May 31, 2009
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Congratulations everyone! Healthcare reform bill passed a few minutes ago. I guess it will be a big acheivement for all Americans.

May you guys share your ideas and views that how would this reform effect the pharmacists' job in the future? I am eager to know everyone's ideas.
 

hwks09

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Less need for pharmacists!
 

Pharmavixen

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From my (extremely superficial) reading thus far, looks like this might be good for pharmacists, as more people with health insurance means more prescriptions, right? But it's hard to say - in a system as complex as yours, it's impossible to predict what effects massive change might have.

Anyway, here's hoping it bodes well for American health care workers. Cheers!
 

Argentium

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From my (extremely superficial) reading thus far, looks like this might be good for pharmacists, as more people with health insurance means more prescriptions, right? But it's hard to say - in a system as complex as yours, it's impossible to predict what effects massive change might have.

Anyway, here's hoping it bodes well for American health care workers. Cheers!
it seems to be good for pharmacists. there is also a provision for mtm
 
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Possible negatives are that cuts in Medicare will cause reimbursements to go down across the board in Health Care. This would hurt the independents. Also, doctors may be encouraged to order less screens for patients, which could hurt nuclear pharmacy. In other sectors of pharmacy, however, the added volume of ~30M to the system, cannot be construed as anything but good for the demand for pharmacists.

I also think we should recognize an excellent point a user recently made in a similar forum. If all of the new schools hadn't opened, and when the economy rebounds we once again faced a shortage of pharmacists, the newly added volume to the health care system could easily have forced the government to regulate more responsibilities to the technicians and permanently reduced the pharmacist demand. I think we are in the clear for our futures.
 
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I think it will affect the profession positively. Ditto on the increased script volume.

I believe there are grants for MTM in this bill - correct? I'm actually rather impressed by how we were represented. Our school's dean is really good about staying in contact with our representative! He is seriously the man.
 

Argentium

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Members of the U.S. House of Representatives have approved an amendment to health care reform legislation that will provide grants for pharmacist-provided medication therapy management services.

The amendment would create a program managed by the Agency for Health Care Research and Quality to award grants for pharmacist-provided medication therapy management services for chronically-ill patients.

ASHP actively lobbied for the inclusion of the amendment and educated congressional staffers on the important contributions that pharmacists provide as part of the health care team.
:thumbup:
 

genesis09

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If script volume increases, retail pharmacies will respond by either building new stores or adding mid-shift pharmacists.
 

PharMed2016

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you mean when script volume increases, right?
I think If is a good word. :laugh: Less disappointment if it doesn't come true.

I'm sure the legislation will have some effect, how much? Well that remains to be seen. Just hope that compensation doesn't fall... but thats better than no job when we get out...
 

Argentium

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MountainPharmD

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If script volume increases, retail pharmacies will respond by either building new stores or adding mid-shift pharmacists.
No they won't. We will be staffed the same or worse than we are now. Take a look at the reimbursement on Medicare Part D patients. It stinks and is only going to get worse. I worked at a Pharmacy that did 85% Medicare part D. Our gross profit margin was 9%. I work at a pharmacy now that does 95% private insurance and the gross profit margin is 24%.

More patients getting prescriptions does not necessarily mean more money. With Medicare it's all about volume. You have to fill more prescriptions with the same staffing levels to generate the same profit margin as private insurance. With Medicare the reimbursement on brand name drugs is around $2.50. You have to do a whole bunch of those to make a profit. You cannot rely on generics to make a profit anymore thanks to Wal-Mart and their four-dollar prescriptions. Now we have some chains giving medications away for free. The name of the game today is volume. Filling the most scripts you can in the fastest time possible with the least amount of staff in order to generate the highest amount of profit. This bill will do nothing to change that and will likely make things worse.

We will not know if this is good or bad until 2014 when most of the changes take effect. It was the same way with Medicare Part D. It was obvious right from the start that the whole plan was a disaster. It took about a year for us to realize just how bad it was.
 
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Argentium

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No they won't. We will be staffed the same or worse than we are now. Take a look at the reimbursement on Medicare Part D patients. It stinks and is only going to get worse. I worked at a Pharmacy that did 85% Medicare part D. Our gross profit margin was 9%. I work at a pharmacy now that does 95% private insurance and the gross profit margin is 24%.

More patients getting prescriptions does not necessarily mean more money. In fact with Medicare you have to more volume with the same staffing levels to generate the same profit margin as private insurance.

Me will not know if this is good or bad until 2014 when most of the changes take effect. It was the same way with Medicare Part D. It was obvious right from the start that the whole plan was a disaster. It took about a year for us to realize just how bad it was.
Well a lot of the 30 million are still going to be on private insurance, not some government run program (if there even will be one).
 
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No they won't. We will be staffed the same or worse than we are now. Take a look at the reimbursement on Medicare Part D patients. It stinks and is only going to get worse. I worked at a Pharmacy that did 85% Medicare part D. Our gross profit margin was 9%. I work at a pharmacy now that does 95% private insurance and the gross profit margin is 24%.

More patients getting prescriptions does not necessarily mean more money. With Medicare it’s all about volume. You have to fill more prescriptions with the same staffing levels to generate the same profit margin as private insurance. With Medicare the reimbursement on brand name drugs is around $2.50. You have to do a whole bunch of those to make a profit. You cannot rely on generics to make a profit anymore thanks to Wal-Mart and their four-dollar prescriptions. Now we have some chains giving medications away for free. The name of the game today is volume. Filling the most scripts you can in the fastest time possible with the least amount of staff in order to generate the highest amount of profit. This bill will do nothing to change that and will likely make things worse.

We will not know if this is good or bad until 2014 when most of the changes take effect. It was the same way with Medicare Part D. It was obvious right from the start that the whole plan was a disaster. It took about a year for us to realize just how bad it was.
It may not be more money for the store but that doesn't mean they won't need more pharmacists to process all those new prescriptions. I never heard of a pharmacist's salary being based on the retail store's profit.
 

Argentium

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It may not be more money for the store but that doesn't mean they won't need more pharmacists to process all those new prescriptions. I never heard of a pharmacist's salary being based on the retail store's profit.
errr lol. wrong thought process!
 
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No they won't. We will be staffed the same or worse than we are now. Take a look at the reimbursement on Medicare Part D patients. It stinks and is only going to get worse. I worked at a Pharmacy that did 85% Medicare part D. Our gross profit margin was 9%. I work at a pharmacy now that does 95% private insurance and the gross profit margin is 24%.

More patients getting prescriptions does not necessarily mean more money. With Medicare it’s all about volume. You have to fill more prescriptions with the same staffing levels to generate the same profit margin as private insurance. With Medicare the reimbursement on brand name drugs is around $2.50. You have to do a whole bunch of those to make a profit. You cannot rely on generics to make a profit anymore thanks to Wal-Mart and their four-dollar prescriptions. Now we have some chains giving medications away for free. The name of the game today is volume. Filling the most scripts you can in the fastest time possible with the least amount of staff in order to generate the highest amount of profit. This bill will do nothing to change that and will likely make things worse.

We will not know if this is good or bad until 2014 when most of the changes take effect. It was the same way with Medicare Part D. It was obvious right from the start that the whole plan was a disaster. It took about a year for us to realize just how bad it was.
I agree that we still do not know much about the details and practical side of the bill. I think we will find out how it would work not earlier than 2014. Everyone of us is now talking based on our assumptions.
 

Rxnupe

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nI think in the long run it will benefit the big chains like CVS, Walgreens, and Wal-Mart- as many of you mentioned- if you just take half the estimate uninsured(15 million) and they get insurance and are able to get to see the doctor more than likely many of them will be on meds- just the idea that if you just kindly say 30 million scripts are going to be written and dispensed- some pharmacy chain is going to welcome that business whether it's a generic or high dollar med.
At my Pharmacy, each week we get projected budget of how many scripts we should fill- most of the big chains go by volume and usually the Pharmacist bonus comes from profit. I encourage my staff to fill all prescriptions even when the MD writes for OTC meds- we fill them as prescription because my chain goes by script volume and not Profit. With out a doubt the Health Reform Bill will mean more business for retail Pharmacies- now whether Retail chains will have increase workload from script volume and keep the same staff is relative to what Chain you work for.
 

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With a low profit margin, a store will inherently reach a limit where the increased number of scripts/workload does not generate enough profit to hire a new pharmacist.

I predict the only ones who'll benefit are the stores that are willing to LOSE money in the pharmacy department and make it up in sales from the rest of the stores. Kroger, Meijer, Walmart will increase while CVS and Walgreens will shrink.
 

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More insured people means more prescriptions written, obviously. maybe we'll get a little boost to avert salary deflation? A girl can dream...

I'd be on the lookout for more data collection on how use of pharmacy products and services affects overall health care spending. If that is positive for a broader population base than the Medicare covered patients, we will probably see an emphasis on increasing the utilization of drugs and drug related service in the general population.

Expect lots of seniors to show up to your pharmacy NOT understanding that the donut hole will not be eliminated fully until 2020.
 

Rxnupe

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With a low profit margin, a store will inherently reach a limit where the increased number of scripts/workload does not generate enough profit to hire a new pharmacist.

I predict the only ones who'll benefit are the stores that are willing to LOSE money in the pharmacy department and make it up in sales from the rest of the stores. Kroger, Meijer, Walmart will increase while CVS and Walgreens will shrink.
I doubt very much that CVS will shrink or Walgreens- let's face it- Walgreens and CVS are true hardcore retail pharmacies. I work for CVS and my particular store averages about 4500 to 5000 scripts a week- we are the busiets by far in the area and within a 2 mile radius we have 2 Walgreens, 2 Wal-Marts, a few independents and a Minyards(supermarket) Pharmacy. I recall about 2 years ago or 3 whichever it was when Wal-Mart first came out with the $4 meds- their(WalMart) business increased to the point where at times we were matching Walgreens price- however, we got to the point where customers were going to WalMart and literally would have to wait 6 hours or so for their prescription and in some days would have to wait over 24 hours because WalMart wasn't use to that volume. We got to the point where we no longer match prices and we give customers the option either fill the prescription at CVS and we will at best offer a universal discount plan to your Rx and you can be out of here in 15 minutes or less with your medicine or go to Walmart and pay $4 but wait anywhere between 6 to 24 hours for your meds. Well it got to the point where customers choose quality service rather than getting 4 meds. I promise you in the last year I may have had 2 customers at the most ask if we have the $4 plan and when we said sorry No we don't they still refuse to go to WalMart- and we still do nearly 1500 more scripts than WalMart. Walmart, Krogers, and Albertson/SavOn will NEVER be able to handle volume on a daily basis as a whole the way CVS or WalGreens because they are not designed to handle that volume so no way will they be the big benefactors of the health care reform.
 

p-rog

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I doubt very much that CVS will shrink or Walgreens- let's face it- Walgreens and CVS are true hardcore retail pharmacies. I work for CVS and my particular store averages about 4500 to 5000 scripts a week- we are the busiets by far in the area and within a 2 mile radius we have 2 Walgreens, 2 Wal-Marts, a few independents and a Minyards(supermarket) Pharmacy. I recall about 2 years ago or 3 whichever it was when Wal-Mart first came out with the $4 meds- their(WalMart) business increased to the point where at times we were matching Walgreens price- however, we got to the point where customers were going to WalMart and literally would have to wait 6 hours or so for their prescription and in some days would have to wait over 24 hours because WalMart wasn't use to that volume. We got to the point where we no longer match prices and we give customers the option either fill the prescription at CVS and we will at best offer a universal discount plan to your Rx and you can be out of here in 15 minutes or less with your medicine or go to Walmart and pay $4 but wait anywhere between 6 to 24 hours for your meds. Well it got to the point where customers choose quality service rather than getting 4 meds. I promise you in the last year I may have had 2 customers at the most ask if we have the $4 plan and when we said sorry No we don't they still refuse to go to WalMart- and we still do nearly 1500 more scripts than WalMart. Walmart, Krogers, and Albertson/SavOn will NEVER be able to handle volume on a daily basis as a whole the way CVS or WalGreens because they are not designed to handle that volume so no way will they be the big benefactors of the health care reform.

So, let me get this straight. you're saying Walmart- one of the highest volume retail companies in the world- is not equipped properly to handle high volume?
 

Silvermist

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Re. prescriptions not being profitable enough to justify hiring more pharmacists:

Isn't pharmacy largely considered a loss leader now? As in, patient gets a generic script, goes to Walmart for his $4 drug. Pharmacist sighs and shrugs because he knows Walmart is losing money on the deal .... While the patient is waiting, he notices there is a flat screen TV on sale! And maybe his wife comes along, and while she's waiting she browses in the kids clothing section and gets $75 worth of Mary Kate and Ashley merch. And look, a rollback on a jumbo pack of diapers! And the kid has come along too and sees a $40 toy that s/he just HAS to have ... and while they are shopping there, may as well pick up some toilet paper, dish soap -- and look at those cool new BBQs for sale cheap!!

All of a sudden that $4 generic more than pays for itself, see? But it was the prescription that got them in the door to shell out $$ on other things. So I'm not sure it's as simple as saying that they wouldn't hire more pharmacists based simple on reimbursement rates. They definitely might hire more pharmacists to attract more customers in for "real" shopping while they wait.
 

type b pharmD

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Re. prescriptions not being profitable enough to justify hiring more pharmacists:

Isn't pharmacy largely considered a loss leader now? As in, patient gets a generic script, goes to Walmart for his $4 drug. Pharmacist sighs and shrugs because he knows Walmart is losing money on the deal .... While the patient is waiting, he notices there is a flat screen TV on sale! And maybe his wife comes along, and while she's waiting she browses in the kids clothing section and gets $75 worth of Mary Kate and Ashley merch. And look, a rollback on a jumbo pack of diapers! And the kid has come along too and sees a $40 toy that s/he just HAS to have ... and while they are shopping there, may as well pick up some toilet paper, dish soap -- and look at those cool new BBQs for sale cheap!!

All of a sudden that $4 generic more than pays for itself, see? But it was the prescription that got them in the door to shell out $$ on other things. So I'm not sure it's as simple as saying that they wouldn't hire more pharmacists based simple on reimbursement rates. They definitely might hire more pharmacists to attract more customers in for "real" shopping while they wait.
Well you look at chains, and if places like Doctor M's place is making on average $16 a script or so.. and you gotta expect chains to be making more money on an individual script, but that is offset some by dealing maybe with more patients like medicare and having promotions. But clearly they are still making a lot of money on drugs.. But you think they are discounting their most profitable drugs to $4 ??

I agree that $4 generics are for getting people in the door, not only to buy more store items but also to drop off more expensive or profitable scripts.

But pharmacies as a whole are not operating at a loss just to attract people to enter stores.
 

Silvermist

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Well you look at chains, and if places like Doctor M's place is making on average $16 a script or so.. and you gotta expect chains to be making more money on an individual script, but that is offset some by dealing maybe with more patients like medicare and having promotions. But clearly they are still making a lot of money on drugs.. But you think they are discounting their most profitable drugs to $4 ??

I agree that $4 generics are for getting people in the door, not only to buy more store items but also to drop off more expensive or profitable scripts.

But pharmacies as a whole are not operating at a loss just to attract people to enter stores.
Nah, I was just using Walmart as an example =) I know a little about retail, having worked on the non-pharmacy side of an independent store, and to varying degrees I know that the WalMart example is applicable. Rite Aid, for example, has huge markups on everything from diapers to shampoo in comparison with other local stores. And even stores that don't deal with prescriptions at all - like health food stores - have a flagship series of merchandise that can attract people into the store (say, in a small grocery store, low-carb food, gluten-free food, fresh random organic vegetables) on which they will not make a huge profit, but they expect people to buy higher-profit items while entering the store for just the niche low-margin ones.

It's just a pattern I've noticed often enough for me to believe it's a deliberate strategy.