Is it just me, or is my employer being really messed up?

[Capp]

I find myself really irritated with this recent decision by my employer, and I was curious what other people thought of it. Am I being unreasonable? Or is this messed up?

I work for one of the major health systems* in my area, and us employees are forced into health insurance plans that penalize us for using services outside of the system. They recently made a new rule that employees of the system are no longer allowed to use the outpatient pharmacy at the hospital. Apparently there is a clinic somewhere in a less convenient location that has much more restrictive hours that we are allowed to use.

I work night shift and the hospital pharmacy is the only 24 hour pharmacy, so I will have to forgo sleep if I ever want to pick up a prescription. Alternatively, there may be a 24 hour Rite Aide or something out there, but even if there is the cost will be much higher since it is out-of-system.

Also, apparently my family is also now banned from the hospital pharmacy. My wife was heading from her doctor's office to the hospital to pick up a prescription and they called her while she was en route and basically said, "So where do you want us to send this prescription that just came in, 'cause you're not welcome here anymore."

They didn't give much of a rationale for the change, but seemed to be suggesting that the goal was to reduce wait times. I guess if you deny services to a group of people than your wait times will improve, but it seems to me the same rationale would work equally well to justify discrimination against any group. I think in a way, it would sort of be less unethical for them to deny services to any other random group since we are the one group of people who are forced into insurance plans that penalize us for using out-of-system services.

So, am I being unreasonable?

*I didn't mention the employer by name in case it is against some policy here on Allnurses.

[Katillac, RN]

All insurance plans I know of have In Network and Out of Network benefit levels and so called narrow networks are becoming more and more popular to keep costs down for employers. To look at it another way, it means they can offer lower cost plans to employees, too. I've never heard of a plan that allows its members only one choice of pharmacy, are you sure you understand this correctly? If a change like this one took place, you would have needed to be notified in writing of what's called a material modification.

While I can see that it was convenient to use the hospital pharmacy, the designation of pharmacies included in your network is up to the administrator of your plan. It's understandable that employees using the inpatient pharmacy may have meant longer wait times for patients being discharged, which the hospital addressed by reducing the number of customers. Without knowing the actual locations and hours of the new choices of pharmacies, it's hard to even give an opinion on whether it's "really messed up" or unreasonable.

[Crush]

All insurance plans I know of have In Network and Out of Network benefit levels and so called narrow networks are becoming more and more popular to keep costs down for employers. To look at it another way, it means they can offer lower cost plans to employees, too. I've never heard of a plan that allows its members only one choice of pharmacy, are you sure you understand this correctly? If a change like this one took place, you would have needed to be notified in writing of what's called a material modification.

While I can see that it was convenient to use the hospital pharmacy, the designation of pharmacies included in your network is up to the administrator of your plan. It's understandable that employees using the inpatient pharmacy may have meant longer wait times for patients being discharged, which the hospital addressed by reducing the number of customers. Without knowing the actual locations and hours of the new choices of pharmacies, it's hard to even give an opinion on whether it's "really messed up" or unreasonable.

I know my facility has a very narrow network but if we do want to go out of network, we pay a little more for those services. For example, if the co- pay in network is $10 then out of network for same service $25. Most places I have worked have similar plans. The physician I see used to be in network but this year is no longer in network but I choose to keep my doctor and willingly will pay a little more. Plus I can literally walk or just ride my bike to his office.

[Capp]

Thanks for the reply.

I'm not sure where from my post you got the impression that we are only are allowed to use one pharmacy; sorry if I was somehow unclear about that. We can use any pharmacy we want, but the cost is higher for in-network rather than out-of-network and is higher for in-network rather than in-system. So even if you are going somewhere that is in-network it will cost more if it is outside of the system. There are no pharmacies in-system that are open during the hours that night shift employees are awake, so we basically have to forgo sleep or pay more.

The recent change that I was talking about was not the fact that there are different prices for in-network versus out-of-network, which is the norm. I was referring to the recent change that employees (who are penalized for using services outside of the system) are now limited in what system services they are permitted to use.

Also, it isn't a change in insurance, that a particular pharmacy I preferred is now designated as "out-of-network." Rather, we are disallowed from the using the hospital pharmacy altogether.

If they were having severe problems with wait times it would make sense to me to say that the pharmacy is no longer open to outpatients in order to reduce wait times for inpatients and emergency patients. I think it is different to say that the pharmacy is still open to outpatients, but employees are disallowed. I may be missing something, but I actually don't understand generally why being an employee means that you are not welcome as a customer. Also, as a side note, I have never been to the pharmacy at a time when there was someone else there; this is probably because I typically show up at 2 am in pajama pants to pick up sleeping pills, which I always imagined is funny for the pharmacy staff.

In any case, it sounds like you are disagreeing with me, which is perfectly okay.

[psu_213, BSN, RN]

I've never used a pharmacy based at the hospital, so, in that light, I am not really feeling outraged at the situation. I don't know you or your exact situation, but I've worked nights and have never missed any significant amount of sleep because I had to get to a pharmacy. It is unfortunate that the hospital forbids you from using the hospital pharmacy, but I would think there is an acceptable solution out there for you.

[llg, PhD, RN]

I've worked for 6 different hospitals in 6 different states over the years and not one of them allowed the staff to buy things at the hospital's pharmacy (unless they were a registered patient of the hospital, of course.) The hospital pharmacy was not set up as an outpatient, commercial pharmacy. In-patient pharmacies and commercial drug stores are really to different things.

As a former night shift employee ... if I needed to meds or groceries, I usually just stopped somewhere on the way home from work in the morning. Stores are usually open by then. If not, they usually are open by the time I got breakfast. And I never worked 7 nights a week: so, I could delay going to bed a bit on the days when I had the next night off.

I can see that it would be irritating for you and your wife to have to change pharmacies, but I don't think it should be huge deal. I've recently had to make a similar change from a very convenient pharmacy to one less convenient ... and while it is frustrating, it is a relatively small issue compared to the bigger issues of life.

[Night__Owl, BSN, RN]

I think some people are getting tripped up that this is a pharmacy in a hospital.

It's not a normal hospital pharmacy. People are able to call in and pick up prescriptions there, correct? So it's a public pharmacy, just located on a hospital campus (and possibly conjoined with the "inpatient" part of the pharmacy. )

It's definitely not fair, but I doubt you could do anything about it. Maaaaybe legal action on the basis of discrimination, but then again they could probably just turn around and say that simply the hospital pharmacy would no longer be considered an "in system" facility.

[caliotter3]

Your argument about night shift inconvenience does not fly. Any person who chooses to work night shift puts up with the inconvenience related to their choice. Life occurs after night shift. I only get concerned with finding an all night pharmacy when there is an after hours need for meds. Nothing at all to do with the convenience of when I go to pick up a prescription.

[City-Girl]

It's a lousy situation when employers make changes to what they consider in and out of network. Does your insurance have a mail order option? Then you wouldn't have to worry about picking it up and often mail order sends a 90 day supply.

[klone, MSN, RN]

IMO it's mostly just you.

[caliotter3]

It's a lousy situation when employers make changes to what they consider in and out of network. Does your insurance have a mail order option? Then you wouldn't have to worry about picking it up and often mail order sends a 90 day supply.

I moved to the mail order home delivery option the first time I found out there was no co-pay for most of my routine meds. Now they have instituted co-pays, but it still beats having to go pick up meds on a routine basis. Ask your physician to write scripts for a 90 supply and you really add to the convenience, as well as obtain a cost savings.

[JKL33]

I've worked for 6 different hospitals in 6 different states over the years and not one of them allowed the staff to buy things at the hospital's pharmacy (unless they were a registered patient of the hospital, of course.) The hospital pharmacy was not set up as an outpatient, commercial pharmacy. In-patient pharmacies and commercial drug stores are really to different things.

But that's not the OP scenario. They are running an outpatient pharmacy which is open to all of their other (health plan) customers whether they are recent inpatients or not. This smacks of some unspoken attitude that employee healthcare is some freebie being provided out of the goodness of their hearts.

I certainly do think it's different. The only disagreement I have with the OP is that the missing sleep issue isn't what would bother me; I think the whole thing's a racket to begin with and that's what I find bothersome.