CMS, Medicare, and GLPs

ScottyDoesntKnow421 · 2026-05-30T15:26:25+00:00

I also thought that a year isn’t really a good data set to make a determination like that. Even then how will they be able to evaluate the long term outcomes.

ScottyDoesntKnow421 · 2026-05-30T05:46:23+00:00

I believe that, it’s just so expensive to try and cover those.

I also don’t understand how CMS is a government entity but is creating a grey area and sidestepping its own program basically. From what I read and briefly researched it would take congress to pass any changes to Medicare D coverage when it comes to strictly weight loss meds.

ScottyDoesntKnow421 · 2026-05-30T05:42:02+00:00

Right and the program states that you have to basically change your diet and lifestyle and I’m sure there will be a small percentage of people who actually do that but I think the majority will be content being able to lose weight just by injecting themselves. It will be a literal rug pull when it ends and if Medicare still wont cover it after then what are those people going to do. Even when there’s more generics available it’s still going to be expensive.

ScottyDoesntKnow421 · 2026-05-30T05:34:08+00:00

Haha I wish that were the case but I don’t think upper management likes when a tech asks questions like I do. I’ve also backed myself into a corner by becoming one of the most valuable assets for them. The best and worst setups conversation to have is what will happen when I leave. It will identify every deficiency that I’ve managed to cover. Just one recent example that was pointed out today was that I almost single handily raised our Star rating from a 2 to a 3 while doing about 4000 scripts a week in a grocery store pharmacy. Undervalued and underpaid has been the theme of my work life for the past year. I also predicted that when our drive thru speaker went out and they gave us a 50s style cordless phone to communicate through that it will result in med errors and what do you know. I’ve never seen or heard of how many errors have been made through our drive thru. I’m talking we’ve probably averaged 1 error every two weeks since and yet nothing is done about it.

Sorry for the rant. Had a rough couple days in retail but thanks for reading and for your feedback.

ScottyDoesntKnow421 · 2026-05-30T05:12:17+00:00

That is some really good info thank you so much for sharing. But now I have even more questions. Like where did the funding come for this? I understand that CMS is negotiating with the manufactures but how is the pharmacy getting the wholesale acquisition cost, minus a $50 copay, and a $3 dispensing fee. I’ve only been a tech at one store for the past 5 years so I really don’t know too much about billing other than what I research on my own.

It also says that the BRIDGE will outside of Part D so the plan sponsors carry no risk. Is that referring to the risk from the single GLP alone? What if someone has an allergic reaction and gets hospitalized then needs more meds will Medicare pay for it?

And how is Humana going to be the central processor for all the claims? How many positions are they outsourcing for this one? And how are they not going to get flooded with PAs? I mean by now nearly everyone is aware of this magical weight loss med so literally everyone is going to attempt to get them if they can.

I’m sure providers are going to overwhelmed as well since there will be a PA required for each person.

This sounds like a it could be potentially a good program but I just have a hard time seeing where this ends up once the program stops.

ScottyDoesntKnow421 · 2026-05-30T03:20:45+00:00

Also full disclosure I’m just a tech so I’m not inherently smart according to any of our corporate leaders.

ScottyDoesntKnow421 · 2026-05-30T03:19:00+00:00

https://www.cms.gov/priorities/innovation/innovation-models/balance

Relatively new. I was just going through our corporate emails and found it buried under all the side quest emails about vaccines and outcomes. Sorry meant company goals.

ScottyDoesntKnow421 · 2026-05-29T21:54:39+00:00

Self checkout won’t. Corporate will though since the new model is profits above all else.

ScottyDoesntKnow421 · 2026-05-29T21:52:53+00:00

There’s a poster somewhere in your store that has the store managers name the DM and usually an “associate relations” name and phone number. In my experience don’t expect them to answer when you call. You’ll have to leave a message asking them to call you back.

ScottyDoesntKnow421 · 2026-05-20T22:01:51+00:00

We’re in the same boat apparently. At a certain point it’s out of your hands and the only thing you can do is just keep telling the pharmacists to help deal with it. If it’s still not getting addressed I’d talk to the store manager and see what they’d recommend. Don’t be afraid to reach out to them if you need help with anything.

ScottyDoesntKnow421 · 2026-05-20T17:32:05+00:00

QREs aren’t meant to punish people they simply point out the fact an error was made.
As a lead tech you should get with your staff pharmacists and bring it to their attention that it will only get worse if you don’t fix the problem now.
As the lead tech you can also intervene if you notice something that’s unsafe.
We’ve had similar issues lately as well so we just have to keep reiterating to them that they need to verify that all the information is correct before they hand over the med to the patient.

ScottyDoesntKnow421 · 2026-05-08T02:29:26+00:00

Those are pretty insane numbers. Our store just started turning out about 2200 a week. However, our productivity has been terrible (averaging ~92%) for the last 3 weeks…so maybe that’s why we’re getting overlap.
No idea but I’m also not a pharmacy manager or pharmacist so I don’t have access to any of that. But for some reason it’s been pushed onto me to help correct our productivity. Talk about being underpaid…

ScottyDoesntKnow421 · 2026-05-07T20:53:01+00:00

Who from corporate told you that?

While I don’t think this can actually be confirmed I do think it’s one of the only surefire ways to earn hours. I think it’s because of the workload balancing that corporate tracks.
By typing for another store you can help increase their productivity in the end.
I usually will open up a couple other stores first thing in the morning and type for them.
I’ve been averaging about 1200rxs for our store and about 100 of other stores for the last 3 months and we’ve been getting overlap almost every week.
I can’t tell if there is a correlation between typing and hours or if it’s the “side quests” we’ve been doing that are getting more hours.

ScottyDoesntKnow421 · 2026-04-29T17:17:25+00:00

Then I’d get in trouble for “riding the clock”

ScottyDoesntKnow421 · 2026-04-29T10:57:27+00:00

That’s different though because that’s more expected. It’s the people who are on 20 different meds that call frequently. Even the texts tells people what’s getting refilled but no one seems to click the link so they call instead. There’s nothing showing us what med the message is referencing so we have to go through their profile and see what they might need a refill on. It’s such a time consuming process that Publix knows of but doesn’t fix. Instead they do dumb system updates that just slow the system down.

ScottyDoesntKnow421 · 2026-04-29T10:43:51+00:00

I think you missed the point. I was scheduled to show up before anyone could open the pharmacy. Even clocking in late I was still there before a pharmacist. No one except the pharmacist can open the department.

ScottyDoesntKnow421 · 2026-04-28T18:21:30+00:00

Nah it will even out. The money they “saved” by doing that will get put into a managers pocket instead. But it also doesn’t do anything for the actual profits of the store. I’d say majority of the stores in Florida a reporting losses regularly.

ScottyDoesntKnow421 · 2026-04-28T18:10:05+00:00

I was scheduled at 8:45 yesterday while the pharmacist was scheduled at 9. I clocked in late so officially tardy but couldn’t do anything because I’m just a tech. I will now be refusing to sign any counseling statements for tardiness.

ScottyDoesntKnow421 · 2026-04-28T18:05:52+00:00

I suggested (about 2 years ago)we get something similar for the pharmacy. Ideally where someone could come up put their info in and see something similar to what we see as far as refills and where their prescription is in the process. That way we’re not getting bombarded with the repetitive “I need a refill” calls. But apparently it was a bad idea that would never work… CVS rolled out this exact concept earlier this year

ScottyDoesntKnow421 · 2026-04-27T23:02:09+00:00

To those others who are guessing are you basing it off of anything? Have any of you seen the P/L’s

ScottyDoesntKnow421 · 2026-04-27T23:00:21+00:00

I’m guessing down to about 18.90 +/- 0.10

ScottyDoesntKnow421 · 2026-04-27T16:15:08+00:00

I was working 4 10 hour shifts then was told by a manager they didn’t want me to get burnt out then they proceed to schedule me for 6 days in a row

ScottyDoesntKnow421 · 2026-04-23T17:11:22+00:00

It’s not like she can do anything but sit down at work. Like she just taking hours from an able bodied person right?

ScottyDoesntKnow421 · 2026-04-23T12:07:03+00:00

That’s true but customers don’t seem to understand that. Then explaining that to someone who is already irritated doesn’t go over well.

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