11/03/2025
From Marty at the Medicine Shoppe
To anyone who uses the Medicine Shoppe St.Clair and has Express scripts insurance/ Wellcare (part-d) I want to share some important news about your prescription insurance coverage. Beginning January 1, 2026, we will no longer be in-network (accepting) 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. Options to stay with us are at the bottom of this letter.
This decision wasn’t made lightly. For years, I’ve worked to be in every insurance network possible, because I 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.
Why? 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.
I will continue doing everything in my power to serve our patients, protect local pharmacy access, and put people ahead of paperwork. For the last 5 years I have gone to the capitol to discuss what PBM’s are doing to my community and try to get PBM reform bills (hb840 & sb45) passed but unfortunately they have bigger pockets then small pharmacies do and were tabled. I have helped the town during Covid, the closing of Health Mart, and in many personal instances for 30+ years but I want to keep my doors open and unfortunately that may mean saying goodbye to many of my favorite customers. To me it is sad I will make a better profit by saying goodbye to customers rather than keeping them but that is where we are at. I don't want to follow the path many pharmacies have succumbed to. If you are a part D patient you do have the option to switch insurance plans this fall, if you are a commercial plan we can look at our cash price option if you are on inexpensive medicine. If you can not switch, I apologize for the inconvenience. We are calling people to let them know of this change but wanted to make a post to reach more people and give them time.
A few notes to help in this transition.
If you are on Medicare Part D: Open Enrollment runs from October 15 to December 7, 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 (United Health Care), 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. Oftentimes, your cash price 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 patients.
Sincerely,
Marty Hinterlong R.Ph. , Medicine Shoppe
Lastly, every April I go to the capitol to fight for my patients. If you have the time to call/email your reps and senators at this time it would greatly help, they need to hear from the people they are affecting. Please contact me if you are interested in doing so.
