Preferred networks — pharmacies and other health providers designated by an insurance plan that will offer lower cost or even free services — are now firmly embedded in the health care landscape. With pharmacies, the intent is to keep the insurer's drug costs in check by securing discounts in exchange for increased customer traffic. But having to choose can be hard on older adults, said Robert Roca, MD, chair of the American Psychiatric Association's Council on Geriatric Psychiatry and chief medical officer for Sheppard Pratt Health System in Baltimore. "All of the plans that direct patients to a particular provider — be they a physician or a pharmacist — do put people in a bit of a spot on whether they continue to patronize a provider," he said. "People often have a trust in their pharmacists, who know them well and who give them advice about how to use medications." Roca noted that pharmacists tend to be more accessible than other health providers. Where physicians may see a patient once or twice a year, pharmacists will see them once or twice a month and may recognize a medical issue in its early stages, particularly if it is a longtime customer.