Current market trend and reimbursement rates

[ZakMeister]

How generous have the PBMs been of late with regards to fairly new generics that are out in the market? They tend to be expensive, particularly the one which are not made by multiple mfts. Are you guys getting a fair deal at all? Has generic abilify reached your shelves yet?

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[SClENCE]

I haven't seen generic Abilify yet but I can tell you that some insurance plans still don't even cover Esomeprazole lol.

 

[PharFromNormal]

I haven't seen generic Abilify yet but I can tell you that some insurance plans still don't even cover Esomeprazole lol.

Many won't ever. OTC "equivalents" are often not covered.

 

[MountainPharmD]

Generous and PBM should not appear in the same paragraph.

 

[CynicalIntern]

How generous have the PBMs been of late with regards to fairly new generics that are out in the market? They tend to be expensive, particularly the one which are not made by multiple mfts. Are you guys getting a fair deal at all? Has generic abilify reached your shelves yet?

Most insurance plans won't cover generic esomeprazole. My theory is that they all negotiated their contract with AZ to expire at approximately the time it was supposed to go generic, and when Ranbaxy ****ed everything up by being a terrible manufacturer, they had to renew for longer than they expected in order to keep a reasonable rebate coming back to them. The price point on that generic esomeprazole isn't significantly cheaper, so the PBM is probably doing better on brand name - rebate anyways. Generic Colcrys is the same way, as is the Vivelle-Dot - if the price point is only about 10% cheaper, the insurance will stick with the brand.

Generic Abilify, on the other hand, cost us about 150 bucks for a bottle of 30, as opposed to the grand that the brand name costs. Insurance companies are going to flock to that one, but supply issues are already looking like they're going to be bad - just like Cymbalta was. PBMs *have* been generous on that, because they haven't had a chance to load the new wholesale prices for it into their system, so I'm getting 800 dollars of reimbursement for a 150 dollar drug. That will probably stop as of Monday.

 

[BidingMyTime]

Many won't ever. OTC "equivalents" are often not covered.

The point is these insurances are covering BRAND Nexium, just not the generic Nexium.

 

[PharFromNormal]

The point is these insurances are covering BRAND Nexium, just not the generic Nexium.

Yea the point is rebates. I know NY state Medicaid had a bunch of brands they covered but generics they didn't. Cheaper on the overall system.

 

[BF7]

Most insurance plans won't cover generic esomeprazole. My theory is that they all negotiated their contract with AZ to expire at approximately the time it was supposed to go generic, and when Ranbaxy ****ed everything up by being a terrible manufacturer, they had to renew for longer than they expected in order to keep a reasonable rebate coming back to them. The price point on that generic esomeprazole isn't significantly cheaper, so the PBM is probably doing better on brand name - rebate anyways. Generic Colcrys is the same way, as is the Vivelle-Dot - if the price point is only about 10% cheaper, the insurance will stick with the brand.

Generic Abilify, on the other hand, cost us about 150 bucks for a bottle of 30, as opposed to the grand that the brand name costs. Insurance companies are going to flock to that one, but supply issues are already looking like they're going to be bad - just like Cymbalta was. PBMs *have* been generous on that, because they haven't had a chance to load the new wholesale prices for it into their system, so I'm getting 800 dollars of reimbursement for a 150 dollar drug. That will probably stop as of Monday.

Where are you able to buy generic abilify for anywhere close to $150 per #30?

 

[CynicalIntern]

Where are you able to buy generic abilify for anywhere close to $150 per #30?

My current rate is $151 for 2-15mg, and $197.73 for 20 and 30 through ABC. I'm still getting reimbursed 700+ on most PBMs, so I think we have a really sweet deal - that said, there are a handful that are reimbursing at like 176 or so, so we're not the only outlier.

 

[BF7]

My current rate is $151 for 2-15mg, and $197.73 for 20 and 30 through ABC. I'm still getting reimbursed 700+ on most PBMs, so I think we have a really sweet deal - that said, there are a handful that are reimbursing at like 176 or so, so we're not the only outlier.

Holy! McKesson and PArmed/ TopRX are in the low 400's for 30 counts on the lower strengths! Can I buy some from you?

 

[BF7]

My current rate is $151 for 2-15mg, and $197.73 for 20 and 30 through ABC. I'm still getting reimbursed 700+ on most PBMs, so I think we have a really sweet deal - that said, there are a handful that are reimbursing at like 176 or so, so we're not the only outlier.

I spoke with 2 AB pharmacy owners in texas.. NEITHER One IS ANYWHERE NEAR $150/30 ct. In fact they're paying more than I am $398.. Post an item number and invoice picture. Otherwise why would you lie about something like this?

 

[BenJammin]

I spoke with 2 AB pharmacy owners in texas.. NEITHER One IS ANYWHERE NEAR $150/30 ct. In fact they're paying more than I am $398.. Post an item number and invoice picture. Otherwise why would you lie about something like this?

I have a source who orders with Cardinal. I'll report back via PM, with pics if you want. Our outpatient uses McKesson and we're at $390 I believe.

 

[southpharmindy]

Yeah 495 is the cheapest I've seen for any strength. If you can get it for 150 let me know and I'll buy a bunch of bottles from you.

 

[southpharmindy]

Also, somebody asked how generous PBMs were in regards to reimbursements. Most of the owners I know and have talked to are averaging about 22% gross margins. Works out to about 12-14 dollars per prescription.

 

[BF7]

I have a source who orders with Cardinal. I'll report back via PM, with pics if you want. Our outpatient uses McKesson and we're at $390 I believe.

Sounds good. Please do. My Mckesson after rebate price is $407. I use Parmed and got it for $398 on invoice.

Www.pharmsaver.net is a God send on many generics and they were at $408.

 

[CynicalIntern]

I spoke with 2 AB pharmacy owners in texas.. NEITHER One IS ANYWHERE NEAR $150/30 ct. In fact they're paying more than I am $398.. Post an item number and invoice picture. Otherwise why would you lie about something like this?

I wouldn't.

 

[BF7]

I wouldn't.

You are the MAN and I owe you a steak dinner. Seriously. PM me and I'll mail you a gift card to outback.

That wasn't 340b pricing correct? that is your traditional community pharmacy cost right?

Also can I buy a few of these from you?

 

[southpharmindy]

Good grief. I'm sorry I doubted you! Can I also buy some of these from you?

P.M. me and tell me which wholesaler and buying group you pharmacy uses. If your prices are like that on everything I need to switch.

 

[CynicalIntern]

I'm going to assume that everyone just assumes that any pharmacist who has any idea about the true cost of medications has to be an indy owner? I'm a standard chain slave, I've just got a pretty good business sense, which lets me keep corporate off my back.

 

[southpharmindy]

Eh. That figures. I knew an independent getting drugs at those prices was too good to be true. Probably Walgreens/Amerisource.

 

[MountainPharmD]

I'm going to assume that everyone just assumes that any pharmacist who has any idea about the true cost of medications has to be an indy owner? I'm a standard chain slave, I've just got a pretty good business sense, which lets me keep corporate off my back.

The chains take great precautions to ensure you do not know the true cost of goods sold. It has nothing to do with your business sense. You could quit tomorrow and go across the street and work for a competing chain or you could go onto an internet forum and post the true COGS. The last thing your current employer wants is detailed knowledge of their true COGS getting out.

 

[BidingMyTime]

I wouldn't.

That's incredible pricing. Even for a chain. I'm impressed.

 

[CynicalIntern]

The chains take great precautions to ensure you do not know the true cost of goods sold. It has nothing to do with your business sense. You could quit tomorrow and go across the street and work for a competing chain or you could go onto an internet forum and post the true COGS. The last thing your current employer wants is detailed knowledge of their true COGS getting out.

I understand conceptually, but what's the end result there? Can BF7 call his wholesaler and say "Internet person CynicalIntern gets his abilify for 150 dollars. No I don't know what state he's in, or where he works, but I've seen a screenshot. Why am I paying in the 400s?" - Does that do anything other than get a laugh and a "sorry I can't help you?"

Does CVS Caremark send a spy on the board and find out that one person is making a ton of profit off of their scripts, but he is the outlier, and they change their pricing structure for everyone? I guess that one is conceivably more possible, but if the contract is based on their choice of AWP/WAC/whatever, they have to use to same number for everyone, right? So if they change that WAC to 160 dollars, all the sudden 60% of the world, including presumably some major chains are calling them raging because the numbers are set absurdly below what they're able to get it for. Which, granted, is kind of the nature of PBMs, but...

 

[BF7]

I understand conceptually, but what's the end result there? Can BF7 call his wholesaler and say "Internet person CynicalIntern gets his abilify for 150 dollars. No I don't know what state he's in, or where he works, but I've seen a screenshot. Why am I paying in the 400s?" - Does that do anything other than get a laugh and a "sorry I can't help you?"

Does CVS Caremark send a spy on the board and find out that one person is making a ton of profit off of their scripts, but he is the outlier, and they change their pricing structure for everyone? I guess that one is conceivably more possible, but if the contract is based on their choice of AWP/WAC/whatever, they have to use to same number for everyone, right? So if they change that WAC to 160 dollars, all the sudden 60% of the world, including presumably some major chains are calling them raging because the numbers are set absurdly below what they're able to get it for. Which, granted, is kind of the nature of PBMs, but...

Well, they don't exactly laugh, they just kinda' ignored me. But precedebt was set with generic Cymbalta last year so this abilify pricing difference is entirely believable ( even if we didn't have the screen shot)