MANAGED CARE Critics rap closed prescription network BY STEVEN STYCOS

For another year, Blue Cross & Blue Shield of Rhode Island and CVS, the Woonsocket-based drug store giant, have successfully prevented Walgreens, Shaw’s Supermarkets, and Stop & Shop from becoming major players in the prescription drug business.

Two "pharmacy choice" bills, which would require health insurance plans to allow prescriptions to be filled at any pharmacy, passed the House only to die without a hearing in the Senate. Blue Cross and CVS each spent more than $7000 a month to defeat these and other bills, according to lobbyist disclosure forms. Pharmacy choice backers also lost a major battle in June, when US District Judge Ernest Torres rejected Stop & Shop’s and Walgreens’ claim that the current Blue Cross network violates anti-trust law.

Pharmacy choice advocates vow to try again next year at the State House. Meanwhile, Walgreens is considering whether to appeal Torres’s decision, according to Michael Polzin, a spokesman for the national drug chain.

Currently, the 54 percent of Rhode Islanders who have Blue Cross insurance must fill their prescriptions at CVS, Brooks, an independent pharmacy, or pay for the drugs themselves. The "network" once contained only CVS and Brooks, but in the mid-’90s, says state Representative Brian Kennedy (D-Hopkinton), the threat of his proposed pharmacy choice legislation pressured Blue Cross to include independent pharmacies, like the East Side Prescription Center in Providence and Phred’s Drug in Cranston.

But state Representative David Laroche (D-Woonsocket), who sponsored the pharmacy choice legislation, says the current law continues to inconvenience people. Senior citizens who live in Woonsocket’s Kennedy Manor, for example, can’t get their prescriptions at the Walgreens across the street, he says. And, adds Grey Panther member Bill McKenna of Cranston, people in his neighborhood cannot pick up prescriptions when they grocery shop at Shaw’s.

"Everyone should have their choice of who they want to use," says Laroche

Advocates say CVS’ opposition to pharmacy choice is hypocritical. In 2001, CVS senior vice president James Smith testified before Congress that a Medicare prescription drug plan should allow pharmacy choice, and CVS is a member of the National Association of Chain Drug Stores, a lobby group that favors pharmacy choice.

But CVS spokesman Todd Andrews says Rhode Island’s small size explains the company’s stance on both sides of the issue. CVS supports pharmacy choice on a national level, Andrews says, because people in rural states need to use their local pharmacies. But in Rhode Island, Andrews says, "where you’re not far from a Brooks, a CVS or an independent pharmacy, [the network] does make sense to lower costs." By funneling policyholders to the 130 CVS, Brooks, and independent pharmacies in the state, says Blue Cross spokesman Scott Fraser, the company can negotiate lower prices and reduce the cost of health insurance. Fraser, however, has no estimate of how much is saved in the process.

The legislature’s only pharmacist, state Senator Leo Blais (R-Coventry), agrees with Blue Cross and CVS. "I don’t see a need for expanding the network if it’s going to increase health-care costs," says Blais, who owns Pawtuxet Valley Prescription and Surgical Center, a member of the existing network.