Anyone have experience with PBMs taking back money due to "overpayment"

[Sparda29]

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Been hearing stuff about Caremark doing something called GER deductions or something with Third Party Station or EPIC to take back money on NDCs that they overpaid on.

Owner bought certain NDCs of generic Zegerid and Doxepin 5% cream that were paying out way above the norm. Eg, Doxepin 5% cream qty #180 would pay out around $5k with a cost of $800. They are looking to take back about 82% of the payment which would bring the new adjusted payment to a little under 1k I believe.

Is this normal?

 

[CetiAlphaFive]

Been hearing stuff about Caremark doing something called GER deductions or something with Third Party Station or EPIC to take back money on NDCs that they overpaid on.

Owner bought certain NDCs of generic Zegerid and Doxepin 5% cream that were paying out way above the norm. Eg, Doxepin 5% cream qty #180 would pay out around $5k with a cost of $800. They are looking to take back about 82% of the payment which would bring the new adjusted payment to a little under 1k I believe.

Is this normal?

The real question is, "what are you gonna do about it?"

 

[Sparda29]

The real question is, "what are you gonna do about it?"

Nothing. Just sip my coffee and watch the owner getting stressed out.

 

[ChalupaBatman86]

Generic Effective Rate % has been a mail order clawback for a long time, didn’t realize it had hit retail. It was designed to avoid mail order pharmacies using generic products not on the MAC list to drive up reimbursement.


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[VictorOfHungerGames]

Been hearing stuff about Caremark doing something called GER deductions or something with Third Party Station or EPIC to take back money on NDCs that they overpaid on.

Owner bought certain NDCs of generic Zegerid and Doxepin 5% cream that were paying out way above the norm. Eg, Doxepin 5% cream qty #180 would pay out around $5k with a cost of $800. They are looking to take back about 82% of the payment which would bring the new adjusted payment to a little under 1k I believe.

Is this normal?

Where are you getting your doxepin from?! You're getting a 45g tube for $200?! If this is real, DM me please! lol

 

[Sparda29]

Where are you getting your doxepin from?! You're getting a 45g tube for $200?! If this is real, DM me please! lol

I think he gets them from either Parmed or Prescriptionsupply or some obscure place in Texas that I can't remember the name of.

 

[VictorOfHungerGames]

I think he gets them from either Parmed or Prescriptionsupply or some obscure place in Texas that I can't remember the name of.

Mind finding out?! We use Parmed but it's not that price lol

 

[CynicalIntern]

I appreciate Sparda threads, they help keep me grounded in reality. When I argue with my partners that it's not worth the time it takes to document the affected areas when the prescriber writes for a pound of triamcinolone cream, I remember that Sparda has a standing order with all his doctors to fill a kiddy pool full of doxepin cream and diclofenac gel and the instructions to roll around in it several times a day as needed for cash flow issues. (And gets mad because those jerks all the sudden want a prior authorization for the drug)

 

[CetiAlphaFive]

Nothing. Just sip my coffee and watch the owner getting stressed out.

Yup. Lol.

I've been getting a kick out of watching the local scammers who chase the local "high AWP" fads losing their pants.

 

[Sparda29]

I appreciate Sparda threads, they help keep me grounded in reality. When I argue with my partners that it's not worth the time it takes to document the affected areas when the prescriber writes for a pound of triamcinolone cream, I remember that Sparda has a standing order with all his doctors to fill a kiddy pool full of doxepin cream and diclofenac gel and the instructions to roll around in it several times a day as needed for cash flow issues. (And gets mad because those jerks all the sudden want a prior authorization for the drug)

I told the guy it's too good to be true. The dude opened up 4 pharmacies last year where the majority of their volume is just these high profit creams. Now he's locked into a lease with 4 pharmacies with no volume and no high profit items that nobody will want to buy/take over.

I have no sympathy for him about this problem. You would think these people would give you a decent bonus. Dude gave me a $5k bonus last year and acted like he was giving me a crazy amount.

The majority of the business at the pharmacy I supervise at is insulins, inhalers, injectable long term antipsychotics, and HIV.