This story is part of a reporting partnership that includes , and Kaiser Health News.
If you鈥檙e heading into a to pick up a prescription, you may first want to check the back of your insurance card. 聽If it says , you can no longer fill your prescription at Walgreens or affiliates like Duane Reade under your insurance plan.
Express Scripts is one of the nation鈥檚 largest . These are companies that health insurers, employers and others hire to for drugs and to oversee prescription drug programs. Express Scripts鈥� clients include the mega-insurer WellPoint.
Express Scripts had been negotiating a new contract to keep Walgreens in its network. But 鈥渢heir rates and terms would be as much as 20 percent more,鈥� according to Express Scripts spokesman Brian Henry. 鈥淥ur clients aren鈥檛 willing to pay that premium for basically the same service you can get at many other thousands of our pharmacies.鈥�
That鈥檚 a charge that Walgreens adamantly denies. 鈥淲e did not propose any increase in our rates,鈥� says Walgreen鈥檚 spokesman Michael Polzin. 鈥淪o there would not be any significant savings to Express Scripts clients for excluding Walgreens from their network. So it鈥檚 really a situation of all pain and no gain for their clients.鈥�
Health care experts are somewhat befuddled by the standoff. Sean Brandle, a pharmacy benefit expert at the , a New York-based employer benefits firm, said that while tussles between pharmacy chains and pharmacy benefit managers are pretty typical, 鈥渁t the end of it, normally what you expect is that some kind of deal is going to be struck,鈥� he said. 鈥淏ut I guess in this instance, it looks like they were just too far apart.鈥�
Brandle is 鈥渟urprised鈥� Walgreens would walk away from so many pharmacy customers and all that in-store foot traffic. According to Express Scripts, of the 750 million prescriptions it processed last year, about 90 million were filled at Walgreens.
Caught in the middle of this dispute is one of the nation鈥檚 largest health insurance companies, , and millions of its customers, like San Francisco resident David Forer. There鈥檚 a Walgreens just down the street from his office, and he used to stop in weekly to pick up insulin for his daughter, who has Type 1 diabetes.
鈥淭hey knew me on a first-name basis,鈥� Forer said, adding, 鈥淭hey would ask how she was doing. And now I can鈥檛 go there anymore.鈥�
Forer has switched his family鈥檚 prescriptions to a CVS pharmacy. But while CVS is a national chain, it doesn鈥檛 have nearly as many stores in San Francisco as Walgreens does, so it will be a 鈥渕ajor inconvenience鈥� to Forer.
WellPoint says nationwide, there鈥檚 another in-network pharmacy typically within a half -mile of a Walgreens. The insurer is trying to help its customers make the transition.
CVS, RiteAid, Safeway and others are advertising their willingness to fill Express Scripts prescriptions while Walgreens is offering incentives and coupons to stem the loss of customers to its competition. In Florida and other states, the company has announced that it will allow some customers with Express Scripts coverage to continue using its pharmacies. Sandy Anderson, a Tampa Walgreens pharmacist, says Express Scripts customers can enroll in Walgreens鈥� discount drug program: 鈥淭he fee to sign up for that has been $20 for an individual and $35 for a family. But for the month of January were knocking that down to $5 for an individual and $10 for a family. And that can include pets as well. That savings club offers discounts on over 8,000 brand-name and generic medications.鈥�
Pharmacy benefit expert Brandle notes there could be an upside to all the hassle. Brandle says Express Scripts should be able to negotiate steeper discounts with CVS and other pharmacies, since excluding Walgreens will mean more business for them.
WFSU鈥檚 Lynn Hatter and WBUR鈥� Martha Bebinger contributed to this story.