Guernsey and Lusk: When Your Clinic, Your Hospital and Your Pharmacy Sit in Three Different Places

Two towns, one pharmacy each, arranged completely differently

Register Cliff Pharmacy is at 437 West Whalen Avenue in Guernsey, Wyoming. 307-836-9270. The only pharmacy in town.

Rawhide Drug is at 232 South Main Street in Lusk. 307-334-3132. The only operating pharmacy there.

Two towns in the same corner of the state, each with one pharmacy, and that is where the resemblance ends. Lusk has its own hospital and its own clinic. Guernsey has neither — it has a clinic run from a different county, and the nearest hospital is in a different town. Which changes what you have to ask a Medicare drug plan, and more to the point, which place you have to name when you ask it.

What is actually in Guernsey

A Rural Health Clinic at 650 West Whalen Avenue, operated by Memorial Hospital of Converse County. The pharmacy is along the same avenue, at 437.

So the clinic and the pharmacy sit on one street, which is about as well arranged as a town this size gets. But the organisation running that clinic is a hospital in Converse County, and Guernsey is in Platte County. The nearest hospital is Platte County Hospital in Wheatland — a Critical Access Hospital, a federal designation Medicare created for small rural hospitals — in your own county, but not your town.

Count the places involved in one person's ordinary care here. The pharmacy, in town. The clinic, in town but run from a second county. The hospital, in a third town. Two counties and three towns, for a routine that looks on paper like one place.

What is actually in Lusk

Lusk has the Niobrara County Hospital District, a Critical Access Hospital, and Lusk Medical Clinic, a Rural Health Clinic. Both in town, along with Rawhide Drug on South Main.

Hospital, clinic and pharmacy in one small town. That is unusual and it deserves saying plainly rather than being treated as the baseline. What is worth noticing is the base it rests on: Niobrara County has a population of about 2,341 people. So the question in Lusk is not where your care is. It is what happens to the one of each that you have when the paperwork stops working for it.

The number that puts both counties in context

About 18.9% of the United States is aged 65 or older.

• Niobrara County — 31.7%
• Platte County — 29.2%

Weld County, Colorado — where most Medicare attention in this region gets pointed — runs 13.9%.

Wyoming as a whole is 68.9% nonmetropolitan: roughly 401,360 people living outside a metro area, against 12.2% in Colorado. Platte and Niobrara are not unusual for Wyoming. They are Wyoming.

So the counties where a network decision does the most damage when it goes wrong also carry close to twice the national share of the people it lands on. That is worth an afternoon rather than a glance.

What a network actually is, in the words Medicare uses

Every Medicare drug plan has a pharmacy network, whether your drug coverage is a standalone Part D plan — Part D being the part of Medicare that covers prescriptions you pick up yourself — or the drug coverage built into a Medicare Advantage plan.

Medicare describes in-network pharmacies as ones that "have agreed to offer a discounted price for members of certain Medicare plans." Some plans go further and designate preferred in-network pharmacies, which Medicare says "have agreed to charge less than other pharmacies in your plan's network." Buy outside the network and, in Medicare's own wording, you will "probably have to pay full cost for the drugs."

One note on vocabulary, because it trips people up. Plan documents commonly say standard for a network pharmacy that is not preferred. Medicare's own site never uses that word — its terms are "preferred in-network" and "other pharmacies in your plan's network." Same distinction, two sets of words. Know both and you will not lose an argument over terms that do not matter.

The question is not "is there a pharmacy near me"

Here is the part specific to Guernsey, and the reason the rest of this is worth reading.

When you ask a plan a question, the answer you get back is about whatever place got named in the question. That is not a trick — it is just how the answer gets looked up.

Ask about "the pharmacy near Guernsey" and you may get an answer about a pharmacy in another town, delivered as though it settles the matter. Ask about "my clinic" and you may get an answer about an organisation headquartered in Converse County. Ask about "the hospital" and, in Guernsey, the answer is about Wheatland. None of those is a lie. All are answers to a question you did not ask.

Two weak questions cause most of it. "Is there a pharmacy near me" invites a yes, and a yes can mean a building in a town you have no reason to drive to. "Is my pharmacy covered" invites a yes as well, and a yes can mean in-network at a higher share than the preferred position would have cost you. Covered and preferred are not the same word and not the same money.

So do not ask about the town, and do not ask whether something is covered. Ask about the street address, and make them say the county back to you.

"Is the pharmacy at 437 West Whalen Avenue in Guernsey, Platte County, Wyoming, in this plan's network — and is it a preferred in-network pharmacy, or another pharmacy in the network?"

In Lusk, the same sentence with 232 South Main Street and Niobrara County.

We are not going to explain here how a plan draws its service area — that is a thing a plan should state in its own documents rather than something to take off a webpage. What is in your hands is making sure the answer you get is about the county you live in and the door you walk through.

Get the answer in writing, and put a date on it

You do not need help with this. You need your prescriptions and about an hour.

1. Write down every prescription you take, off the bottles. Name, strength, how often. Not from memory. It is the step people skip and the step everything after it depends on.
2. Ask for the pharmacy directory for your county, by name. Not the map tool — the directory is the document that states positions. If you are told to use the website, ask again for the directory for Platte County, Wyoming, or Niobrara County, Wyoming.
3. Read the line for your own address yourself. One line, one building. That is the whole answer you came for.
4. If you have to ask by phone, take the name and the date. Write both next to the answer. If this turns into a second call, the note from the first one keeps the second one short.
5. Ask the same question about a longer supply. Medicare notes that some pharmacies may offer a 2- or 3-month supply of covered drugs, and that mail order can run up to a 3-month supply. Those are not necessarily priced the same, and if winter driving is a real constraint this question is worth more than it looks.
6. Check your own drugs against the plan's formulary — the list of what it covers and which tier each drug sits on. A plan can put your pharmacy in the preferred position and still have moved a prescription to a tier that costs more, or attached a rule requiring approval before it will pay.

Then take the answers to the counter and ask the pharmacist whether it matches what they see. They fill prescriptions under these plans every week.

Counsellors with nothing to sell

Wyoming runs the Wyoming State Health Insurance Information Program — WSHIIP — with counsellors trained on Medicare who do not sell plans and do not work for one.

1-800-856-4398.

No cost and nothing being closed at the end of the call. Most of the people entitled to it have never been told it is there. If you deal with Colorado or Nebraska too, the equivalents are 888-696-7213 and 1-800-234-7119.

Where we come into this

Haven Health Plans was started by the pharmacists at Good Day Pharmacy. Good Day operates a network of local community pharmacies across Colorado, Wyoming and Nebraska, and both Register Cliff in Guernsey and Rawhide in Lusk are part of that group. The group is still growing.

Which means the obvious suspicion ought to be answered before you have to raise it.

We do not pick plans around pharmacies. What a recommendation rests on is your medication list, your doctors and your budget. Your pharmacy enters the conversation when you say you want to keep it — and if the plan that fits your list best treats some pharmacy other than ours better, that is the answer you get. Hold us to it.

The reason a pharmacist is useful here is narrow and real. It is that somebody who has filled these prescriptions for years can look at the six steps above and tell you which two of them actually matter in your case, because your list is in front of them while they answer.

Covered is not the same as workable. A pharmacist knows the difference.

And the standing rule, here and in everything else we write: do not stop, skip or reduce a medication on your own over a cost question. Take it to the person who prescribed it. If cost is the real problem, say it out loud to the prescriber and the pharmacist — there are usually more moves available than people expect, and none of the good ones involve stretching a prescription out.