Could it be happening soon???

[Doctor M]

First I said nothing about you. I made an analogy about two groups that don't like each other (Tea Party hates Obama Doctor M hates CVS) to make a point that the information you posted was not factual. You don't like CVS and that's fine, I could care less about that, but it is not right to post factually incorrect or misleading information in support of your dislike of said company.

Let me know when you count the increase in value of your 401K as part of your income. Do you say I made X from my salary and y from the profit of my company and z from the increase in my retirement and x+y+z is my income for the year.
You keep calling me names. You imply you know my height and therefore can explain my posts based on my lack of stature (that you have no knowledge of) and just so you know, you are as accurate about my height as you are about Tom Ryan's Salary.

I'll let you know in 5 years Oldtimer...I will be out of this business by 43 years old, i can guarantee you that...

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[PumpkinSmasher]

I'll let you know in 5 years Oldtimer...I will be out of this business by 43 years old, i can guarantee you that...

 

[Doctor M]

First I said nothing about you. I made an analogy about two groups that don't like each other (Tea Party hates Obama Doctor M hates CVS) to make a point that the information you posted was not factual. You don't like CVS and that's fine, I could care less about that, but it is not right to post factually incorrect or misleading information in support of your dislike of said company.

Let me know when you count the increase in value of your 401K as part of your income. Do you say I made X from my salary and y from the profit of my company and z from the increase in my retirement and x+y+z is my income for the year.

You keep calling me names. You imply you know my height and therefore can explain my posts based on my lack of stature (that you have no knowledge of) and just so you know, you are as accurate about my height as you are about Tom Ryan's Salary.

I must have missed that part Oldtimer...Yes, I pulled "my" article out of my rear end...and I beg to differ, you do care, cause if you didnt, you wouldnt put up a fight for said wonderful company CVS...I do care and i admit it...I despise CVS with a passion...Given a choice between working for CVS or having a job from "dirty jobs" i pick a "dirty job"...any one of them jobs from picking up pig doo doo to sanitation...Yes, that is sad...

And i never said i knew your height, i just stated you probably need to compensate to make yourself feel worthy; maybe your lacking in some aspects of your life that you need to make yourself mightier...i dont know and dont care...A napoleon complex, short man syndrome...Im not attacking your height, im attacking your personality, that is all....Either way, if i offended you or your company, i deeply deeply apologize...

 

[Doctor M]

Here's an article worth reading...although i do believe the author is pro-PBM 110%. What I dont understand is this: He states that plan sponsors pick the plan that saves them the most money...Of course CVS/Caremark is gonna make maintenance choice the best plan available for the plan sponsor...CVS pharmacy fills the script and caremark collects the payment, all for CVS/caremark...why not make maintenance choice the best opportunity to save money...


http://www.drugchannels.net/2010/03/pepsi-cvs-caremark-and-ftc.html

I dont believe that Caremark is violating the firewall requirement, but what i do believe is that by them sending letters to my customers that they must use a CVS pharmacy, they are severely violating antitrust laws...I just dont get it...Why not just send them to straight mail order...How does it save the plan sponsor money by the pt filling 3 months at a cvs retail store???? It must be a lower contract rate for the cvs retail store? I doubt that cause either way Caremark collects AWP from the plan sponsor or rebates...Its all one huge pot for CVS/caremark...

I welcome intelligent discussion...

 

[Old Timer]

I'll let you know in 5 years Oldtimer...I will be out of this business by 43 years old, i can guarantee you that...

I hope you retire with wealth and good health and enjoy your life. Just remember, you really can't retire at 43. It's better to wear out than rust out....

 

[Doctor M]

I hope you retire with wealth and good health and enjoy your life. Just remember, you really can't retire at 43. It's better to wear out than rust out....

Thanks oldtimer...you as well...

 

[Doctor M]

http://www.ncpanet.org/media/releases/2009/ftccvs.php

I can post these articles all day...upsetting to say the least....

 

[Doctor M]

http://ncpanet.wordpress.com/2010/04/01/cvs-caremark-to-congress-we’re-not-that-bad/

Drug store-PBM = bad for everyone

 

[Old Timer]

Here's an article worth reading...although i do believe the author is pro-PBM 110%. What I dont understand is this: He states that plan sponsors pick the plan that saves them the most money...Of course CVS/Caremark is gonna make maintenance choice the best plan available for the plan sponsor...CVS pharmacy fills the script and caremark collects the payment, all for CVS/caremark...why not make maintenance choice the best opportunity to save money...


http://www.drugchannels.net/2010/03/pepsi-cvs-caremark-and-ftc.html

I dont believe that Caremark is violating the firewall requirement, but what i do believe is that by them sending letters to my customers that they must use a CVS pharmacy, they are severely violating antitrust laws...I just dont get it...Why not just send them to straight mail order...How does it save the plan sponsor money by the pt filling 3 months at a cvs retail store???? It must be a lower contract rate for the cvs retail store? I doubt that cause either way Caremark collects AWP from the plan sponsor or rebates...Its all one huge pot for CVS/caremark...

I welcome intelligent discussion...

It was a very interesting article and I agree this is a very pro-industry guy. He does point out the major flaw in our health care system in that the payer and the consumer are not the same person and they do not have the same interests. That is where most of the conflict in our health care system comes from.

Next, disabuse yourself of the notion that AWP means anything. When they bid these contracts they hone them down pretty well. Unless you know for a fact that PBM's charge straight AWP and then work off of the inside discount, I think it's reckless to make such an unsupported statement. The amount of profit varies depending on the year of the contract, the size of the group, the competition at any given time with Express Scripts and Medco.

The major thing I agree on is the legality of Maintenance Choice. It's a closed network. I personally think, as I have stated many times before, that as long as you are willing to accept the reimbursement you should be allowed to participate in any plan in the country. I was in favor of this when I fought the PBM's 20 years ago and I am in favor of this now even though I work for a company that owns a PBM. I don't think closed networks are right or good, but they are legal.

As for sending letters to "your" patients, they are "Caremarks" patients as well and there is nothing wrong with informing them that a 90 day supply is available at retail as well. They don't charge the plan anything different and they don't charge patient anything different. Once they have a mandatory mail order they are lost to you anyway.

I think the way to go is for all of pharmacy to push for any willing provider legislation. Short of a single payer system that's the only way to stop closed networks...

 

[Old Timer]

http://www.ncpanet.org/media/releases/2009/ftccvs.php

I can post these articles all day...upsetting to say the least....

http://ncpanet.wordpress.com/2010/04/01/cvs-caremark-to-congress-we’re-not-that-bad/

Drug store-PBM = bad for everyone

You realize these are as obnoxiously anti Caremark as the other article was obnoxiously pro Caremark.

I don't think many of the claims in the first NCPA article will stand up to scrutiny.

You worked at CVS, did you ever get information from Caremark or Corporate to fill prescriptions for somebody not in your system? I never have.

I have dealt with their specialty mail order provisions, but again the plan sponsor has to sign up for that. The patient is given the information but chooses not to pay attention until they need something now.

I don't like everything CVS does. They are just a big company trying to make as much money as possible for their share holders. During the recession, they cut everything but jobs. They have treated me well, but I also know that I could get a new DM or Supe tomorrow and life could suck for me. That's the way the corporate world works and I accept that. I have another 13 years to go. I go in, I do the best I can and I go home. I have no skin in the game....

I don't mind the give and take. I like a good discussion without name calling. A little sarcasm is ok, but don't dehumanize your opponent if you can't defeat his/her arguments.

 

[Doctor M]

It was a very interesting article and I agree this is a very pro-industry guy. He does point out the major flaw in our health care system in that the payer and the consumer are not the same person and they do not have the same interests. That is where most of the conflict in our health care system comes from.

Next, disabuse yourself of the notion that AWP means anything. When they bid these contracts they hone them down pretty well. Unless you know for a fact that PBM's charge straight AWP and then work off of the inside discount, I think it's reckless to make such an unsupported statement. The amount of profit varies depending on the year of the contract, the size of the group, the competition at any given time with Express Scripts and Medco.

The major thing I agree on is the legality of Maintenance Choice. It's a closed network. I personally think, as I have stated many times before, that as long as you are willing to accept the reimbursement you should be allowed to participate in any plan in the country. I was in favor of this when I fought the PBM's 20 years ago and I am in favor of this now even though I work for a company that owns a PBM. I don't think closed networks are right or good, but they are legal.

As for sending letters to "your" patients, they are "Caremarks" patients as well and there is nothing wrong with informing them that a 90 day supply is available at retail as well. They don't charge the plan anything different and they don't charge patient anything different. Once they have a mandatory mail order they are lost to you anyway.

I think the way to go is for all of pharmacy to push for any willing provider legislation. Short of a single payer system that's the only way to stop closed networks...

But dont you think, even if its not AWP they charge, they are keeping a huge chunk of the generic price? For example, if i get paid a total 7.50 cents for 30 amlodipine, from caremark but then the pt goes to CVS and the pharmacy gets paid $20 and caremark keeps $35. Why am I reduced to MAC pricing? I know that there are contracts and we accept what they are willing to pay...But why cant i accept a 90 day contract with caremark if im willing to accept their terms for "maintenance choice"?

In regards to the letters, caremark or express scripts or Medco may be providing DURS, doing formularies, but i consider a patient someone that i have direct contact almost everyday and I provide the medication that patient needs...I consider them my patient, one who ive known for years and taken care of for years...A caremark pharmacist or medco or express scripts has little to no patient relationship...I consider it a patient-pharmacist relationship. Its hard for me to recognize a patient of mine also being a patient for a PBM...

Also, what do you mean by the size of the group? Also, how do you explain the VAST difference in reimbursement between CVS and a small independent for the drug spmvastatin when the PBM is Caremark...I read that the independent got paid 4 dollars from the PBM and a $5 copay for a total of $9 dollars...CVS/caremark was paid a total of $165 for the same drug...This was a medicare plan with the PBM caremark...It just seems so anticompetitive...very frustrating...but we make do with state sponsored plans and cash paying pts...

 

[Doctor M]

You realize these are as obnoxiously anti Caremark as the other article was obnoxiously pro Caremark.

I don't think many of the claims in the first NCPA article will stand up to scrutiny.

You worked at CVS, did you ever get information from Caremark or Corporate to fill prescriptions for somebody not in your system? I never have.

I have dealt with their specialty mail order provisions, but again the plan sponsor has to sign up for that. The patient is given the information but chooses not to pay attention until they need something now.

I don't like everything CVS does. They are just a big company trying to make as much money as possible for their share holders. During the recession, they cut everything but jobs. They have treated me well, but I also know that I could get a new DM or Supe tomorrow and life could suck for me. That's the way the corporate world works and I accept that. I have another 13 years to go. I go in, I do the best I can and I go home. I have no skin in the game....

I don't mind the give and take. I like a good discussion without name calling. A little sarcasm is ok, but don't dehumanize your opponent if you can't defeat his/her arguments.

Thats why i dont believe there are any firewall issues...I believe there are issues when the plan sponsor sits down with caremark and caremark lays the options on the table...i wonder if they say:

Heres our first option, A, which is good, but why not go with Option B, in fact lets talk about option B some more and let us tell you how we can save you big money...

I never had Caremark contact me about a patient and when we did bridge supplies we had caremark call us for the transfers, so i dont believe there are firewall issues...And yes these articles are skewed to opposite ends...NCPA, sooooo Pro-independents...

Im not one to post false facts or post incorrect info on purpose, and im down for good discussion, but your post inferred that i was all wrong and my facts were skewed, when what we really had was two different articles stating the facts in two different ways...I would rather of discussed it than put on a show for this forum

 

[Doctor M]

I truly believe that CVS/Caremark will either be broken up, or they will have to open their retail network...They can keep the mail order option, but open the retail option network...I mean you have to at least agree that they should at least allow the pt use what ever pharmacy they want at the retail level and mail order for cost savings opportunities...We cant even compare apples to apples when you talk about CVS/Caremark and other retail chains including independents...

 

[Old Timer]

I truly believe that CVS/Caremark will either be broken up, or they will have to open their retail network...They can keep the mail order option, but open the retail option network...I mean you have to at least agree that they should at least allow the pt use what ever pharmacy they want at the retail level and mail order for cost savings opportunities...We cant even compare apples to apples when you talk about CVS/Caremark and other retail chains including independents...

There is a possibility since the Democrats are in control of the FTC. If the R's were in control, there would be no shot.

Remember what I said. I think that closed networks are wrong, but not illegal. So I don't think they will be broken up. I don't think you can show harm. As a matter of fact, the number of indies opening since CVS purchased Caremark has increased. How are they restraining trade. Remember you have make and prove this on a macro scale. Your sales are still increasing and you are growing, so I don't think this is a winnable case. Again the National Organizations are wasting time and money when they should put every single dollar into any willing provider legislation. That would solve the problem....

 

[Doctor M]

There is a possibility since the Democrats are in control of the FTC. If the R's were in control, there would be no shot.

Remember what I said. I think that closed networks are wrong, but not illegal. So I don't think they will be broken up. I don't think you can show harm. As a matter of fact, the number of indies opening since CVS purchased Caremark has increased. How are they restraining trade. Remember you have make and prove this on a macro scale. Your sales are still increasing and you are growing, so I don't think this is a winnable case. Again the National Organizations are wasting time and money when they should put every single dollar into any willing provider legislation. That would solve the problem....

But i will say what a DM said to me 4 years ago at CVS: "We want every script, we are greedy"...

I agree, really any closed network is wrong...I got an rx phoned in today for pegasys kit for a pt and WHI first said it was PA...Ok, PA was done and then it said Non match pharmacy ID. WHI wanted the rx to go to their specialty pharmacy...I called them to argue this cause honestly, i did all the PA work...all the leg work...I tried to argue every case...even saying "you're gonna mail pegasys...hopefully the ice truck dont break down"...Anyhow, WHI has a closed network for drugs like that...At least they let me fill the Ribavirin...

As for CVS, my hatred for stems way beyond what you may think...Yes, the closed network kills me...but also, its just how they treat us as basic human beings... im not talking about salary (cause the pay was good)...for 4 years i worked at a busy store, a store that was not in the best part of town and i gave 110% but it seemed like it was never good enough...DM was a douche as was the store manager...so I quit...

If you dont think they will be broken up, what steps do you think the FTC are going to take to prevent any potential trade issues? What can they do? If the claims that some of these independent pharmacies are true,, then there must be some file sharing occurring...I mean the PBM can see anything if they wanted to...

 

[Old Timer]

But i will say what a DM said to me 4 years ago at CVS: "We want every script, we are greedy"...

That's their job. That's what their shareholders want. Don't worry, they can't possibly achieve it.

I agree, really any closed network is wrong...I got an rx phoned in today for pegasys kit for a pt and WHI first said it was PA...Ok, PA was done and then it said Non match pharmacy ID. WHI wanted the rx to go to their specialty pharmacy...I called them to argue this cause honestly, i did all the PA work...all the leg work...I tried to argue every case...even saying "you're gonna mail pegasys...hopefully the ice truck dont break down"...Anyhow, WHI has a closed network for drugs like that...At least they let me fill the Ribavirin...

We run into this with all PBM's. Aetna has injectable pharmacies, WHI has what you ran into and so does Caremark. They keep inventory down by keeping it in one or two locations. They negotiate a better price

As for CVS, my hatred for stems way beyond what you may think...Yes, the closed network kills me...but also, its just how they treat us as basic human beings... im not talking about salary (cause the pay was good)...for 4 years i worked at a busy store, a store that was not in the best part of town and i gave 110% but it seemed like it was never good enough...DM was a douche as was the store manager...so I quit...

And my experience is just the opposite. I have a great DM who has a Christmas Party and a Summer Barbecue at his home for the PIC's and store managers every year. The attitude of my DM and Pharmacy Supervisor is professional. They don't always agree with everything corporate does, but they do their best to carry out their instructions. They have our backs and they appreciate those who work hard for them. If you don't, you are screwed. The last independent I worked for was like your DM, no matter what I did, it wasn't good enough. If I went right, I should have gone left. I didn't do anything fast enough or well enough. Now I know that I am appreciated and that my work is valued. I also know that could change tomorrow if I get a new DM or Pharmacy Supervisor.

If you dont think they will be broken up, what steps do you think the FTC are going to take to prevent any potential trade issues? What can they do? If the claims that some of these independent pharmacies are true,, then there must be some file sharing occurring...I mean the PBM can see anything if they wanted to...

I think they (the government) will try to limit the type of information the PBM is allowed to share with the retail side of the company. As it is now, the PBM sees every claim, it's what they are doing with the information.

In theory they are trying to leverage information so they can start running MTM services. They envision having Pharmacists call physicians to suggest therapy changes like adding an ACEI to a diabetic patient who has no history of ACEI therapy. They feel with an integrated model they can lower health care costs and make their offerings more palatable to the business that purchase them. They want to get pharmacists away from the count and pour mentality and towards the MTM mentality. Will this work? What are the ramifications for pharmacists? Will it mean we need less of them? Will it create a two tiered system with clinical pharmacists making more than just dispensing pharmacists? Who knows. I don't own a crystal ball....

 

[Old Timer]

Im not one to post false facts or post incorrect info on purpose, and im down for good discussion, but your post inferred that i was all wrong and my facts were skewed, when what we really had was two different articles stating the facts in two different ways...I would rather of discussed it than put on a show for this forum

I don't think you posted incorrect information intentionally. I think you have such a burning hatred for the way CVS treated you that you are willing to believe anything bad about them. When I read this stuff, I just look at the source as well as the content and make sure it passes the smell test. My mother sent me an article during flu season that electric hand driers spread bacteria. A little digging showed the study was paid for by the people that make paper towels.....

 

[Doctor M]

I don't think you posted incorrect information intentionally. I think you have such a burning hatred for the way CVS treated you that you are willing to believe anything bad about them. When I read this stuff, I just look at the source as well as the content and make sure it passes the smell test. My mother sent me an article during flu season that electric hand driers spread bacteria. A little digging showed the study was paid for by the people that make paper towels.....

I would say you are correct...My hatred has diminished a bit, but not by that much...

 

[Doctor M]

That's their job. That's what their shareholders want. Don't worry, they can't possibly achieve it.


We run into this with all PBM's. Aetna has injectable pharmacies, WHI has what you ran into and so does Caremark. They keep inventory down by keeping it in one or two locations. They negotiate a better price


And my experience is just the opposite. I have a great DM who has a Christmas Party and a Summer Barbecue at his home for the PIC's and store managers every year. The attitude of my DM and Pharmacy Supervisor is professional. They don't always agree with everything corporate does, but they do their best to carry out their instructions. They have our backs and they appreciate those who work hard for them. If you don't, you are screwed. The last independent I worked for was like your DM, no matter what I did, it wasn't good enough. If I went right, I should have gone left. I didn't do anything fast enough or well enough. Now I know that I am appreciated and that my work is valued. I also know that could change tomorrow if I get a new DM or Pharmacy Supervisor.



I think they (the government) will try to limit the type of information the PBM is allowed to share with the retail side of the company. As it is now, the PBM sees every claim, it's what they are doing with the information.

In theory they are trying to leverage information so they can start running MTM services. They envision having Pharmacists call physicians to suggest therapy changes like adding an ACEI to a diabetic patient who has no history of ACEI therapy. They feel with an integrated model they can lower health care costs and make their offerings more palatable to the business that purchase them. They want to get pharmacists away from the count and pour mentality and towards the MTM mentality. Will this work? What are the ramifications for pharmacists? Will it mean we need less of them? Will it create a two tiered system with clinical pharmacists making more than just dispensing pharmacists? Who knows. I don't own a crystal ball....

I think we're starting to get on the same page oldtimer...

 

[Old Timer]

I think we're starting to get on the same page oldtimer...

I never thought we were that far apart. It's just you can't understand why I like CVS and it's because your DM and Pharmacy Supervisor were pricks and mine aren't.....

 

[Doctor M]

I never thought we were that far apart. It's just you can't understand why I like CVS and it's because your DM and Pharmacy Supervisor were pricks and mine aren't.....

I think your situation is not the norm...You are very lucky! When I'd wake up to go to work, the misery started...It's a complete 180 now!

 

[StevePerry]

I think we're starting to get on the same page oldtimer...

After reading the last ten pages on this thread, I think you two are ready for your own reality TV show...

 

[Doctor M]

After reading the last ten pages on this thread, I think you two are ready for your own reality TV show...

I agree...it could be old vs young, independent vs chain LOL