11/04/2025
To our patients and friends,
I want to share some important news about your prescription insurance coverage. Beginning January 1, 2026, The Medicine Shoppe in Mt Vernon will no longer be in-network for Express Scripts Medicare Part D or commercial prescription plans. This includes Medicare Part D plans from companies such as Cigna, Centene, Health Spring and WellCare.
This does not affect any Illinois Medicaid or Medicaid Managed Care plans, which we remain fully in network with.
This decision wasn’t made lightly. For years, we’ve worked to be in every insurance network possible, because we know how important it is for you to keep your pharmacy care close to home. However, Express Scripts has offered contract terms that would require us to dispense nearly all prescriptions for less than what it costs us to buy the medicine. This isn’t a case of not making a large enough profit for the pharmacy, it is a case of losing money and putting the pharmacies health at stake. No business can survive selling dollar bills for eighty cents, and a community pharmacy is no exception.
The hard truth is that middlemen known as pharmacy benefit managers (PBMs) like Express Scripts don’t make the drugs or fill prescriptions but they control who gets them, what they cost, and how pharmacies are paid. When their payments fall below our actual cost, we face an impossible choice: accept contracts that put us under water, or step away to keep the pharmacy healthy for the community as a whole.
We will continue doing everything in our power to serve our patients, protect local pharmacy access, and put people ahead of paperwork. We are here, as always, if you have questions or concerns. Call us at 618-242-8776
Sincerely,
Eric Black RPh
A few notes to keep in mind:
📅 If you are on Medicare Part D: Open Enrollment runs from October 15th to December 7th, 2025. Now is the time to review your coverage and, if needed, choose a plan that keeps us in-network so you can continue filling prescriptions with us. Contact us and we would be happy to consult with you on options. Express Scripts managed Part D plans are not the only option. Others include AARP, Humana, and SilverScript/Aetna.
💊 If you take inexpensive generic medications: In many cases, we can continue to serve you on a simple, affordable cash basis.
💊In fact, we offer 6 and 12 month supplies for 100's of different generic drugs that for most people will save them $$$. Oftentimes, these prices could be lower than your copay. Please ask our pharmacy staff if this option works for you.
🏢 If you are covered under a commercial insurance plan managed by Express Scripts: Please speak with your HR department or employer about the impact of these contracts, and encourage them to consider other PBM or plan options that allow you to continue using your local independent pharmacy. If they are willing, we would appreciate the opportunity to discuss better options for their business and employees.
