Cash only pharmacy

[VictorOfHungerGames]

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Got hit with huge dir fees. Pharmacy lost a ton of money. Im getting tired of this insurance/pbm bs.

What are your thoughts on cash only pharmacy? Ive read a few articles about them most have been financially very successful.

 

[SoylentGreen]

I can't imagine that would work in my area since almost everybody has some sort of insurance and will go wherever their insurance pushes them. Who are these people going to cash only pharmacies?

 

[projektreverb]

Aren’t most compounds not covered? I can imagine that would be a great model in the right area. Compounding cash only pharmacy.

 

[Wickett]

Aren’t most compounds not covered? I can imagine that would be a great model in the right area. Compounding cash only pharmacy.

My friend works at a compounding pharmacy that is cash only and makes a killing. They located to a wealthy area and cater to that crowd.

 

[mentos]

My friend works at a compounding pharmacy that is cash only and makes a killing. They located to a wealthy area and cater to that crowd.

Don't wealthy people have insurance? I don't get it.

 

[projektreverb]

My friend works at a compounding pharmacy that is cash only and makes a killing. They located to a wealthy area and cater to that crowd.

Yup the pharmacy I'm thinking of is exactly the same.

Don't wealthy people have insurance? I don't get it.

I’m at a store in a relatively well off area that does compounding overnight. Compounds rarely go thru insurance. Usually all cash.

 

[VictorOfHungerGames]

My friend works at a compounding pharmacy that is cash only and makes a killing. They located to a wealthy area and cater to that crowd.

Where is he getting all these compound scripts from? Our profit for compounds is somewhere b/w $30-50 per script. That means that we have to do about 20-30 scripts per day to say that we are making good profit.

 

[Sabril]

What's about veterinarian (also compounding i guess)? Surely people are willing to fork over money for their pets?

 

[projektreverb]

What's about veterinarian (also compounding i guess)? Surely people are willing to fork over money for their pets?

We’ve all dealt with patients who argue a 5$ copay every 3 months but gladly pay 50$ plus for a per month on a per. Pets deserve care but i think vet compounding would be easy money.

 

[Hels2007]

I'd only do it if I had a large number of people who already don't mind forking over money for drugs not covered and prefer to not wait a week for prior auth and just pay cash price (I've had that happen occasionally!). Successful ones probably do a lot of legwork to figure out their offerings and their location and their target population.

PS Weren't you just posting very recently how great it is to be an indie and how you can win on good service?

 

[Wickett]

Don't wealthy people have insurance? I don't get it.

Wealthy people also like novel, customized dosage forms, cosmetic compounds, etc to feel special. Those things are almost never covered by insurance.

 

[Wickett]

Where is he getting all these compound scripts from? Our profit for compounds is somewhere b/w $30-50 per script. That means that we have to do about 20-30 scripts per day to say that we are making good profit.

His boss/the owner has had the business a while and has a sizable clientele. They established relationships with specialists that like to really customize treatments for patients (ie HRT, cosmetics, psych, pain management, etc). They also do mail order services and have a multi state network of patients that they'll send out medications to (my friend is licensed in like 5 states). They started local and branched out from there over the years.

 

[Sabril]

PS Weren't you just posting very recently how great it is to be an indie and how you can win on good service?

An indie can go from being great to belly up in a hurry. All it takes is one failed third party audit, or a decrease in reimbursement, or sustained rising costs.You need to hussle on another level to survive in this setting.

 

[Sine Cura]

I'd rather start a boba shop. LOL

 

[VictorOfHungerGames]

An indie can go from being great to belly up in a hurry. All it takes is one failed third party audit, or a decrease in reimbursement, or sustained rising costs.You need to hussle on another level to survive in this setting.

Love working at an indie. It's awesome. Probably the best job a pharmacist can have. Low reimbursements, DIR fees and damn claw backs are killing retail pharmacy in general. I would never go back to working for CVS lol I'd rather become a pilot lol

 

[MilknCheerios]

@VictorOfHungerGames

I've never worked for an independent so I don't see these chargebacks and fees in the same light as you do. We have a link for a history of view them, mostly Medicare B and immunizations billed to medical, but some of them are reversible, no? Like, you can submit appropriate documentation to show why something should be reimbursed? When I talked to my DM (who isn't a pharmacist) about chargebacks , his face took on a glazed-over appearance and recited that it's just the "nature of the business" and do our best to work with them. So, I guess it's kind of nice that even though corporate can be challenging, I don't have to inspect the numbers just to stay afloat.

Honestly, with so much "NotsogoodRx" running around and plans with uber-high deductibles, a cash only pharmacy has the possibility of succeeding. I'll never open one because I'm so risk-adverse, but if you're in a rich community, docs willing to try stuff, and you have the grey matter to research it all, I can see why people do it.

 

[VictorOfHungerGames]

@VictorOfHungerGames

I've never worked for an independent so I don't see these chargebacks and fees in the same light as you do. We have a link for a history of view them, mostly Medicare B and immunizations billed to medical, but some of them are reversible, no? Like, you can submit appropriate documentation to show why something should be reimbursed? When I talked to my DM (who isn't a pharmacist) about chargebacks , his face took on a glazed-over appearance and recited that it's just the "nature of the business" and do our best to work with them. So, I guess it's kind of nice that even though corporate can be challenging, I don't have to inspect the numbers just to stay afloat.

Honestly, with so much "NotsogoodRx" running around and plans with uber-high deductibles, a cash only pharmacy has the possibility of succeeding. I'll never open one because I'm so risk-adverse, but if you're in a rich community, docs willing to try stuff, and you have the grey matter to research it all, I can see why people do it.

Hmm it doesnt quite work that way. Not sure if youve been paying attention but several states now have passed or is about to pass a law to regulate pbms and its opaque practice. The reason for this is because of their immoral practice of unfair reimbursements and clawback/dir fees. Especially the dirs. Stupid amount of dir fees is whats killing independents. We could do several hundred scripts a day and make $5000 in profit but a month later pbm can take away most of that money for dir. the problem with this is, no one except for very few top dogs at pbm know what those dir fees entail. Hell, i hear $200k on some independents for dir fees a year. This is just a robbery at this point.

 

[MilknCheerios]

@VictorOfHungerGames

That's horrible and I feel for you and other independents. I hope the law passes and reins them in. It would be a victory for all pharmacists.

 

[PikminOC]

Hmm it doesnt quite work that way. Not sure if youve been paying attention but several states now have passed or is about to pass a law to regulate pbms and its opaque practice. The reason for this is because of their immoral practice of unfair reimbursements and clawback/dir fees. Especially the dirs. Stupid amount of dir fees is whats killing independents. We could do several hundred scripts a day and make $5000 in profit but a month later pbm can take away most of that money for dir. the problem with this is, no one except for very few top dogs at pbm know what those dir fees entail. Hell, i hear $200k on some independents for dir fees a year. This is just a robbery at this point.

What are dir fees?

 

[VictorOfHungerGames]

What are dir fees?

It stands for Direct and Indirect Remuneration fee. Basically a way for PBMs to take your money without a reason. Also known as stealing. You should google and find out more about it. It is the reason why retail pharmacy is so messed up right now yet since chain pharmacies dont educate their pharmacists, probably on purpose, on these, most are clueless. Schools dont teach this either. This is why i think schools are in on it too.

 

[PikminOC]

It stands for Direct and Indirect Remuneration fee. Basically a way for PBMs to take your money without a reason. Also known as stealing. You should google and find out more about it. It is the reason why retail pharmacy is so messed up right now yet since chain pharmacies dont educate their pharmacists, probably on purpose, on these, most are clueless. Schools dont teach this either. This is why i think schools are in on it too.

Our schools and residency don't teach about malpractice and board complaints because no one would stay with all that responsibility on their heads and ability for licenses to be snatched

 

[VictorOfHungerGames]

Our schools and residency don't teach about malpractice and board complaints because no one would stay with all that responsibility on their heads and ability for licenses to be snatched

Right. I get that its important to learn about like.... stufffff and what not. You know like what statins do and why insulins are important but... if i dont get paid or dont got a job because you didnt teach me about this ONE thing that could keep this profession together, i mean like wtf... lol

 

[RxPal]

This is a nice animation video to educate lay persons about DIR fees. Also urge others to visit the suggested website to urge the Congress to pass the Phair Pricing Act.

 

[quickpic007]

Got hit with huge dir fees. Pharmacy lost a ton of money. Im getting tired of this insurance/pbm bs.

What are your thoughts on cash only pharmacy? Ive read a few articles about them most have been financially very successful.

Ive thought about this quite a bit, it is a fantastic idea. In my mind this works only when costs are low, and you can always win on price (get all good rx patients sent to you, use their pricing but do not pay their fee/claw back.
Partner with a doctor who sees mostly uninsured and writes the same fast movers over and over and over.
I do not think it can match a chain manage salary though.

 

[mentos]

Love working at an indie. It's awesome. Probably the best job a pharmacist can have. Low reimbursements, DIR fees and damn claw backs are killing retail pharmacy in general. I would never go back to working for CVS lol I'd rather become a pilot lol

Do you get benefits? I hear a lot of them don't offer any besides a small amount of vacation time.

 

[VictorOfHungerGames]

Do you get benefits? I hear a lot of them don't offer any besides a small amount of vacation time.

Yeah. I get 401k and medical. Opted out on medical since wifes medical plan is too awesome. Owner pays for it though so im basically covered. Lots of vacation time as well. I honestly dont think he cares as long as pharmacy is filling scripts and its not burned down lol

 

[rph3664]

Back when my parents still had their cat, they got her methimazole gel prescription filled at a cash-only compounding pharmacy. (Yeah, they did take checks and credit cards, but no insurance.) If you have a mostly veterinary clientele, it's definitely doable.

 

[Sparda29]

His boss/the owner has had the business a while and has a sizable clientele. They established relationships with specialists that like to really customize treatments for patients (ie HRT, cosmetics, psych, pain management, etc). They also do mail order services and have a multi state network of patients that they'll send out medications to (my friend is licensed in like 5 states). They started local and branched out from there over the years.

I did a rotation at a place like this. Out east on Long Island.

 

[Wickett]

Back when my parents still had their cat, they got her methimazole gel prescription filled at a cash-only compounding pharmacy. (Yeah, they did take checks and credit cards, but no insurance.) If you have a mostly veterinary clientele, it's definitely doable.

I did an APPE rotation at an indie compounder....probably 1/3 of their scripts were vet compounds.

 

[PharmCompliance.com]

I think a cash-only pharmacy might work, IF you could get exclusive contracts with employers where they pay you, instead of the PBM, for medications. You would also likely have to provide extra value to their employees they can't get elsewhere.

If surgeons can do it, pharmacies potentially could. This article is from a few years ago, but these surgeons have done that exact same thing: What Happens When Doctors Only Take Cash

 

[angelsplight]

Depending on location, it could work out. My current independent had (coronavirus reduced it a lot) a lot of foreigners that come from China and usually go to the local doctors to have scripts sent for 6 months of medications. Of course that come and buy all 6 months in cash and we made a killing from those.

 

[bokonon82]

Got hit with huge dir fees. Pharmacy lost a ton of money. Im getting tired of this insurance/pbm bs.

What are your thoughts on cash only pharmacy? Ive read a few articles about them most have been financially very successful.

I've considered a generic only, cash only, no control pharmacy before. Basically gets rid of half of the bull-crap. Just do a standard markup on everything plus dispensing fees and operation costs, similar to how Costco prices their general merchandise.