Sean and Shannon Parsons operate Lost and Found Pharmacy in Penn Hills, a faith-based, not-for-profit retailer that welcomes nearly all insurance plans.
But the feeling is not entirely mutual.
Mr. Parsons says he got a jolt earlier this month when he learned that UPMC Health Plan’s 2018 Medicare Advantage offerings has excluded Lost and Found from its preferred pharmacy network, which followed a similar non-preferred designation by Highmark when the shop opened in June 2016.
That means that while Lost and Found (the name is in reference to lyrics in the hymn, “Amazing Grace”) is still in network for both major insurers, it cannot offer the same zero-copayment deal that customers get at a preferred pharmacy.
With co-payments typically running $5 to $9 for many generic drugs, Mr. Parson fears that’s enough of a difference for seniors buying multiple medications on a fixed income to consider changing pharmacies.
UPMC for Life sales represent 18 percent of the pharmacy’s prescription sales, he said. Losing that, he added, “potentially puts the business in danger.” Just under 30 percent of the medications they dispense are for people who don’t have insurance.
Independent pharmacies have increasingly found themselves in non-preferred categories or even out of network as a means for insurers to hold down drug costs.
The Lost and Found owners believe their charitable work and community involvement should make them an exception. They are in a preferred network for Aetna and SilverScript Medicare plans.
Last year, Mr. Parsons, a pharmacy technician, and Ms. Parsons, the full-time pharmacist, converted the Forward Center strip mall space formerly held by the Penn Hills Kitchen Center into a combined pharmacy/general store/soda fountain business that also hosts Bible study and knitting groups.
“We felt compelled” to offer a family-friendly place for neighbors to gather, Mr. Parsons said. “That’s one of those things that had been lost and we wanted to bring it back.”
The place has collected some fans.
“It’s like a small-town neighborhood pharmacy. You go in there and they recognize you,” said retired bookkeeper Donna Newton of Penn Hills.
But it’s more than just a friendly place to visit, she said. After her husband, Wally, was diagnosed with Alzheimer’s, she said he needed B12 injections three times a week for nine weeks.
Ms. Parsons offered to show Ms. Newton, 71, how to give the shots so they would not have to pay for a doctor’s office visit. When she noticed Ms. Newton’s hand tremors, Ms. Parsons arranged to have a nurse volunteer come in to administer the shots “and there was no charge,” Ms. Newton said. “They’re just wonderful, helpful people.”
Joseph O’Leath, 67, also of Penn Hills says someone at UPMC steered him to Lost and Found Pharmacy when the cost of his insulin medications kept going up.
The Parsons offer a $100 discount whenever Medicare beneficiaries hits the “donut hole” prescription drug gap when coverage is temporarily limited after spending a specified amount ($3,700 for 2017), then resumes as catastrophic coverage for the remainder of the year after those costs reach an outer limit ($4,950 for this year).
“That was a big deal for me. It helped me like you cannot believe,” the retired bank courier said.
While the $1 ice cream scoops, Christian book sales and board games bring people in, Mr. Parsons said the pharmacy sales generate 90 percent of Lost and Found’s annual revenue.
He’s appealing to UPMC and its pharmacy benefit manager Express Scripts to reconsider and include Lost and Found in its preferred pharmacy list.
Otherwise, he said, “It’s going to be a hard sell to tell customers, ‘Hey, I know you can get this drug cheaper somewhere else, but why don’t you come here anyway?’”
Steve Twedt: stwedt@post-gazette.com or 412-263-1963.
First Published: October 30, 2017, 10:45 a.m.
