GNP plan reduces Rx choices Workers, retirees limited to Bangor area purchases

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MILLINOCKET – Great Northern Paper employees and retirees seeking to fill prescriptions under an interim health care plan will have to get their medication from the Bangor area.

The $1.9 million plan provides GNP employees and retirees with limited health insurance for prescriptions, urgent and emergency care. Those seeking to fill prescriptions will have to use Affiliated Pharmacy Services, a subsidiary of Eastern Maine Healthcare, which has two locations in Bangor and one in Brewer.

Great Northern’s self-insured health care plan ended when the company ran out of money, leaving coverage in peril for 1,130 employees at its paper mills in Millinocket and East Millinocket and for 677 people who retired from both the paper company and Pinkham Lumber Co. since 1992. About 500 of the total have opted not to participate in the temporary plan, which was ordered by a bankruptcy judge.

Stephen Ryan, president and chief executive officer of Maine Network for Health, the organization directed by the court to set up the new health plan, said it will expire on April 29 or when the paper company is sold.

Some GNP employees and retirees received their health cards Wednesday, but others said they had yet to receive them.

Diane Khiel, an Orono attorney working with Great Northern and Pinkham retirees, said she is concerned about the people who haven’t been taking their medications while awaiting their cards.

“I am getting information every day about people who are being very negatively impacted by this either through misunderstanding or the obstacles in the program,” she said. Khiel is encouraging people to get the medical treatment they need and to take their medications as prescribed.

Ryan said the new health/prescription cards were mailed out from Wisconsin last Friday and should be arriving any day. “I can’t imagine them not being there in a few more days,” he said. On Tuesday, Ryan’s office staff mailed out letters to health providers about billing procedures.

Along with the new cards, participants will receive other valuable information about the health plan.

Khiel said anyone who has paid out of pocket for prescriptions or medical care should submit their receipts for reimbursement to the claims address listed in the information. The address is Comprehensive Benefits Administrator Inc., P.O. Box 2365, South Burlington, Vt. 05407-2365. CBA’s two customer service numbers are 1-800-525-8788 or 1-802-864-8321.

Ryan said that only Affiliated Pharmacy Services offered to participate in the interim plan. “They are the only ones that decided economically to bear the burden of this,” he said. “This is a very lean reimbursement and there is a huge exposure for pharmacies.”

Richard Bryant, an attorney working with GNP’s trade unions, earlier said participating medical providers agreed to be paid 50 percent of the cost now and the remainder later. If the plan runs out of money, health care providers would have to file an administrative claim against Great Northern. Those claims won’t be given priority reimbursement status from proceeds of a sale. Instead, they will stand in line with all of the other unsecured creditors, he said.

Ryan said those who go to “out of network” providers, those not participating in the program, will face higher out-of-pocket costs. If the provider does not bill CBA for their services and charges the patient directly (forcing the participant to seek reimbursement from CBA), Ryan said the patient would absorb any payment shortfalls. “We just have no leverage to force out of network providers to participate,” he said.

Khiel is urging people to call Affiliated Pharmacy Services before they travel to Bangor to refill a prescription. “People should call ahead and tell them they’re coming,” she said.

Paul Sevigny, a pharmacist and the chief operating officer of Affiliated Pharmacy Services, wholeheartedly agreed.

Sevigny said the pharmacies want to make the process as easy as possible for everyone. He said pharmacists need to have prescriptions on file to fill them.

He said people who have refills left on their prescriptions should call ahead and provide information such as the telephone number of the pharmacy that previously filled their prescription and the prescription number. “It will save them a lot of time,” he said. “Do everything you can to make sure that we have adequate information so we can fill your prescription when you are here.”

People who have no refills left on their prescriptions should contact their doctor and ask them to fax or call in their prescription. People should call Affiliated’s pharmacies to make sure prescriptions have been called in before making the trip to Bangor or Brewer.

Sevigny said the pharmacies could mail prescriptions to people. The easiest way is to have doctors fax or call in the prescription. A fee to cover shipping costs will be charged. He said people should not wait until their supply of medicine is low and should allow for a two- to three-day turn around especially during a weekend.

For assistance

The locations, hours and telephone numbers of Affiliated’s pharmacies are:

Airline Pharmacy, 405 North Main St. in Brewer, open from 8 a.m. to 8 p.m. Monday through Friday, from 9 a.m. to 5 p.m. on Saturdays and from 9 a.m. to 1 p.m. Sundays. Telephone, 1-866-989-2424 and fax 989-6060

Riverside Pharmacy, near the entrance to Eastern Maine Medical Center in Bangor, open from 8 a.m. to 8 p.m. Monday through Friday and from 9 a.m. to 5 p.m. on Saturdays. It is closed Sundays. Telephone, 1-888-277-4007 or fax 973-8891.

Westgate Pharmacy, 915 Union St. in Bangor, open from 8 a .m. to 6 p.m. Mondays, Wednesdays and Fridays, from 8 a.m. to 8 p.m. Tuesdays and Thursdays, and from 9 a.m. to 2 p.m. Saturdays. It is closed Sundays. Telephone 1-800-639-8801 or fax 973-6782.

A partial listing of hospitals participating in the plan are:

Acadia Hospital, Bangor

Calais Regional Hospital

Cary Medical Center, Caribou

Downeast Community Hospital, Machias

Eastern Maine Medical Center in Bangor

Houlton Regional Hospital

Maine Coast Memorial, Ellsworth

Mayo Regional Hospital, Dover-Foxcroft

Millinocket Regional Hospital

Mount Desert Island Hospital

Northern Maine Medical Center, Fort Kent

Penobscot Valley Hospital, Lincoln

St. Joseph Hospital, Bangor

The Aroostook Medical Center, Presque Isle.

Plan summary

A summary of Great Northern’s interim health plan is:

Workers and retirees pay no premiums, but will pay a $10 co-payment for each prescription.

It will cost participants $10 co-payment for prescriptions costing up to $68.

For prescriptions costing between $68 and $999 each, it will cost $10 co-payment plus the difference between $68 and the cost of the drug.

A prescription costing more than $1,000 will cost a $10 co-payment plus the difference between $68 and $1,000 ($932). The plan will pay any balance over $1,000. But if a worker or retiree has to get another prescription in the same month, all they will pay is $10 co-pay because the plan caps costs at $932 per month, per person.

There are no co-payments for emergency services, which are defined as services provided in an emergency setting for “sufficiently” severe symptoms of an illness or medical condition that could result in serious jeopardy to health without immediate treatment.

Urgent services are those needed within a 24-hour period to prevent serious risk of harm to a person. Plan participants will pay 20 percent of allowable charges up to a maximum payment of $450 per individual or $900 per family during the term of the new plan.