Figuring out what to charge cash customers.

[All4MyDaughter]

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You can't think about the profit made on a per rx basis. Bringing customers into your store, and perhaps continued business is often worth the gamble/investment. You sold them their drugs very cheap. 25 minimum on Augmentin,15 on the Tylenol #3. A good point of reference I always use is Costco. Their website shows cash prices for card carrying members. I had been delivering amazing customer service and building long-lasting relationships by insinuating a customer paying cash (and some drugs aint cheap folks) call Costco and ask me to price match, but I think I might do a Costco+5-10 bux or +20% or something deal in the future instead of an outright match.

A lady paying ~80 bux cash for #90 clonazepam 0.5's with us was able to get the same deal from Costco for 30 bux, so I matched and kept a customer and pleased.

You most certainly DO need to pay attention to profit on a by RX basis. Our owner (who has been an independent pharmacist for 40 years, gets a daily report of how many RXs we are losing money on, how many we make < $2, < $5, etc. on. Sure, losing 25 cents here, $1 there, $ 2 here and there doesn't sound like much, but it adds up. Our state Medicaid changed dispensing fees as of August 1 and he's been very up on how much money we've lost in that time period. It isn't much per RX, but it's going to add up to thousands of dollars when you put it all together. I think most business owners would agree you have to pay attention to the details.

I don't understand what you are saying in the bolded/underlined part. What do you mean by insinuated?

 

[All4MyDaughter]

Let's not forget that single source generics are often the best profit maker for a pharmacy.

LOL. No.

Huh?? No, not at all. If anything, a single source generic is still highly priced and many PBMs reimburse at AWP brand pricing. The best time to make money is when that single source generic loses exclusivity. When Zyprex and Geodon lost exclusivity, that is when pharmacies win. Single source generics are a pain in my ass.

Right. I was going to tackle that one next. We don't do very well with the single source generics at all. And don't get me started on the BS that ensues when brand manufacturers pay to get their branded product preferred over the new generics, so patients are pissed because they've been told, "oh hey, it's going generic, it will be cheaper" and they still get brand and it's not really any lower cost to them.

 

[Doctor M]

You most certainly DO need to pay attention to profit on a by RX basis. Our owner (who has been an independent pharmacist for 40 years, gets a daily report of how many RXs we are losing money on, how many we make < $2, < $5, etc. on. Sure, losing 25 cents here, $1 there, $ 2 here and there doesn't sound like much, but it adds up. Our state Medicaid changed dispensing fees as of August 1 and he's been very up on how much money we've lost in that time period. It isn't much per RX, but it's going to add up to thousands of dollars when you put it all together. I think most business owners would agree you have to pay attention to the details.

I don't understand what you are saying in the bolded/underlined part. What do you mean by insinuated?

We pay attention to each claim we submit. Red numbers are bad, Green is good. Almost always, when a screen pops up with a warning sign that we are losing money, the tech brings it to my or my partners attention. We want to know when we are losing because maybe we dont fill the script or we purchased a more expensive product. Monthly, we lose anywhere between $100-400 dollars on claims. Either due to MAC pricing on a generic that increased in price or we the PBM has reduced the reimbursement due to generics losing exclusivity. The latter is sooooo important cause that can be huge. When a generic loses exclusivity, the price drops by hundreds of dollars!!

 

[Doctor M]

LOL. No.



Right. I was going to tackle that one next. We don't do very well with the single source generics at all. And don't get me started on the BS that ensues when brand manufacturers pay to get their branded product preferred over the new generics, so patients are pissed because they've been told, "oh hey, it's going generic, it will be cheaper" and they still get brand and it's not really any lower cost to them.

The Lipitor fiasco was BS BS BS BS. If ANY of you who know anything about PBMs and still think PBMs are good people, please know that Lipitor was kept on formulary after it went generic because,wait for it.....Because they get R-E-B-A-T-E-S, Yes, Rebates. A given PBM gets the spread, yes, there are spreads on Brands, plus their $16-$20 rebates on each retail claim for that drug. I make 5 dollars, while the PBM makes $30. LOL LOL LOL For a drug i purchased and dispensed, and then, and then, they come and audit me and take back the cost of lipitor plus my 5 dollars profit and leave me with a huge loss and then charge me 15% of the recoupment for their troubles

 

[All4MyDaughter]

We pay attention to each claim we submit. Red numbers are bad, Green is good. Almost always, when a screen pops up with a warning sign that we are losing money, the tech brings it to my or my partners attention. We want to know when we are losing because maybe we dont fill the script or we purchased a more expensive product. Monthly, we lose anywhere between $100-400 dollars on claims. Either due to MAC pricing on a generic that increased in price or we the PBM has reduced the reimbursement due to generics losing exclusivity. The latter is sooooo important cause that can be huge. When a generic loses exclusivity, the price drops by hundreds of dollars!!

Yes, that's how we look at it too. Whenever I get a script to verify that's in the red, I have to give it some thought before I approve it. Sometimes, it's that we've run something incorrectly. I once had an Arixtra script that was losing 1700$ 😱 before we fixed an issue with the quantity (or something). Often, I look at what else the patient is getting filled, and if it all looks OK on balance, I go ahead and fill. When I work, I'm always the only pharmacist, so I have to decide. But I can expect that if I verify something that is losing a lot of money, I'm going to get a call or a note from the owner. He is VERY hands on.

We've had a problem with our generic Lortab 10/500 lately. One generic brand is unavailable and the others raised their prices (OF COURSE). But did the PBMs account for that? No... so we've been losing money left and right. The owner has been making calls, writing letters, etc. Our GPO is fighting the battle too. We finally got notice that Humana had agreed to a higher reimbursement rate retroactive to about a month ago. The other companies... nada.

 

[Doctor M]

Yes, that's how we look at it too. Whenever I get a script to verify that's in the red, I have to give it some thought before I approve it. Sometimes, it's that we've run something incorrectly. I once had an Arixtra script that was losing 1700$ 😱 before we fixed an issue with the quantity (or something). Often, I look at what else the patient is getting filled, and if it all looks OK on balance, I go ahead and fill. When I work, I'm always the only pharmacist, so I have to decide. But I can expect that if I verify something that is losing a lot of money, I'm going to get a call or a note from the owner. He is VERY hands on.

We've had a problem with our generic Lortab 10/500 lately. One generic brand is unavailable and the others raised their prices (OF COURSE). But did the PBMs account for that? No... so we've been losing money left and right. The owner has been making calls, writing letters, etc. Our GPO is fighting the battle too. We finally got notice that Humana had agreed to a higher reimbursement rate retroactive to about a month ago. The other companies... nada.

Did you hear about Humanas amended contract for indys? Like I said, my partner and I are looking into the numbers of future reimbursement of retail pharmacy. There has to be a level of profit sustainability, which is why we are looking at LTC and compounding.

 

[All4MyDaughter]

The Lipitor fiasco was BS BS BS BS. If ANY of you who know anything about PBMs and still think PBMs are good people, please know that Lipitor was kept on formulary after it went generic because,wait for it.....Because they get R-E-B-A-T-E-S, Yes, Rebates. A given PBM gets the spread, yes, there are spreads on Brands, plus their $16-$20 rebates on each retail claim for that drug. I make 5 dollars, while the PBM makes $30. LOL LOL LOL For a drug i purchased and dispensed, and then, and then, they come and audit me and take back the cost of lipitor plus my 5 dollars profit and leave me with a huge loss and then charge me 15% of the recoupment for their troubles

Hell yes. And patients knew Lipitor was going generic so they were EAGERLY awaiting their $1 copays (or whatever) and thought that we were cheating them when it wasn't any cheaper... LMAO. But we explained it to them. Still sucked.

 

[All4MyDaughter]

Did you hear about Humanas amended contract for indys? Like I said, my partner and I are looking into the numbers of future reimbursement of retail pharmacy. There has to be a level of profit sustainability, which is why we are looking at LTC and compounding.

Our owner was recently very upset with Humana. Something about specialty drugs. Is that what you mean? I know they forced some changes that he didn't like but I haven't spent a lot of time with him lately.

 

[Doctor M]

Hell yes. And patients knew Lipitor was going generic so they were EAGERLY awaiting their $1 copays (or whatever) and thought that we were cheating them when it wasn't any cheaper... LMAO. But we explained it to them. Still sucked.

Yeah, totally sucked. 2 years ago, business was much better. I am grateful that we are well diversified but we still get hit hard from these PBMs. We have hired someone to dedicate their time to office work and Audits. Full Time.

 

[All4MyDaughter]

Yeah, totally sucked. 2 years ago, business was much better. I am grateful that we are well diversified but we still get hit hard from these PBMs. We have hired someone to dedicate their time to office work and Audits. Full Time.

Yes, we have a full time business manager who is based out of our #1 location. At the #2 location (where I work), we have a tech who is an accounting major who tracks all of this stuff.

 

[Doctor M]

Yes, we have a full time business manager who is based out of our #1 location. At the #2 location (where I work), we have a tech who is an accounting major who tracks all of this stuff.

It is all numbers and technicalities! ahhhhhh...Independent pharmacy....I still love it though!

 

[Pharmacy Kid]

Come on guys, I know he makes half of his posts up.

 

[Doctor M]

Our owner was recently very upset with Humana. Something about specialty drugs. Is that what you mean? I know they forced some changes that he didn't like but I haven't spent a lot of time with him lately.

The amendment includes a clause where your pharmacy must have a pharmacist available 24/7 365 days of the year or be able to return a call to a patient within 30 minutes. also, if you use a carrier service for delivery, you cannot have more than 30% of your business be delivery. Once again, the reason we wre going LTC and compounding.

http://www.truthrx.org/wp-content/uploads/2011/09/Humana-Pharmacy-Provider-Agreement.pdf

 

[Doctor M]

The amendment includes a clause where your pharmacy must have a pharmacist available 24/7 365 days of the year or be able to return a call to a patient within 30 minutes. also, if you use a carrier service for delivery, you cannot have more than 30% of your business be delivery. Once again, the reason we wre going LTC and compounding.

http://www.truthrx.org/wp-content/uploads/2011/09/Humana-Pharmacy-Provider-Agreement.pdf

I cannot comment on this amendment. Doing so may violate my contract. 🙂

 

[rxlea]

Come on guys, I know he makes half of his posts up.

Sadly, I don't think he does.

 

[297point1]

I'm catching up on this thread from over the weekend...
It's too dang early to start drinking 😱