NAVARRE, Fla. (WEAR) — Pharmacist John Sloan has a story that, as a father, really sticks with him.
On January 26th, Sloan said a man walked into Rx Express Pharmacy in Navarre, just as they were closing. The man was looking for Tamiflu because he had a sick daughter at home.
"She was about five or six years old," Sloan said. "The man had come into the pharmacy as a last resort, after trying other pharmacies. He ran into another issue at Rx Express."
The man was insured through Humana. Humana's network extends to the big box store pharmacies, but not to independents like Rx Express.
"Four other pharmacies in town in the network didn't have it, and we had the dosage," Sloan said, expressing his frustration.
Sloan said the pharmacy and the father contacted Humana, but couldn't clear coverage for the medicine. Without the insurance, the generic for Tamiflu would've cost the man about $150. He walked out of the store without it.
"The parent didn't have the ability to pay," Sloan said. "It's a situation where you have someone in the highest risk group from the flu, a young child not able to get treatment."
Sloan said Tamiflu needs to be taken within 48 hours of getting the virus. He hasn't heard from the father and wonders how the little girl is doing.
State Senator Doug Broxson looked into the matter. Going through the Agency For Health Care Administration (AHCA), Broxson said it was a mistake on the part of Humana.
Because none of the other pharmacies in Humana's network had the medicine, Humana was supposed to make an exception.
"Whoever they spoke with at Humana was giving the wrong information," Broxson said. "It's a big network, mistakes happen. And I'll tell you [AHCA] is tracking that down to see what happened and make sure it's not repeated."
Broxson said the case is an example of a bigger problem caused by Humana, when it dropped independent pharmacies from their networks more than a year ago.
In August, the state's other Medicaid insurance provider, Molina, made plans to drop small pharmacies from their network but decided to make an exception for Northwest Florida because it would have a negative impact on prescription access of people in rural areas.
"Molina is doing something much different here than the rest of the state," Broxson explained.
Pharmacies like Rx Express thought Humana would follow suit but never did.
Broxson said AHCA is in talks with providers. They are hoping to start a pilot program that would address the concerns of independent pharmacies and their customers.
"It would be for Escambia, Santa Rosa, and Okaloosa County and Walton," Broxson said. "We probably have one of the most rural areas when you consider Milton, Jay, Century and Crestview. In some of those areas, people have to go 30 to 40 miles to get to a box store where some of the networks are set up."
The specifics aren't quite available on the pilot program, but Broxson explained they were, "asking them to look at independent pharmacy programs to make sure people will have immediate access to their medicines."
We contacted Humana. A company spokesperson said they were unaware of the pilot program.
He also said the following, regarding the story of the father who could not get Tamiflu for his daughter:
"We cannot discuss or comment on individual members' health conditions or history due to federal patient privacy and confidentiality laws. If you'll provide us with the name, address and phone number of the member in question, we'll be happy to research the matter and provide the member with a full update."
Michael Jackson with the Florida Pharmacy Association said they constantly reach out to state lawmakers, hoping to make them understand what is happening to small businesses and how the benefit plans are hurting small business owners and their customers.
Jackson said belonging to one health network may not be enough to keep some pharmacies in business for the long run.
"In an ideal world there would be equal patients enrolled in each health plan but that is not how the health market works," Jackson explained. "If most of my patients that come to my pharmacy are in one plan and that plan decides to exclude me from their network then yes, my business will be harmed considerably."
In August, then State Senator Greg Evers told WEAR that a third party provider maybe an issue worth exploring, but Jackson isn't sure that will solve the larger issue.
"Unless the policy that allows these plans to discriminate against pharmacies are addressed the problem will never be solved," Jackson said in a statement to WEAR.