My Last day at CVS 7/16/09

[MountainPharmD]

What Dr. M is getting at is CVS is a ****ty company and what they are doing is illegal and they know it. They will do it until they are forced to stop all the while making millions of dollars in profit that will pale in comparison to any fine they may receive. The merger should have never been allowed, is totally illegal and bad for the whole profession.

PBM's are destroying pharmacy and not saving anyone a dollar like they claim. The same profit is being made off prescription drugs only now the largest part of it is going to the PBM's.

---

Members don't see this ad.

 

[Doctor M]

That's misleading. If Caremark did not merge with CVS, your partner still wouldn't be able to pick up med at his pharmacy. He would have to go thru Caremark mail order pharmacy.

Not necessarily, if cvs did not merge with caremark, these so called rules may not have been into place...Whats misleading is CVS/Caremark "rules"...

 

[Doctor M]

What Dr. M is getting at is CVS is a ****ty company and what they are doing is illegal and they know it. They will do it until they are forced to stop all the while making millions of dollars in profit that will pale in comparison to any fine they may receive. The merger should have never been allowed, is totally illegal and bad for the whole profession.

PBM's are destroying pharmacy and not saving anyone a dollar like they claim. The same profit is being made off prescription drugs only now the largest part of it is going to the PBM's.

Wow, maybe i should just go through you to get my point across...nicely said...

 

[Doctor M]

I thought the antitrust ball was already rolling on them. I could be wrong though. It happens.

Yes, the ball is rolling...but it will be a long time before they break this up...

 

[PharmDstudent]

A lot! realize my partner and I paid cash; no loans. about 125k-150k

Seriously? That's all?
I would have guessed like 300-500k.

Please. Tell me how you got by on 125-150k.

 

[Doctor M]

Seriously? That's all?
I would have guessed like 300-500k.

Please. Tell me how you got by on 125-150k.

I dont know what to tell you...We started with an initial investment of 20k each before we opened, infused cash as needed, and the last time we checked, which was 1 week ago, we figured we had infused about 150k total...you dont need 500k to start an independent...We started with an initial inventory of $25000 legend drugs, and 8k in OTC items... We grew from there...took every dime of profit and infused it back into the business...

 

[PharmDstudent]

I dont know what to tell you...We started with an initial investment of 20k each before we opened, infused cash as needed, and the last time we checked, which was 1 week ago, we figured we had infused about 150k total...you dont need 500k to start an independent...We started with an initial inventory of $25000 legend drugs, and 8k in OTC items... We grew from there...took every dime of profit and infused it back into the business...

What about the real estate? Do you lease? How are the utility bills?

I could save 150k. That's very doable.

 

[Old Timer]

Again with experience comes perspective:

1) First of all, restrictive networks are not something new. They have been in existence since long before Caremark was Caremark and long before CVS bought Caremark.

2) PBM's are evil and unfortunately they are not going away. I think one of the reasons CVS bought Caremark was becuase if you can't beat them join them.

3) Mail order has always been a rip off to independents. It was that way 20 years ago and it's that way now. CVS/Caremark is doing nothing that hasn't been done since PBM's came into existence.

What I don't know is CVS accessing information from Caremark in an unlawful manner. I guess only time will tell. There are supposed to be safeguards in place to prevent this from happening. If you thing the FTC will make CVS divest itself from Caremark, you need to seriously rethink your position, because it's not going to happen.

There is only one way to stop this and it will never happen. Pharmacists and pharmacy owners need to get together and become politically active. There needs to be any willing provider legislation that allows any provider who is willing to accept the reimbursement to participate in any plan. I don't know how that will happen now when we couldn't do it 15 or 20 years ago when there were way more pharmacies than there are now. I don't know this is legal, but is legal.

Don't blame CVS, they couldn't take it either so they bought them out.

 

[Doctor M]

What about the real estate? Do you lease? How are the utility bills?

I could save 150k. That's very doable.

We are leasing with the option to buy in 2011. Our rent is 2350 monthly, payroll for techs is $5000 monthly, utilities around $1300 monthly...business ins $600 monthly, misc expenses $1000. so our bills come out to like 10k monthly. seems like a lot, but expenses do add up!

 

[PharmDstudent]

We are leasing with the option to buy in 2011. Our rent is 2350 monthly, payroll for techs is $5000 monthly, utilities around $1300 monthly...business ins $600 monthly, misc expenses $1000. so our bills come out to like 10k monthly. seems like a lot, but expenses do add up!

Ok. Thanks for sharing.

Did they help you with the floorspace or did you get lucky? I'm looking at some commercial properties right now, and they would need to be reconfigured.

 

[Doctor M]

Ok. Thanks for sharing.

Did they help you with the floorspace or did you get lucky? I'm looking at some commercial properties right now, and they would need to be reconfigured.

We had to remodel the whole place...We got lucky cause my partners father did it all...we have 1600 sq ft of space...pretty good size...

 

[PharmDstudent]

We had to remodel the whole place...We got lucky cause my partners father did it all...we have 1600 sq ft of space...pretty good size...

That sounds so exciting!

 

[museabuse]

Not necessarily, if cvs did not merge with caremark, these so called rules may not have been into place...Whats misleading is CVS/Caremark "rules"...

Shouldn't you be mad at your partner's wife employer and Not cvs? Her employer probably had many options, one option was probably caremark and no restrictions on pharmacies or mailorder but they decided to to go with the cheapest that has restrictions.

 

[Doctor M]

Shouldn't you be mad at your partner's wife employer and Not cvs? Her employer probably had many options, one option was probably caremark and no restrictions on pharmacies or mailorder but they decided to to go with the cheapest that has restrictions.

im more upset at the fact that there even is an option that would sway pts toward CVS because caremark and CVS are 1 company. Please name me another drug store/PBM company that sways pts toward their pharmacies. Again, Mail order facilities are not new, but this is not the case. Pts can either go to CVS or CVS mailorder...No where else...I can see if it was just mail order...Do you see what Im saying...

 

[wes011]

Dr. M.,

I have enjoyed readying this thread (just started about 10 minutes ago) and if I was around I'd make a point to bring you my scripts and shake your hand. I work for a family owned chemical distributor, so I understand the feeling of wanting to not be the corporate slave.

One thing I was disappointed to learn is that insurance companies do not recognize or pay very little for MTM services. I am hoping that changes, as I always envisioned seeing myself either as a clinician pharmacist or setting up an independent pharmacy with MTM services. Looks like I am going to have to rethink those plans.

 

[Doctor M]

Dr. M.,

I have enjoyed readying this thread (just started about 10 minutes ago) and if I was around I'd make a point to bring you my scripts and shake your hand. I work for a family owned chemical distributor, so I understand the feeling of wanting to not be the corporate slave.

One thing I was disappointed to learn is that insurance companies do not recognize or pay very little for MTM services. I am hoping that changes, as I always envisioned seeing myself either as a clinician pharmacist or setting up an independent pharmacy with MTM services. Looks like I am going to have to rethink those plans.

Wes011,

I urge you to not rethink what you want to do...The PBM's are here to stay for now so dont let anyones experience sway you...Find a niche and stick with it...My pharmacy will survive as will others...The only thing we can do is fight back and trust me we will...Just dont take the attitude 'If you cant beat them, join them', cause then you're no different than the chains...Good luck to you...

 

[Old Timer]

im more upset at the fact that there even is an option that would sway pts toward CVS because caremark and CVS are 1 company. Please name me another drug store/PBM company that sways pts toward their pharmacies. Again, Mail order facilities are not new, but this is not the case. Pts can either go to CVS or CVS mailorder...No where else...I can see if it was just mail order...Do you see what Im saying...

Again this is NOT new. When Rite-Aid (a PA corporation with HQ in the state capital) had their own PBM in the 80's State workers had to go to Rite Aid. This happens all of the time. There are many, many, many plans with closed or restricted networks. I agree that CVS is the 1000 lb gorilla in the room due to it's size, but again this is nothing new....

Like I said, change the law to any willing provider....

 

[Doctor M]

Sometimes I wonder why I post here...Im here telling you all whats going on and some here are like "ehhh...whatever...cant do nuttin about it"...thats exactly the attitude they want you to have...Whatever...Like I said...my issue is with what they do...plain and simple...And we are gonna do whatever we can to fight this...and we will fight the next one and the next one and the next one...Those who wish to sustain a lifetime of being someones slave...by all means, be my guest...and i dont care what some tell you on here...you are a slave at those chains...subconsciosly you tell yourself your not...but you are...Good luck

 

[Doctor M]

http://info.cvscaremark.com/newsroom/press-releases/cvs-drops-three-plans-that-force-mandatory-mail

hmmm...Tom Ryan at his best...Old timer...Your CEO at his best...what a hypocrite...

 

[BMadjuster]

http://info.cvscaremark.com/newsroom/press-releases/cvs-drops-three-plans-that-force-mandatory-mail

hmmm...Tom Ryan at his best...Old timer...Your CEO at his best...what a hypocrite...

"I want to be clear," stated Mr. Ryan. "We are not opposed to dispensing
medication through mail order services. However, we are opposed to forcing patients to use a mail order service and then dictating which mail order pharmacy to use. At best, this practice eliminates patient choice and deprives them of the opportunity to obtain personal counseling from a community pharmacist. At worst, it is unfair and anti-competitive."

What a load of crap. His minions will speak no ill will of him though.

 

[owlegrad]

Sometimes I wonder why I post here...Im here telling you all whats going on and some here are like "ehhh...whatever...cant do nuttin about it"...thats exactly the attitude they want you to have...Whatever...Like I said...my issue is with what they do...plain and simple...And we are gonna do whatever we can to fight this...and we will fight the next one and the next one and the next one...Those who wish to sustain a lifetime of being someones slave...by all means, be my guest...and i dont care what some tell you on here...you are a slave at those chains...subconsciously you tell yourself your not...but you are...Good luck

Is this not a little disrespectful towards slaves? Equating what most Americans would call an excellent career choice with slavery seems dismissive toward a very real problem. Perhaps I am too PC?

 

[BMBiology]

unfortunately, the word "slave" is a pretty accurate description. I was once a slave but now, I am free, freE, FREE! Hell, now I even have a few slaves of my own.

 

[BMadjuster]

Is this not a little disrespectful towards slaves? Equating what most Americans would call an excellent career choice with slavery seems dismissive toward a very real problem. Perhaps I am too PC?

Some people...

 

[Doctor M]

Is this not a little disrespectful towards slaves? Equating what most Americans would call an excellent career choice with slavery seems dismissive toward a very real problem. Perhaps I am too PC?

That is just stupid...grow up...Again, i ask myself why i post here...

 

[MountainPharmD]

That is just stupid...grow up...Again, i ask myself why i post here...

Don't get discouraged Dr. M. You are one of the few people on here who understands what is going on. It is nice to have a voice of reason amongst all the senseless babble. Keep at it...try and get as many to understand as possible and forget about the rest.

 

[Doctor M]

Don't get discouraged Dr. M. You are one of the few people on here who understands what is going on. It is nice to have a voice of reason amongst all the senseless babble. Keep at it...try and get as many to understand as possible and forget about the rest.

Dont you worry mountainPharmD...i will keep at it and try to make these "students"get it...as well as other who have been in the business a long time...Please read the article below wriiten by the WSJ in Nov 2009:

http://online.wsj.com/article/BT-CO-20091105-718822.html

I love this part the best:

"remains confident that its business practices and service offerings, which are designed to reduce health-care costs and expand consumer choice, are being conducted in compliance with the antitrust laws"

OLD TIMER...I KNOW there are mail order facilities out ther and blah blah blah...but please name me one other PBM/pharmacy company that does what they do...and rite Aid does not count...They barely exist anymore...Im speaking about Drug store/PBM owning each other...As I understand, WHI and walgreens do not practice this...

 

[wes011]

Wes011,

I urge you to not rethink what you want to do...The PBM's are here to stay for now so dont let anyones experience sway you...Find a niche and stick with it...My pharmacy will survive as will others...The only thing we can do is fight back and trust me we will...Just dont take the attitude 'If you cant beat them, join them', cause then you're no different than the chains...Good luck to you...

Thank you for the response, and I assure you, I will not go quietly into the night.

 

[museabuse]

im more upset at the fact that there even is an option that would sway pts toward CVS because caremark and CVS are 1 company. Please name me another drug store/PBM company that sways pts toward their pharmacies. Again, Mail order facilities are not new, but this is not the case. Pts can either go to CVS or CVS mailorder...No where else...I can see if it was just mail order...Do you see what Im saying...

first off let me say I am not drinking old timer's kool aid, there are many things wrong with CVS. I also think mandating mail order sucks but this is how I see it.

Your partner's wife employer sat down with caremark but it could have been medco or exspress scripts for all I care. The employer was probably given several options(packages) with different prices. Option a could have been your employees can have no restrictions, these many teirs, blah blah blah at this price. Then there were probably several variations on those options and prices. The cheapest was probably mandatory mail order on maitainance medications. All of the pbms probably have some mandatory mail order options. Now if cvs was not in the picture your partner would have to get meds through mailorder. But now that caremark and cvs are the same they decided to allow pts to get 90 days at cvs using cvs like the mailorder company. The employer went the cheapest route, exactly what I tell xpress customers when they find out they have to use mail order.

Can you fill antibiotics for your partner because if the plan is mandating you have to fill everything through cvs then that is not right especially if you accept all caremark plans. Although hmo's like cigna mandate their pts use their pharmacy.

 

[Old Timer]

Dont you worry mountainPharmD...i will keep at it and try to make these "students"get it...as well as other who have been in the business a long time...Please read the article below wriiten by the WSJ in Nov 2009:

http://online.wsj.com/article/BT-CO-20091105-718822.html

I love this part the best:

"remains confident that its business practices and service offerings, which are designed to reduce health-care costs and expand consumer choice, are being conducted in compliance with the antitrust laws"

OLD TIMER...I KNOW there are mail order facilities out ther and blah blah blah...but please name me one other PBM/pharmacy company that does what they do...and rite Aid does not count...They barely exist anymore...Im speaking about Drug store/PBM owning each other...As I understand, WHI and walgreens do not practice this...

Do you read carefully. I said done before. All I said is this is not new. And Walgreens PBM has done and is doing the same thing. Restrictive networks are not new. I'm sorry you are not acquainted with the facts, but they are what they are.

I also gave you the solution, though you prefer crying in your beer. That's why pharmacy is in the shape it's in. Pharmacy owners spend all their time whining and no time doing anything about it.

 

[Doctor M]

Do you read carefully. I said done before. All I said is this is not new. And Walgreens PBM has done and is doing the same thing. Restrictive networks are not new. I'm sorry you are not acquainted with the facts, but they are what they are.

I also gave you the solution, though you prefer crying in your beer. That's why pharmacy is in the shape it's in. Pharmacy owners spend all their time whining and no time doing anything about it.

You crack me up oldtimer...You should be glad im humble as Im glad you are too...Anyway, we are starting the process of doing something about it...What have you done about it? Do you even care? I wonder if chains started cutting benefts and salaries in relation to reimbursement how many of you would jump...Either way, Yes Oldtimer, I can read but I do thank you for your concern...And I realize there are restrictive networks...But im still looking for that answer oldtimer...Help me help you all

 

[Doctor M]

first off let me say I am not drinking old timer's kool aid, there are many things wrong with CVS. I also think mandating mail order sucks but this is how I see it.

Your partner's wife employer sat down with caremark but it could have been medco or exspress scripts for all I care. The employer was probably given several options(packages) with different prices. Option a could have been your employees can have no restrictions, these many teirs, blah blah blah at this price. Then there were probably several variations on those options and prices. The cheapest was probably mandatory mail order on maitainance medications. All of the pbms probably have some mandatory mail order options. Now if cvs was not in the picture your partner would have to get meds through mailorder. But now that caremark and cvs are the same they decided to allow pts to get 90 days at cvs using cvs like the mailorder company. The employer went the cheapest route, exactly what I tell xpress customers when they find out they have to use mail order.

Can you fill antibiotics for your partner because if the plan is mandating you have to fill everything through cvs then that is not right especially if you accept all caremark plans. Although hmo's like cigna mandate their pts use their pharmacy.

thats exactly my point...there should be NO option to mandate that a caremark pt MUST use only CVS retail drug stores for maintenence medicines...Fine, caremark mail order, i will accept that...But to limit competition amonst drug stores because CVS/Caremark made the cheapest option to only fill at CVS drug stores is absurd. Mail order is one thing, I cant compete with that, but i can compete with CVS and walgreens drug stores... As for Cigna, at least here in florida, Cigna had to open their network because cigna pharmacies had bankers hours...Cigna pharmacies are no more here in the Tampa area....And i do not drink Kool aid

 

[Old Timer]

You crack me up oldtimer...You should be glad im humble as Im glad you are too...Anyway, we are starting the process of doing something about it...What have you done about it? Do you even care? I wonder if chains started cutting benefts and salaries in relation to reimbursement how many of you would jump...Either way, Yes Oldtimer, I can read but I do thank you for your concern...And I realize there are restrictive networks...But im still looking for that answer oldtimer...Help me help you all

I have done 10 times more about this you will ever do. You will be as successful as I was. I tried to get pharmacists together in my community in the 80's when this crap really started, but it was like herding cats. I worked in independent community pharmacy longer than I have been at CVS. I was involved in the lawsuit with US Healthcare when pharmacists were getting ripped off with their capitation payments. It is very difficult to get independent businesses to cooperate with each other especially when they are going up against better funded opposition. I personally don't favor any restrictive networks and I do favor any willing provider legislation.

The only point I am making is this all is nothing new. This has been going on for 25 years. CVS will use all of it's power to influence events for their benefit and so will you. If you double your volume, you will call your wholesaler and demand better terms. Less profit for them, more for you. That's the way the world works.

If you organize pharmacists to fight this stuff, you are a better man than I am.

 

[Doctor M]

I have done 10 times more about this you will ever do. You will be as successful as I was. I tried to get pharmacists together in my community in the 80's when this crap really started, but it was like herding cats. I worked in independent community pharmacy longer than I have been at CVS. I was involved in the lawsuit with US Healthcare when pharmacists were getting ripped off with their capitation payments. It is very difficult to get independent businesses to cooperate with each other especially when they are going up against better funded opposition. I personally don't favor any restrictive networks and I do favor any willing provider legislation.

The only point I am making is this all is nothing new. This has been going on for 25 years. CVS will use all of it's power to influence events for their benefit and so will you. If you double your volume, you will call your wholesaler and demand better terms. Less profit for them, more for you. That's the way the world works.

If you organize pharmacists to fight this stuff, you are a better man than I am.

You are extremely sensitive...I actually like it cause its easy to set you off People like me thrive on that, lol. Anyway, I have 40 years to prove you wrong... Again, I will do whatever I can...Bottom Line Oldtimer, Its wrong, its illegal and it will be stopped. This one, CVS/Caremark is not gonna win...