Are PBM's unprofessional work places

[SlaveRPH]

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I would be curious of your thoughts on the functions of pharmacists at PBM's. I refer to the practice of drug switching the patient to so called lower copay drugs, but really higher rebated or profitable drugs for the PBM's. My understanding is that the PBM's pharmacist call doctors and get patients switched to alternate meds. In some cases it not just a matter of brand VS generic it a case of changing to "theraputic equivilent" drugs. I also understand the patient is not contacted just the doctor. Is this correct? Are these activities unprofessional and should not be done by pharmacists.

 

[ZpackSux]

I would be curious of your thoughts on the functions of pharmacists at PBM's. I refer to the practice of drug switching the patient to so called lower copay drugs, but really higher rebated or profitable drugs for the PBM's. My understanding is that the PBM's pharmacist call doctors and get patients switched to alternate meds. In some cases it not just a matter of brand VS generic it a case of changing to "theraputic equivilent" drugs. I also understand the patient is not contacted just the doctor. Is this correct? Are these activities unprofessional and should not be done by pharmacists.

We do it all the time at hospitals. If it's cost effective and the alternative is equivalently efficacious, what's so unethical about it.

 

[bananaface]

I attended a panel discussion last quarter and listened to some PBM pharmacists describe their job roles. The PBM pharmacists I met helped to develop the drug formulary and were available for consulting when exceptions to the formulary were requested. There was no mention of this switching activity. The whole business about calling the physician and requesting a change to a formulary medication is generally done by retail pharmacists. Or, are you talking about mail order? Perhaps you could clarify your question.

 

[SlaveRPH]

The PBM's and the mail order deals are pretty much one and the same. The mail order is the worst area for drug switching. However, the present ajudication process has markers on certain drugs that either won't go through or require extra calls etc on the pharmacists part. Ask a practicing pharmacist they will explain it. The whole formulary deal is nothing more than the PBM's making money by pushing higher rebated drugs. The savings to the employer via mail order is now being questioned. The part I really dislike is the therapeutic substitutions where they can change the type of drug used. For example, allegra was the drug of choice for the local HMO. If a doctor wrote a script for claritin it would be a much higher copay or require a bunch of red tape on the doctor and/or pharmacist's part. So if people got headaches with allegra, which can happen, they had a tough time getting their claritin. Its all a financial game. Patient care is secondary to the PBM's profit. My opinion. Next time the PBM pharmacists are in you should drill them on rebates and drug switching. As far as mail order I question if the generics they use. For example, When I take V-cillinK 500 I can smell it in my urine. Just like you should. I have never taken a generic that did the same thing. Ever smell the brand name keflex and then smell the generic? The generic smells like rotton eggs. Why? Who regulates the PBM's? Check into it. They are not regulated as much as you think. Not as much as a regular pharmacy. The jobs are about production checking or drug switching.

 

[bananaface]

The PBM's and the mail order deals are pretty much one and the same. The mail order is the worst area for drug switching. However, the present ajudication process has markers on certain drugs that either won't go through or require extra calls etc on the pharmacists part. Ask a practicing pharmacist they will explain it. The whole formulary deal is nothing more than the PBM's making money by pushing higher rebated drugs. The savings to the employer via mail order is now being questioned. The part I really dislike is the therapeutic substitutions where they can change the type of drug used. For example, allegra was the drug of choice for the local HMO. If a doctor wrote a script for claritin it would be a much higher copay or require a bunch of red tape on the doctor and/or pharmacist's part. So if people got headaches with allegra, which can happen, they had a tough time getting their claritin. Its all a financial game. Patient care is secondary to the PBM's profit. My opinion. Next time the PBM pharmacists are in you should drill them on rebates and drug switching. As far as mail order I question if the generics they use. For example, When I take V-cillinK 500 I can smell it in my urine. Just like you should. I have never taken a generic that did the same thing. Ever smell the brand name keflex and then smell the generic? The generic smells like rotton eggs. Why? Who regulates the PBM's? Check into it. They are not regulated as much as you think. Not as much as a regular pharmacy. The jobs are about production checking or drug switching.

You might be interested in reading up on the Therepeutic Interchange Program in WA state.

With the insurance related drug switching, the physician can opt not to change the prescription, but pursue a prior authorization instead. I personally appreciate the cost lowering aspect of formularies. Here in WA until 4 the state implemented mandatory generics, they would pay for brand Vicodin and stuff. You know that just went to resale. It was ridiculous. No one said every plan has to cover every drug, either. I do wish they would have to give notice prior to changing their formularies though. I really disagree with the current legal situation on that front.

I find it really interesting that you appear to be against PBMs operating with financial motives, but seem to favor pharmacists doing so.

As long as your stinky pee V-cillin is AB rated, or approved by your physician, there shouldn't be an issue. Aesthetic things go to save cost. In the end, your premiums reflect the difference in the benefits actually used by the people in your insurance cohort. It works like car insurance. If your group costs alot for an insurance company to maintain, everyone's premiums go up the next year. There is no reason not to keep costs down in a reasonable manner. I would like it if the PA system was better. But, I understand why it's there. And, I accept that I have to work within it to ensure that my patients get the care that they need.

 

[ZpackSux]

The PBM's and the mail order deals are pretty much one and the same. The mail order is the worst area for drug switching. However, the present ajudication process has markers on certain drugs that either won't go through or require extra calls etc on the pharmacists part. Ask a practicing pharmacist they will explain it. The whole formulary deal is nothing more than the PBM's making money by pushing higher rebated drugs. The savings to the employer via mail order is now being questioned. The part I really dislike is the therapeutic substitutions where they can change the type of drug used. For example, allegra was the drug of choice for the local HMO. If a doctor wrote a script for claritin it would be a much higher copay or require a bunch of red tape on the doctor and/or pharmacist's part. So if people got headaches with allegra, which can happen, they had a tough time getting their claritin. Its all a financial game. Patient care is secondary to the PBM's profit. My opinion. Next time the PBM pharmacists are in you should drill them on rebates and drug switching. As far as mail order I question if the generics they use. For example, When I take V-cillinK 500 I can smell it in my urine. Just like you should. I have never taken a generic that did the same thing. Ever smell the brand name keflex and then smell the generic? The generic smells like rotton eggs. Why? Who regulates the PBM's? Check into it. They are not regulated as much as you think. Not as much as a regular pharmacy. The jobs are about production checking or drug switching.

You can tell the efficacy of brand vs generic by the odor of your urine? Man you're good.

 

[bananaface]

You can tell the efficacy of brand vs generic by the odor of your urine? Man you're good.

Well, sometimes things like that disturb our patients. But, it is a pretty funny way for someone with a medical background to judge a drug.

 

[ZpackSux]

Well, sometimes things like that disturb our patients. But, it is a pretty funny way for someone with a medical background to judge a drug.

Recommend Asparagus to your patients...for them to void more potent aroma containing urine.

 

[bananaface]

Recommend Asparagus to your patients...for them to void more potent aroma containing urine.

I'll be sure to do this for all of my patients on anticoagulant therapy. 😉

 

[SlaveRPH]

Banana,

I'm surprised as a student of pharmacy science you don't see the very obvious potential the antibiotic tablets are not equivilent. Equivilent means +- 20%. Would this be important for coumadin switching to generic?. Who polices the PBM's. Where do the drugs come from? Oone is already in trouble for redispensing returned drugs. You also miss my point about the PBM's. They were originally a processing center period. Over the years they have entered the drug switching, prescribing steering and huge profit taking area. My point is they sell the so called lower costs of mail order to companies. What really happens is there may or may not be a saving to the company, they push lower cost and in my opinion less effective and/or older technology drugs onto the patient. They suck healthcare dollars out of the health care system unsecessarily and for no benefit to anyone but the PBM's. When you get out of school remember the reason the work conditions are the way they are is the lousy fees paid by PBM's. The chains make up those lousy reimbursments by working pharmacists like slaves. The result is an unprofessional work environment and poor patient pharmacists interaction. Ask yourself how come they won't come out with a scanable benefit card. It would save a bunch of time and make prescription processing easier. This prior authorization crap sucks time from physicians and their staff , the pharmacy and the patient. Have you ever considered the reason they have the cumbersome system is to discourage scripts from going through the system. Out of frustration the patient just pays cash. Medical insurance companies use this method all the time to reduce payouts. In my experience BCBS is the worst. Don't take everything you are told in pharmacy school as the truth either.

 

[MNnaloxone]

This argument becomes not so important when you take into account:
No one forced anyone to enroll into the PBM. You don't like the rules, don't play the game. One can always pay cash if they don't like the benefit.

Don't want to put up with therapeutic interchanges? If we didn't utilize it, no one could afford insurance.

Too many people consider health insurance a right. It is a privilege.

 

[bananaface]

Banana,

I'm surprised as a student of pharmacy science you don't see the very obvious potential the antibiotic tablets are not equivilent. Equivilent means +- 20%. Would this be important for coumadin switching to generic?. Who polices the PBM's. Where do the drugs come from? Oone is already in trouble for redispensing returned drugs. You also miss my point about the PBM's. They were originally a processing center period. Over the years they have entered the drug switching, prescribing steering and huge profit taking area. My point is they sell the so called lower costs of mail order to companies. What really happens is there may or may not be a saving to the company, they push lower cost and in my opinion less effective and/or older technology drugs onto the patient. They suck healthcare dollars out of the health care system unsecessarily and for no benefit to anyone but the PBM's. When you get out of school remember the reason the work conditions are the way they are is the lousy fees paid by PBM's. The chains make up those lousy reimbursments by working pharmacists like slaves. The result is an unprofessional work environment and poor patient pharmacists interaction. Ask yourself how come they won't come out with a scanable benefit card. It would save a bunch of time and make prescription processing easier. This prior authorization crap sucks time from physicians and their staff , the pharmacy and the patient. Have you ever considered the reason they have the cumbersome system is to discourage scripts from going through the system. Out of frustration the patient just pays cash. Medical insurance companies use this method all the time to reduce payouts. In my experience BCBS is the worst. Don't take everything you are told in pharmacy school as the truth either.

I understand your TE stance quite well. We are talking in this scenario about an antibiotic, not a low TI drug. Any pharmacy, mail order or retail, filling a DAW = 0 Rx for Coumadin for a new patient is going to fill for warfarin. Frankly, the generic substitution argument makes little sense. It's not as if they are going outside of the US drug supply or using non AB rated products. They are also not making switches without physician permission.

I realize that the whole process is a pain to discourage the filling of certain prescriptions. But, as I said before, I understand why, from a shared healthcare plan perspective, as a consumer.

I'm not saying that I like mail order; I don't. But, I have different reasons for not likeing it. I am worried that having patients fill maintenance meds and non-maintenance meds with different pharmacies will drastically increase the chance that drug interactions will occur and bring about patient harm. I also worry that patients who do not receive their medications in time will go without.

 

[SlaveRPH]

Naloxzone,
Its sad those who have grown up with so much given to them place no value on what they have. I wonder if you remember the days employees had no benefits. Young folks today take a lot for granted and some such as yoursef have become quite hartless and pompus. I wonder how you would feel making 25k a year and your employer had no benefits(ie see walmart and part time help california). You needed meds and the pharmacy said cash or get lost. I'm not against cost control in pharmacy. However the money "saved" by PBM's goes to their profit not to patient care. PBM's take about 25% of the prescrition costs and provide no service to the patient. If they went back to doing what they were originally designed to do you would have an immeddiate 25% reduction in costs. The other concern I have is none of you have clue about the drugs they use where they come from. Can you testify in a court of law you know for a fact the drug they dispense is in fact AB rated? Who polices the PBM's Ask your professors I'd be curious what they say. It really is very sad you have such a callous attutude. I bet you wouldn't if the shoe was on your foot.

 

[MNnaloxone]

"Young folks such as yoursef"

I'm glad you're such a thoughtful individual to start a pissing match with someone you don't know. That's a pretty good definition of p-o-m-p-o-u-s. If I considered myself young, I might be offended. Quit being bitter and stop the attitude-lest you get some back. (BTW: y-o-u-r-s-e-l-f, also n-a-l-o-x-o-n-e (if you forgot, that's Narcan(tm)...)

You're right, I don't know that the generic is AB-rated any farther than the Orange Book tells me. I also don't know if that gas in my cas is 92 octane or not. Neither instance is particularly my responsibility. If the Orange says it is AB, its AB, and dispensible under many state's laws. End of story. Faulty manufacturing is not my onus.

Twenty-five percent is a large number. Care to check your MACs? As for profit...when was the last time you did anything for free? Again, you don't like it...leave it.

Ever work in as an anticoagulation pharmacist? You really think that 80-125% BA is going to sink an INR? You'll see more INR variation from a patient with the common cold. Don't buy it? Find some literature.

What professor? I don't have any...what I do have is two licenses and a ticket for the BCPS this October. What's sad? People that want something for nothing...especially when that something is paid for with something of mine.

Banana, Caverject, lord999, anyone else I missed...later cats. You can play with Grandpa Welfare. I'll try to drop in to check PMs once in a while if you need some advice/chat/bs/whatever. I've got to go save the federal government a half-million dollars by thinking like a PBM.

 

[Caverject]

It really is very sad you have such a callous attutude.

Wow...you of all people to speak. All you have been since you made your grand arrival here is callous and quite frankly, borderline jackass. Try removing your head from the darkside and maybe you can see the world again.

 

[ZpackSux]

Wow...you of all people to speak. All you have been since you made your grand arrival here is callous and quite frankly, borderline jackass. Try removing your head from the darkside and maybe you can see the world again.

All is not lost... I came because of him...