Mesa County Has Plenty of Pharmacies. Palisade Has One.

One pharmacy on Elberta Avenue

The pharmacy in Palisade, Colorado is Palisade Pharmacy, 707 Elberta Avenue, Unit B. The phone number is 970-464-5668.

That is not a recommendation. It is an inventory. There is one pharmacy in Palisade.

Now look at the same place from a distance. Palisade sits in Mesa County, and Mesa County has about 162,845 people in it. It has hospitals. It has a good number of pharmacies. On any list of Colorado counties that are well supplied with health care, Mesa County comes out looking fine.

Both of those things are true at once, and the gap between them is the whole subject of this post.

A drug plan sees a county. You live on a street.

Every Medicare drug plan has a pharmacy network. That is true whether the coverage is a standalone Part D plan — Part D is 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." Inside that network, plans generally sort pharmacies into two positions.

A preferred pharmacy is one the plan has a closer arrangement with. In Medicare's own words, preferred in-network pharmacies "have agreed to charge less than other pharmacies in your plan's network."

A standard network pharmacy is in the network, and the plan will cover the prescription there, but your share is generally higher than at a preferred one.

And then there is out of network, which is not a worse deal — it is a different situation. In Medicare's wording, there you will "probably have to pay full cost for the drugs."

A note on the words themselves. Plan documents commonly say standard; Medicare's own site never uses that word, and says "other pharmacies in your plan's network" instead. Same distinction, two vocabularies, and knowing both saves you an argument about terms that do not matter.

Plans are required to have a pharmacy network for the area they are sold in. Whatever the precise obligation is, it is satisfied across an area, not street by street. Which means a plan can put together a perfectly respectable network for Mesa County — several pharmacies, easy driving, nothing to complain about on a map — and have arranged none of it in Palisade.

Nobody has broken a rule when that happens. Networks are assembled contract by contract, and the plan that made a good arrangement in Grand Junction did not necessarily make one on Elberta Avenue.

The county number hides the town

About 18.9% of the United States is aged 65 or older. Mesa County is 23.5% — higher than the country, and high enough that plans compete there.

But a county figure is an average of everything inside it, and averages are exactly the wrong tool here. What matters to a person in Palisade is not how many pharmacies exist within the county line. It is how many exist within the distance they are actually willing and able to drive, in February, at seven in the morning, to pick up a prescription they need that day.

For the people we are describing, that number is one.

We are not going to print a mileage to Grand Junction. We have not measured the roads and we are not going to invent a figure. You know your own drive better than anyone writing this does. What we will say is that the drive is real, that it is a different proposition in January than in June, and that a plan's paperwork treats it as though it costs nothing.

What is in Palisade, and what is not

It helps to be precise about this, because it changes how much the pharmacy is carrying.

Palisade has clinics. It does not have a hospital. The hospitals are in Grand Junction.

So for a great many days of the year, the health professional a person in Palisade can reach without a car ride is the pharmacist. That is a real thing, and it is worth weighing before signing something that changes where prescriptions get filled.

Mail order, honestly

Mail order is a legitimate option and for some people it is the better one. Ninety days of a stable medication, arriving without a trip, is a genuine convenience.

It is also a different relationship, and it is worth naming what changes.

Nobody at a mail-order facility is going to notice that a new blood pressure prescription sits badly with something you have taken for four years. Nobody there knows your name or your history. And when a refill has not turned up and there are two tablets left in the bottle, the number you call is not in your town and the person answering it cannot hand you anything.

Some people trade that away and are glad they did. The point is only that it is a trade, and it should be made deliberately rather than discovered in February.

Three questions, and the exact words

If you do nothing else with this post, do this. It is one phone call to the plan, and the wording matters more than it should.

"Is the pharmacy at 707 Elberta Avenue in Palisade in this plan's network?"

Ask by street address, not by town. A plan's pharmacy finder will cheerfully show you a pharmacy thirty minutes away and count that as coverage for where you live. The address is the only version of the question that cannot be answered sideways.

"Is it preferred or standard?"

These are different and the plan's own materials say which. If the answer is standard, that is not automatically a reason to walk away — plenty of people are better off on a plan that treats their drugs well and their pharmacy adequately than the reverse. But it should be a decision you made, not a discovery you had.

"What happens on a ninety-day fill?"

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. If driving is hard for you, or if winter driving is, this question is worth more than it looks.

Then ask a fourth thing, of a different person. Take the answers to the pharmacy and ask the pharmacist whether the picture matches what they see. They fill prescriptions under these plans every week and they will know immediately if something sounds off.

Free counselling, from someone with nothing to sell

Colorado runs a State Health Insurance Assistance Program — SHIP — with counsellors trained on Medicare who do not sell plans and do not work for one.

888-696-7213.

There is no cost and no catch. It exists precisely so that a person can get a Medicare question answered without being sold something at the end of it, and most of the people entitled to it have never been told it exists. There is also a companion program for suspected fraud and billing errors, at 800-503-5190.

Write the first number inside a cupboard door.

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 Palisade Pharmacy is one of them. The group is still growing.

So the suspicion a sensible person is already having needs answering directly.

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 happens to treat some other pharmacy better than it treats ours, that is what you will be told. You should hold us to that.

The reason the pharmacy side matters is not referral volume. It is that a pharmacist who has filled your prescriptions for nine years can tell you which of the three questions above actually applies to you, 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 because of something you read about cost. Take it to the person who prescribed it. If cost is the real problem, say so plainly to both the prescriber and the pharmacist — there are usually more moves available than people expect, and none of the good ones involve stretching a prescription.