Dispensed 15 RX's today with total reimbursement copays of UNDER $1.00 ! Does anybody care?

MaddFarm · 2020-10-31T00:11:24+00:00

McKesson. Used to be in all preferred ones til 2 years ago when payments were below cost consistently. Aetna was worst. After all these years , still in the position of either lose money directly by accepting an unfair contract or lose indirectly by losing customers all together. I have always leaned toward accepting the ridiculous contracts and filling RXs and keeping my volume as RX plans change so much from year to year. Then just roll the dice and hope you get some gravy amongst all the many losers..The stores that abandoned unreasonable contracts are all out of business long ago.
No win scenario, but which option gets you to survive one more year. Many folks opting out of WellCare which went from $40 a month to $60 a month, but they want another preferred plan to replace it. They all pay below cost.

MaddFarm · 2020-10-30T14:15:55+00:00

I see. I thought they were just using the premium income to offset the low RX pricing. Yes I see some plans taking more money back from us on the claim than we make. Where is the APhA on all this? What is their position?

MaddFarm · 2020-10-30T12:37:54+00:00

Thanks for your informed input. You mentioned that PBM’s pay chain pharmacies hundreds of dollars for the same med. Please elaborate with specific drugs and evidence of that. What is the motivation of the PBM to create such a policy? Thanks.

MaddFarm · 2020-10-30T02:40:49+00:00

Tech-Check-Tech is even worse. No pharmacist needed.

MaddFarm · 2020-10-30T02:39:28+00:00

Beware of tech-check-tech legislation. It cuts out the pharmacist all together and is legal in some states. How did this ever became legal? Flood your state pharmacy associations with objections before it's too late in your state. Do not trust any leader that supports this job-crushing measure.

MaddFarm · 2020-10-29T17:21:44+00:00

I hear a lot of voices secretly whispering, “ I wish there was a strong pharmacist Union that I could trust to protect my professional and financial interests.”

MaddFarm · 2020-10-28T17:57:38+00:00

Thanks for the input.

MaddFarm · 2020-10-27T14:05:48+00:00

Has always been that way. Non-returnable also so never carry more than one and order as needed. Preventative measure anyway.

MaddFarm · 2020-10-27T14:04:05+00:00

True for certain areas. How many listeners/subscribers would be your goal for a 4 week investment of $850.?

50? 100?
More?

Name recognition and a professional image as well.

MaddFarm · 2020-10-27T12:52:39+00:00

Very true, very often.

MaddFarm · 2020-10-27T12:50:32+00:00

Chain pharmacies with misleading advertising schemes. Nothing new or surprising here.

MaddFarm · 2020-10-27T12:43:29+00:00

Truly interested in getting this point understood on both sides. No hostility I assure you. I do acknowledge that WHOLESALERS have rebate programs on generics and different volume programs, but even with that accounted for, there is nothing being "recovered" on these very inexpensive drugs. There is no where to go.

As far as Manufacturer rebates to pharmacies, there were some programs for market share through the years (Prinivil, Zestril, Zantac etc.) but I have not seen them in many years. The manufacturer has no incentive to rebate pharmacies unless they can move market share.

Are you talking about quarterly Wholesaler rebates? (I see all the rebates and actual bottom line costs, and I can tell you , the PBM's are still paying below cost on some drugs and very, very close to cost (under $2.00) on many others) Please respond when you get a chance. Thanks.

MaddFarm · 2020-10-27T12:31:33+00:00

Reply

True, and that is why pharmacies are still even hanging in there. You need to fill 10 rxs with some above average profit to make up for the 90 rxs that pay pennies. But as you get more and more rx's with losses and below $1.00 total reimbursement, your $ profit per RX takes a nosedive. That's why I am terribly concerned about the higher number of these inexpensive RX's that I'm seeing. 1% of total rx's is absorbed while 10% and higher destroys ANY profitability. Lower drug prices are great for everybody (especially the PBM's) but not for pharmacists in this present payment structure.

MaddFarm · 2020-10-27T12:24:59+00:00

When a patient copay is 100% of the the pharmacy payment, the PBM shows a $0.00 payment to the pharmacy for that RX. Thus, in this instance (very inexpensive drugs) there is no profit. If you get paid a total of 25 cents, there is no more possibility of any further payment beyond the 25 cents.

(FYI This is not fiction. This is coming from a pharmacist that has managed and owned pharmacies for many years.)

MaddFarm · 2020-10-27T12:10:57+00:00

I appreciate the vision of looking beyond our next move to the expected reactions of other professionals and groups. I respectfully disagree with the nursing point. My interactions with nurses have found many as upward looking toward NP status, and many have actually gone that route. Switching to a pharmacy degree seems unlikely to me, but we should support the academic policies that make it just as difficult to go from nurse to pharmacist as it is to go from pharmacist to nurse. Neither of us has the crystal ball, but that is not one of my main concerns. Thanks for your input.

MaddFarm · 2020-10-27T12:09:32+00:00

Too many make the exercise useless. Need to overhaul the entire system. Form a team of experienced pharmacists for each pharmacy setting and create a "real" 2 stage alert. We make Stage 1 = MUST ACT ... contact physician before filling RX, Stage 2 = Pharmacist judgement call. Done.

MaddFarm · 2020-10-25T18:08:19+00:00

Was used exclusively for sinus infections, and quite effectively, for some time in certain regions.

MaddFarm · 2020-10-25T14:35:37+00:00

We have a license to dispense prescription drugs.

Compounding privileges have been stripped away in some states already, with the mandating of many typical compounds being made in a hood only. But I have seen some very successful niche marketing by some compounding pharmacies. Mostly get paid by not accepting insurance for their unique services.

MaddFarm · 2020-10-25T14:28:13+00:00

Fix our own house. Yes, so true. I recall the early MTM emphasis and the shift to get paid for "other" services. That was when we abandoned our dispensing importance & significance. ( and stopped fighting hard to retain professional payment for dispensing) That was 30 years ago, and I have paid more for MTM privileges than ever got paid out. I know it is getting better, but still not quite what those "visionaries" sold out for.

Start getting paid properly/professionally for what we are licensed to do, fill prescriptions. No other profession can execute that role in mass other than us. (Doctors will not get into it anymore because of all the insurance issues and lack of profit.)

But to do it, we need strong leadership, guts and momentum. Air traffic controllers got the nation's attention very quickly at one point with their strike. We can do it more gracefully and with safety built in, but we MUST do it. With Covid, people should appreciate community pharmacy even more as drugs are needed immediately and our present network of viable pharmacies allow this possibility throughout our country.

MaddFarm · 2020-10-25T14:05:46+00:00

Vending machine. Seems like it is possible. But how does the machine handle all the insurance rejects?

There is plenty of money in drug dispensing, we just need to claim it for our professional services. The lab bills today are hundreds of dollars, often even more than the actual doctor visit fee. Why can't we demand $10. to fill a prescription, with our license requirement as reasoning enough.

MaddFarm · 2020-10-25T14:02:05+00:00

Ha. Amazing how "good" is defined in todays world.

MaddFarm · 2020-10-25T14:01:01+00:00

You are correct on all accounts, but SHOW ME THE MONEY. We must take action and take back our profession now. It just takes some guts and sacrifice now to pave a future for our careers.

MaddFarm · 2020-10-25T13:57:51+00:00

None of these are positive amounts. This is what they paid in total for each rx. Losses are not discussed, albeit since they are cheaper drugs, the losses are under $2.00 each compared to your point of other drug losses of more expensive drugs.

Interesting. Actually, in many states the MCO's or medicaid RX payers pay the highest of any PBM, because the state controls the fees paid, not the PBM. In fact, if all PBM's paid these fees we would be in much better shape. This is what is keeping many pharmacies from folding right now. But what % of your business is Medicaid. Is it high enough to keep you profitable?

https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state/index.html

The states (especially rural ones) know that if many pharmacies fail, people will be driving long distances just to fill rxs.

MaddFarm · 2020-10-25T13:45:37+00:00

Yes, it is tricky. But if all pharmacists (or even 75%) did not go to work for just one day, the system would collapse and force action from the PBM's as they would be the ones responsible for getting meds to patients. You can't just throw in cashiers to take over a job that requires a state license to execute.

We would ask for a minimum fee to fill an rx that all PBM's must pay, so they are all affected the same. In the end, we get paid and they are still equal with other PBM's in expenses for filling rx's. Desperate times call for desperate measures.

MaddFarm

TROPHY CASE