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Chain Drug Stores: Major Force in Enrolling Uninsured?

By John Reichard, CQ HealthBeat Editor

July 25, 2013 -- CVS Caremark plans to roll out a program at its 7,400 retail drug stores and 6,500 clinics to educate customers about coverage opportunities under the health care overhaul law.

The program includes trying to have "Navigator" organizations set up on site to give people individualized help in learning about the law, their coverage options, and the costs involved.

Walgreens has already announced plans for an educational program at its 8,000 stores that includes distributing information brochures and setting up a website in coordination with Blue Cross Blue Shield plans.

Depending on how robust the efforts of these chains are, it's potentially an important channel for the Obama administration to reach uninsured Americans who may qualify to obtain coverage at little or no cost or for sizeable subsidies to sharply lower their premium costs.

CVS Caremark, for example, has stores in 42 states. It says they serve five million people per day, and that 75 percent of Americans live within three miles of a CVS pharmacy.

But polling shows that there's a huge lack of understanding of the law and what it offers, which creates a big education challenge.

A new CVS Caremark survey suggests awareness of the law is growing, but that knowledge is still very limited. It found that 74 percent of the public has some awareness of the overhaul, up from 57 percent in 2011.

But the poll also revealed that 36 percent of respondents who are likely to enroll in health exchanges need help in understanding how the new marketplaces work. Many of those with the least understanding fall into the 18 to 35 age group. Those with the most questions also include Hispanics who are "newer to the country," the company said. The Obama administration and insurers are already engaged in a massive campaign to reach the Latino community.

The survey found that many people don't realize they can get tax credits that would lower their premiums. "Only 48 percent of those who are eligible for a subsidy believe that they are," CVS Caremark said in a news release. "We have a tremendous opportunity to help Americans understand the new health care law and how it affects them so consumers receive the coverage that best fits their families," said Helena Foulkes, the company's executive vice president.

More Than The Chains?

How broad based the effort by pharmacies will be to help with enrollment is unclear.

How willing, for example, will the owners of individual pharmacies be to cooperate with the health law (PL 111-148, PL 111-152)? Kevin Schweers, a spokesman for the National Community Pharmacists Association, said "it will be an owner by owner decision," he said. Pharmacists may get more heavily involved after exchanges open and customers have questions about whether their stores fill prescriptions covered by plans offered in exchanges, he said. They will try to help individuals who have problems getting their prescriptions covered, he predicted.

In general, chains might be more heavily involved. The National Association of Chain Drug Stores has named "implementation of health care reform as one of the top priorities for the association," spokeswoman Chrissy Kopple said in an email message. Opinion polling shows that pharmacies "are among the most highly trusted sources of health information," she said. "These actions may range from distribution of information at pharmacies to more formal roles in patient education. "

Foulkes said in an interview that the chain serves many uninsured customers who could benefit from knowing more about the health law.

"If you look at the 50 million Americans who did not have health insurance, last year 55 percent of them filled a prescription," she said. "When people fill a prescription at any one of our stores and don't have insurance, it's pretty clear to us that they don't have insurance because they just pay cash. We see a real opportunity to find these people as they are filling their prescriptions and educate them.

"We hope we can help them get to the right plan if that's what they're interested in," she added. "I think the most impactful thing that we can do is provide brochures and material in all of our stores to help people."

The chain also plans "retail events" in some of its outlets. "This fall we have about 375 stores that are in low-income communities where we think we can be very helpful" as part of a eight-year-old program called Project Health that does screenings to help people find out if they have diabetes or high cholesterol or some other health issue.

"Eighty-six percent of the people who have participated are African American or Hispanic, and 45 percent of the people do not have insurance," she said. "Our thought is to continue to have that screening program and add on to it a component where they can also learn more about the Affordable Care Act and their options on the exchanges." Those screenings will largely be in states with big uninsured populations, such as Florida, Texas, Georgia, California, and New York.

"Our goal is to make all our stores available to navigators," Foulkes added. "We're hopeful that many of them will take advantage of that."

The health law is a significant business opportunity for drug store chains, says Paul Heldman, an analyst with the Potomac Research investment firm. Heldman said in an interview that as insurance coverage grows so does the number of people going to pharmacies to get their prescriptions filled. Chains like CVS Caremark also have primary care clinics that would be used more heavily as coverage increases, he added.

One issue that could affect pharmacy involvement is the divisive nature of the health care law. Senate Republican leaders recently leaned on the National Football League not to become involved, with apparent success, raising the question whether they will apply similar pressure on other businesses.

"I wouldn't rule it out," said Heldman. But he also drew a distinction between the NFL and health companies. For health-related businesses, the health law represents an opportunity to grow revenues and Republican leaders may recognize that, he said. And if they do apply pressure anyway, there's a greater chance health businesses will resist it, he said.

"The NFL's business does not depend on whether they get people covered," Heldman said. But that's not the case with health companies, he added. "They have to run a business. It's like in Casablanca where Rick says 'your business is politics, mine is running a saloon," Heldman joked.

For her part, Foulkes of CVS Caremark said she has gotten no resistance from Republicans for the planned outreach effort. "Not at all," she said. "I think as a health care company it's very different than being the NFL. It's a very natural role for pharmacists. And it's very similar to 2006 when the Medicare prescription drug benefits was rolled out. "Our pharmacists were really critical in terms of helping seniors" enroll in Part D plans. "So we have history doing it. It's in our DNA. It's I think something customers would expect from us. So I don't think it's viewed as a political issue."

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