Gainesville resident Linda Cash says she has been a customer of Riverside Pharmacy on Green Street for 14 years. But she’s afraid she will have to change pharmacies after her Medicare insurance prescription plan moved to having a network of preferred pharmacies that doesn’t include Riverside.

Gainesville has about 10 to 15 locally owned pharmacies, Riverside pharmacist Scott Barton said. He said he’s seen between 20 and 25 customers leave his pharmacy in favor of national retailers who own insurance companies or have contracts with big pharmacy benefit managers such as CVS Caremark and Express Scripts.

They have introduced preferred pharmacies for Medicare Part D patients that advertise lower co-pays or eliminates them. CVS Caremark and Express Scripts representatives said they give their clients a variety of options that include their network pharmacies and mail-order pharmacies.

“I would hate to have to go somewhere else,” Cash said.

Local pharmacists and state and national trade associations say preferred pharmacy networks are hurting independent pharmacists by driving business to big retailers, reducing patient choice and confusing elderly Medicare patients with unclear marketing campaigns.

“Your head’s on the chopping block,” Barton said. “There’s a time when you have to start stepping up or they’re going to bury you.”

Riverside Pharmacy is known by its customers for service. Barton has 21 employees and the staff call customers by their names as they are helped. The pharmacy has been around since 1954 and Barton bought it in 2010. It also offers delivery. Barton has worked at the pharmacy since 1992 when he started as a delivery boy.

“There are people who have grown up in this store,” Barton said.

The impact of preferred networks is already hitting his business.

Customer Johnny Collins is retired from the Air Force and enrolled in Tricare for Life, a prescription drug supplement managed by Express Scripts for the U.S. Department of Defense. In the National Defense Authorization Act for fiscal 2013, it establishes a five-year pilot program in which long-term medications, also known as maintenance drugs, are required to be filled by mail-order pharmacy.

David Whitrap, director of corporate communications for Express Scripts, said the company manages the Tricare program, which includes more than 9 million participants. The company’s mail-order pharmacy is less expensive, more convenient and has better adherence rates, Whitrap said.

“It’s tough on Scotty,” said Collins, who has a zero co-pay for the mail service. “He can’t compete with that. I felt really bad for leaving.”

Last Wednesday morning, Barton started his day with an email from Collins.

“I’ve tried to find an opportunity to talk with either you or Bob (McWhorter) about the absence of my smiling face around the pharmacy ...” the email said.

Barton said he has more than 2,000 customers, 90 percent of them ages 65 or older and filling more than half a dozen medications a month at an average of $45 a prescription. Prescription fills dropped by 15 percent for the month of January. He wants to become a preferred pharmacy, but can’t find out how to become one, he said.

Insurer Humana and Walmart joined forces in 2010 to offer the first Medicare Part D plan with preferred pharmacies. It signed up about 2 million people in two years, said Jeff Lurey, director of the Georgia Pharmacy Association’s Academy of Independent Pharmacy.

Independent pharmacists are willing to participate at the same rates as the preferred pharmacies but are excluded, he said.

“Other large plans saw their (Humana and Walmart) success and started to mimic them,” Lurey said. “It wouldn’t cost the government any more money to let everyone participate.”

Lurey and Kevin Schweers, spokesman for the National Community Pharmacists Association, say independent pharmacies are mostly located in underserved rural and inner-city locations and may be the only pharmacy in that community. In some cases, the nearest pharmacy could be many miles away, Schweers said. The national organization represents 23,000 independent and community pharmacists, 725 in Georgia.

CVS Caremark’s network of pharmacies includes national and regional retail chains, pharmacies located in supermarkets or other retail locations and the majority of independently owned community-based pharmacies, said Christine Cramer, director of public relations for CVS Caremark.

The company reported a profit of $1.13 billion in net profit for the fourth quarter, or 90 cents a share, up from $1.1 billion, or 81 cents a share, a year earlier.

“Some clients select our maintenance choice program. In this program, members have the option to fill their 90-day maintenance prescriptions for chronic diseases either through the mail service pharmacy or at CVS/pharmacy stores,” Cramer said in a statement.

Edward Reynolds, Bainbridge mayor and a pharmacist, became an investor in RX Preferred Benefits, a “transparent” pharmacy benefit manager founded by independent pharmacists after it was discovered that the southwest Georgia city’s self-funded insurance program was paying tens of thousands more in employee claims than the pharmacy was being reimbursed for, and that the benefit manager was keeping the difference.

Decatur County changed its manager from Caremark of Woonsocket, R.I., a subsidiary of CVS Pharmacy, to RX Preferred Benefits of McKinney, Texas, The Post-Searchlight reported in 2011. Bainbridge, population of more than 12,000 residents, is in Decatur County.

“Independent pharmacists are better at reducing the cost for people,” Reynolds said.