also a registered certified pharmacy technician (RCPhT).
