NYT:At Walgreens, Complaints of Medication Errors Go Missing

[Old Timer]

You realize indies make more profit per script than chain right?

You really must be smoking some really good stuff. CVS Has 10,000 retail locations, a mail order division and a long term care division and a PBM. You seriously underestimate the purchasing power of a company that fills 1/3 of all retail scripts in the USA.. You seem to think Amazon or someone else can out purchase them. Some rinky independent doing 1000 scripts a week. At 52000 scripts per year at an average price of $250.,00 per rx you would have 1.3 million in sales. And I am being generous at $250.00 average per rx. The last store I managed had 5 million in sales per year.

They have enormous purchasing power. Your dinky little independent doing 1K per week doe snot buy anywhere near what CVS buys at. The same goes for everything else. Let's say you want to upgrade your laser printer. You look at Newegg, Tiger Direct, Amazon or BestBuy. They call Lexmark and order 25,000. Who do you think gets the better price per unit?

I have 15 stores in my district. NONE of them do less that 1200 per week. We have multiple store over 3000, one at 5000 and one at almost 10,000. This is a very profitable company. CVS Health is the 8th largest corporation in the USA and the 19th largest in the world. They are enormously powerful and profitable.

You may feel they are understaffed, but they are well run from a financial stand point. No, the average independent is not more profitable than an average CVS. The economies of scale do not compare.

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[deleted898085]

It is not the online stores. It is the low reimbursements and dir fees of pbms. Online pharmacies are not the problem. Amazon does not have the grasp of pharmacy as it does in other retail. Mail order, although messed up and stupid, does not affect enough to a point where it forces cvs and wags to close down and walmart to cut 40% of its pharmacists. It is the PBMs. Look into it. Seriously.

I understand PBMs make pharmacists' wage going down bc all the profits go to PBMs. It looks like there's nothing they can do about it. CVS has to have its own PBM.
But population is up, volume is up. Why are they closing more stores? I think it's bc they have the option to open/expand online stores.
CVS and Walgreens will close brick and mortar stores and open up online stores too?
(and I guess when numbers of brick and mortar stores are closed, layoffs happen.)

 

[deleted898085]

You really must be smoking some really good stuff. CVS Has 10,000 retail locations, a mail order division and a long term care division and a PBM. You seriously underestimate the purchasing power of a company that fills 1/3 of all retail scripts in the USA.. You seem to think Amazon or someone else can out purchase them. Some rinky independent doing 1000 scripts a week. At 52000 scripts per year at an average price of $250.,00 per rx you would have 1.3 million in sales. And I am being generous at $250.00 average per rx. The last store I managed had 5 million in sales per year.

They have enormous purchasing power. Your dinky little independent doing 1K per week doe snot buy anywhere near what CVS buys at. The same goes for everything else. Let's say you want to upgrade your laser printer. You look at Newegg, Tiger Direct, Amazon or BestBuy. They call Lexmark and order 25,000. Who do you think gets the better price per unit?

I have 15 stores in my district. NONE of them do less that 1200 per week. We have multiple store over 3000, one at 5000 and one at almost 10,000. This is a very profitable company. CVS Health is the 8th largest corporation in the USA and the 19th largest in the world. They are enormously powerful and profitable.

You may feel they are understaffed, but they are well run from a financial stand point. No, the average independent is not more profitable than an average CVS. The economies of scale do not compare.

Do you think CVS will close more stores and expand mail order division?
Do you know how Walgreens is operating? Their structure seems different from CVS?

 

[Sine Cura]

You would be raking in the dough at $250 per sold Rx.

 

[confettiflyer]

340b

Or is that a bad word around here


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[footfairy]

You really must be smoking some really good stuff. CVS Has 10,000 retail locations, a mail order division and a long term care division and a PBM. You seriously underestimate the purchasing power of a company that fills 1/3 of all retail scripts in the USA.. You seem to think Amazon or someone else can out purchase them. Some rinky independent doing 1000 scripts a week. At 52000 scripts per year at an average price of $250.,00 per rx you would have 1.3 million in sales. And I am being generous at $250.00 average per rx.

Your point stands about economies of scale, but your example yields 13million in sales/revenue not 1.3 million. I think the quoted average price of a retail RX is around $70 so still a couple million in sales per year.

I wonder how much more negotiating power the big chains have on their contracts. I could actually see a PBM milking them for lower reimbursements since no chain wants to lose a large amount of their rx volume and front end traffic across dozens of store.

 

[PharmDWithaPorscheGT3RS]

More info on how to acquire GT3 RS please

Haven't purchased anything big since graduating 6 years ago. Worked my ass off (full-time + prn) and been saving up to buy my dream car. I have student loan but graduated with <100K. Married but don't have kids yet.

 

[APN-59 rph]

Nothing will change until Pharmacy board members get dragged into court to explain themselves...Until that starts to happen...the chains got them by the nether parts....

 

[APN-59 rph]

Haven't purchased anything big since graduating 6 years ago. Worked my ass off (full-time + prn) and been saving up to buy my dream car. I have student loan but graduated with <100K. Married but don't have kids yet.

Who can even fit in one of those ticket magnets?

 

[PharFromNormal]

What you said is a contradiction. If theyre running at a loss then how is that making a profit?

if you just opened an indie and fill 10 scripts a day then no, youre not gonna have much profit but i said more profit per script. Meaning, if cvs and indie fill for the same script, indie will make more money off of that than cvs. Think about it. Its fairly a simple concept. When we make money, we dont have to worry about corporate greed. We just gotta pay the rent, employees and overhead costs. You may ask, how about cheaper drug prices? There are plenty of vendors that are selling generic drugs dirt cheap. Cvs dont have the options of exploring that either.

But with all the unethical practice of PBMs, we are having to pay for dir fees.

if you run an indie and fill about 1000 per week, trust me, without all these unethical clawback bs, youre gonna be set for life.

As i have posted before, there are now dozens of law suits on state and federal level against PBMs. Hoping that by this time next year, things have changed.

What was in contradiction?

If CVS has 10,000 stores they can use profits from 9,999 to cover one store that is operating at a loss. CVS’s business is managed at a fleet of stores. They will strategically place stores in certain locations knowing the profitability of that location might be lower but having that store there allows them to be in a network that will benefit other profitable stores.

The first part of my statement said another way is this: the most profitable CVS location is more profitable than the least profitable independent.

I would also like to see your sources on a store level profitability. If you take corporate overhead out of the picture, I’m not sure your statement is true... I find it hard to believe that Indy’s have a lower COGS (or acquisition) than a CVS. I imagine you mean same script means same reimbursement. Therefore you are inferring that the indy is purchasing better or have an ever lower operating cost basis than the skeleton crew chains.

 

[PharFromNormal]

I understand PBMs make pharmacists' wage going down bc all the profits go to PBMs. It looks like there's nothing they can do about it. CVS has to have its own PBM.
But population is up, volume is up. Why are they closing more stores? I think it's bc they have the option to open/expand online stores.
CVS and Walgreens will close brick and mortar stores and open up online stores too?
(and I guess when numbers of brick and mortar stores are closed, layoffs happen.)

It’s not even about online stores. It’s about a consolidated footprint. You know what the most profitable prescription a store fills is? The next one. The more scripts a store fills (with the same or a few more labor hours) the more diluted the operating costs become on those prescriptions. They would rather one store filling 4k/week vs 2 x 2k/week. Not only for the operations but consolidate overhead (rent, utilities, etc.). You get supply chain/logistic benefits with less supply delivery routes... there’s a lot...

 

[JustFillIt]

It’s not even about online stores. It’s about a consolidated footprint. You know what the most profitable prescription a store fills is? The next one. The more scripts a store fills (with the same or a few more labor hours) the more diluted the operating costs become on those prescriptions. They would rather one store filling 4k/week vs 2 x 2k/week. Not only for the operations but consolidate overhead (rent, utilities, etc.). You get supply chain/logistic benefits with less supply delivery routes... there’s a lot...

Yes - thank you... the more Rx we sell the more money is made.. gotcha

 

[deleted898085]

It’s not even about online stores. It’s about a consolidated footprint. You know what the most profitable prescription a store fills is? The next one. The more scripts a store fills (with the same or a few more labor hours) the more diluted the operating costs become on those prescriptions. They would rather one store filling 4k/week vs 2 x 2k/week. Not only for the operations but consolidate overhead (rent, utilities, etc.). You get supply chain/logistic benefits with less supply delivery routes... there’s a lot...

I see. So they want patients to walk/drive farther to pick up meds. I understand. Cos I was wondering all the time why they have store at every corner.
No, I don't know what the most profitable prescription a store fills. What do you mean "the next one"?

 

[PharmDWithaPorscheGT3RS]

Who can even fit in one of those ticket magnets?

When you buy a car like this, you're not worrying about it being a ticket magnet or who can fit. You're wanting to enjoy the car yourself. But to answer your question completely, my wife can fit.

 

[PharFromNormal]

Yes - thank you... the more Rx we sell the more money is made.. gotcha

Except when you are filling scripts that are underwater. That math gets complicated. You lose more from a gross perspective but your allocated operational costs at a unit level improve. So you might be losing money faster, losing money slower or slowly earning more.

 

[VictorOfHungerGames]

You really must be smoking some really good stuff. CVS Has 10,000 retail locations, a mail order division and a long term care division and a PBM. You seriously underestimate the purchasing power of a company that fills 1/3 of all retail scripts in the USA.. You seem to think Amazon or someone else can out purchase them. Some rinky independent doing 1000 scripts a week. At 52000 scripts per year at an average price of $250.,00 per rx you would have 1.3 million in sales. And I am being generous at $250.00 average per rx. The last store I managed had 5 million in sales per year.

They have enormous purchasing power. Your dinky little independent doing 1K per week doe snot buy anywhere near what CVS buys at. The same goes for everything else. Let's say you want to upgrade your laser printer. You look at Newegg, Tiger Direct, Amazon or BestBuy. They call Lexmark and order 25,000. Who do you think gets the better price per unit?

I have 15 stores in my district. NONE of them do less that 1200 per week. We have multiple store over 3000, one at 5000 and one at almost 10,000. This is a very profitable company. CVS Health is the 8th largest corporation in the USA and the 19th largest in the world. They are enormously powerful and profitable.

You may feel they are understaffed, but they are well run from a financial stand point. No, the average independent is not more profitable than an average CVS. The economies of scale do not compare.

Lol Think about how many indies there are compared to any chain. And imagine those being “one” purchaser. There are 20,000 plus indies. Know anything about buying groups? Rebates indies get?

You keep smoking what you want and live in your cvs bubble but old owner of pharmacy retired as a millionaire. Have fun being a corporate slave. All your hard work and your employees sacrifice gets you what? The mustache man $20mil a year lol yup keep on working hard to make them more money, help them keep on increase that purchasing power. While i do minuscule 1000 (we actually do about 2000) a week and have a life and contemplate on what other pharmacy to buy.

 

[wagrxm2000]

Lol Think about how many indies there are compared to any chain. And imagine those being “one” purchaser. There are 20,000 plus indies. Know anything about buying groups? Rebates indies get?

You keep smoking what you want and live in your cvs bubble but old owner of pharmacy retired as a millionaire. Have fun being a corporate slave.

Where can one go to get into this buying group?

 

[VictorOfHungerGames]

Where can one go to get into this buying group?

Ask the expert @Old Timer lol he seems to know alot more about indies than i do...

 

[VictorOfHungerGames]

@Old Timer oh and one more thing... if they are so well run financially, why are they keep cutting hours? Yet, their ceo and every else in corporate keeps on getting raises? How is it that we at indies have at least 3 full time techs and 2 cashiers at all times while cvs that is so well run keeps on getting less and less tech hours? Hmmmmm.....

 

[PharFromNormal]

Lol Think about how many indies there are compared to any chain. And imagine those being “one” purchaser. There are 20,000 plus indies. Know anything about buying groups? Rebates indies get?

You keep smoking what you want and live in your cvs bubble but old owner of pharmacy retired as a millionaire. Have fun being a corporate slave. All your hard work and your employees sacrifice gets you what? The mustache man $20mil a year lol yup keep on working hard to make them more money, help them keep on increase that purchasing power. While i do minuscule 1000 (we actually do about 2000) a week and have a life and contemplate on what other pharmacy to buy.

But they aren’t all in one purchaser... there are several different purchasing groups out there...

Also the mustached man isn’t THE “owner” of CVS although he is one of the owners. How much did CVS shell out in dividends to all shareholders in a year? Several hundred millions? Billions? It’s a false narrative to compare the CEO to the owner. If the mustached man Larry 100% of the stock he’d have way more money. I’m not arguing that you might think it’s a better personal situation and you make more money at an independent but the business itself does not make as much money.

Edit: looked it up because I was curious. The dividend is $2/yr. There are roughly 1.3Billion shares outstanding so the collective owners of CVS Health made $2.6 billion last year on dividends alone. Some of those owners are likely also employees which would also benefit from their salaries.

 

[JustFillIt]

One of the things that chain pharmacies fail miserably at is inventory management.

 

[Old Timer]

CVS had a free cash flow of over 10 billion dollars in 2019. I think that says it all. If you think indy buying groups have the same clout in the market as CVS, well you are entitled to your opinion. I prefer clarity to agreement. You don't need to agree with me. I sleep well at night. I don't think all of the indies in the USA times 10 generates 10 billion in free cash flow. Now that is not all from stores, but still it is an impressive financial machine. Remember, they are buying for 10,000 stores, the mail order division Omnicare as well as for Silverscript. They are probably the largest purchaser of drugs in the USA. I don't know about the VA, as that is also a large operation. But outside of that, who buys more drugs than CVS?

 

[wagrxm2000]

Ask the expert @Old Timer lol he seems to know alot more about indies than i do...

I'm actually curious. Where can one go

 

[VictorOfHungerGames]

CVS had a free cash flow of over 10 billion dollars in 2019. I think that says it all. If you think indy buying groups have the same clout in the market as CVS, well you are entitled to your opinion. I prefer clarity to agreement. You don't need to agree with me. I sleep well at night. I don't think all of the indies in the USA times 10 generates 10 billion in free cash flow. Now that is not all from stores, but still it is an impressive financial machine. Remember, they are buying for 10,000 stores, the mail order division Omnicare as well as for Silverscript. They are probably the largest purchaser of drugs in the USA. I don't know about the VA, as that is also a large operation. But outside of that, who buys more drugs than CVS?

My point is that indies make more per script due to not having to spend money to satisfy corporate greed. Yes, I do understand that cvs makes alot of money. Again, off of your and your coworkers misery. Of course you sleep well at night lol im sure all cvs cult followers do. Again, do you even know why your masters keep on cutting hours despite record breaking profits?

 

[Old Timer]

@Old Timer oh and one more thing... if they are so well run financially, why are they keep cutting hours? Yet, their ceo and every else in corporate keeps on getting raises? How is it that we at indies have at least 3 full time techs and 2 cashiers at all times while cvs that is so well run keeps on getting less and less tech hours? Hmmmmm.....

They keep cutting hours because they can. The more they cut, the more goes back to the shareholders. They know they have pharmacists by the balls. There is no market out there and whatever market is at significantly lower pay. Now, I'm not saying eventually if they don't pay a premium they will lose good staff, but there are people lining up to take the jobs. It's the nature of our economic system. As the supply of pharmacists explodes, the price goes down......

 

[Old Timer]

My point is that indies make more per script due to not having to spend money to satisfy corporate greed. Yes, I do understand that cvs makes alot of money. Again, off of your and your coworkers misery. Of course you sleep well at night lol im sure all cvs cult followers do. Again, do you even know why your masters keep on cutting hours despite record breaking profits?

I'm not a cult follower. I just report the facts. If independents were so successful, there would be increasing numbers not decreasing numbers.

 

[JustFillIt]

They keep cutting hours because they can. The more they cut, the more goes back to the shareholders. They know they have pharmacists by the balls. There is no market out there and whatever market is at significantly lower pay. Now, I'm not saying eventually if they don't pay a premium they will lose good staff, but there are people lining up to take the jobs. It's the nature of our economic system. As the supply of pharmacists explodes, the price goes down......

Yes - I agree with this 100%... these chains are making plenty of money, and they can afford plenty more staff.

They just dont... why? It’s greed that’s all.

 

[confettiflyer]

They just dont... why? It’s greed that’s all.

It’s not greed, it’s maximizing shareholder value. If the executive officers/board fail to do this...they’d be a) kicked out, b) sued, or heck both.

They have a shareholder duty to cut expenses. They do not have any duty to labor aside from what’s required by state/federal law.


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[WVUPharm2007]

By law they have a fiduciary duty to maximize value to shareholders.

 

[VictorOfHungerGames]

I'm not a cult follower. I just report the facts. If independents were so successful, there would be increasing numbers not decreasing numbers.

Report the facts huh? Why dont you look into why numbers of indies are decreasing then? Look at what dir fees are and how thats related to killing pharmacy in general including your awesome cvs.

 

[BMBiology]

By law they have a fiduciary duty to maximize value to shareholders.

By law, they can’t kill people

 

[JustFillIt]

It’s not greed, it’s maximizing shareholder value. If the executive officers/board fail to do this...they’d be a) kicked out, b) sued, or heck both.

They have a shareholder duty to cut expenses. They do not have any duty to labor aside from what’s required by state/federal law.


Sent from my iPhone using SDN

Fair enough.... Bottom line is they are trying to make a McDonald’s out of a pharmacy.

 

[Old Timer]

Report the facts huh? Why dont you look into why numbers of indies are decreasing then? Look at what dir fees are and how thats related to killing pharmacy in general including your awesome cvs.

That's they way it goes. They fees are just the cost of doing business. And if paying the fees means you lose money, then you don't make a profit. If my grandmother had wheels, she would be bicycle.

 

[Old Timer]

Fair enough.... Bottom line is they are trying to make a McDonald’s out of a pharmacy.

They have already done it

 

[JustFillIt]

By law, they can’t kill people

Yes - and at some point it becomes reckless and hazardous to the population. Which is why regulation is appropriate.

I can think of many regulations similar to this. Truckers can only drive x amount of hours before stopping to sleep. Truckers also have to have a certain blood pressure. If they are outside of these regulatory parameters they put the public at risk. This is just one example of an appropriate regulation that does not entirely overthrow the principles of free market capitalism.

I believe that x amount of prescriptions in a community pharmacy should equal y amount of hours (both pharmacist and tech).

 

[JustFillIt]

That's they way it goes. They fees are just the cost of doing business. And if paying the fees means you lose money, then you don't make a profit. If my grandmother had wheels, she would be bicycle.

I followed you right up until the grandmother comment.

 

[Old Timer]

I followed you right up until the grandmother comment.

he said he makes money except for the fees. IF there were no fees he would make money. IF my grandmother had wheels she would be a bicycle., In other words, he doesn't make money.

 

[mentos]

he said he makes money except for the fees. IF there were no fees he would make money. IF my grandmother had wheels she would be a bicycle., In other words, he doesn't make money.

I don't get it either, what's your grandmother have to do with pharmacy fees?

 

[confettiflyer]

By law, they can’t kill people

So long as the costs to settle and/or litigate don’t exceed the costs to prevent, nothing’s gonna change.

Plus, they can always say it’s the pharmacist’s fault.

It’s difficult to charge a corporation with manslaughter as a corporation doesn’t have a “mind” for which to apply mens rea to, which is a key component in any manslaughter/murder charge. Even PG&E was only charged with criminal failure to inspect a gas pipeline, not manslaughter/negligent homicide, even though that negligence lead to multiple deaths. There’s need to be a specific statute and, to my recollection, such a statute doesn’t exist with pharmacy.


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[VictorOfHungerGames]

That's they way it goes. They fees are just the cost of doing business. And if paying the fees means you lose money, then you don't make a profit. If my grandmother had wheels, she would be bicycle.

Nope. These fees did not exist 10 years ago. It is not the cost for anything. Are you not understanding what a dir fee is?

 

[PharFromNormal]

Nope. These fees did not exist 10 years ago. It is not the cost for anything. Are you not understanding what a dir fee is?

Just because a fee didn’t exist 10 years ago does not mean it is not a new cost of doing business...

You may not like the newer terms of engagement but that doesn’t make them untrue.

 

[VictorOfHungerGames]

Just because a fee didn’t exist 10 years ago does not mean it is not a new cost of doing business...

You may not like the newer terms of engagement but that doesn’t make them untrue.

again, do you know what and how dir fees work?

 

[PharFromNormal]

again, do you know what and how dir fees work?

Very much so.

Again, fees that didn’t exist before that exist now does not remove them. If you want to do business on prescriptions that are impacted by “new” DIR fees, then DIR fees are a cost of doing that business.

Does it suck you are exposed to new, additional, arguably “unfair” fees? Sure. But it still doesn’t change the fact that they are a cost of business.

 

[Old Timer]

I don't get it either, what's your grandmother have to do with pharmacy fees?

Nothing, it is the word IF.
IF he didn't have to pay the fees he would be profitable. Since he does he isn't.

 

[VictorOfHungerGames]

Very much so.

Again, fees that didn’t exist before that exist now does not remove them. If you want to do business on prescriptions that are impacted by “new” DIR fees, then DIR fees are a cost of doing that business.

Does it suck you are exposed to new, additional, arguably “unfair” fees? Sure. But it still doesn’t change the fact that they are a cost of business.

Sure, same way you would have to account for your store being robbed. If you know know anything about DIR fees or clawbacks, you should also know that those are unpredictable. They can pretty much charge whatever they want which is why there are several law suits against PBMs in multiple states.

My point again was this. DIR fees are affecting ALL pharmacies, CVS included. Low reimbursements are affecting ALL pharmacies, CVS included. If you're working at CVS, you don't see this because it's all hidden from you. You don't know how much you're getting reimbursed vs how much the drug is going to cost you after rebates.

Caremark is reimbursing CVS 1000% more than other pharmacies, other PBMs, to counter and level the playing field is doing the same to CVS. Now, this is all going to stop once the legislation to regulate PBMs occur. Some states already implemented them and will take affect 1/1/2021. At which point, CVS isn't going to be able to profit from pure thievery. Imagine what would happen to your staffing then.

To drive my point home, even with these unethical DIR fees, independents still make more profit per script with equal reimbursements, which has been the case until a few years ago when what I mentioned above started happening. And yes, EVEN WITH THESE FEES, @Old Timer, most indies are profitable. The ones that close are the ones that recently opened and do not have wide range of clientele. Yes, indie could be a lucrative business just filling 1000 scripts a week. How, again, you ask? Buying groups and wholesale rebates. All, from the way you're talking, you should know much about.

 

[owlegrad]

Yes I am sure CVS wishes they had the buying power of purchasing groups and could get wholesale rebates. It makes you wonder how CVS even stays competitive. Must be hard for them.

 

[VictorOfHungerGames]

Yes I am sure CVS wishes they had the buying power of purchasing groups and could get wholesale rebates. It makes you wonder how CVS even stays competitive. Must be hard for them.

Your sarcasm doesn't make sense since I wasn't saying CVS doesn't have the buying power or get wholesale rebates. You just missed my point entirely... but you wouldn't care about that since you would care more about mic dropping on your sarcasm lol

 

[PharFromNormal]

Sure, same way you would have to account for your store being robbed. If you know know anything about DIR fees or clawbacks, you should also know that those are unpredictable. They can pretty much charge whatever they want which is why there are several law suits against PBMs in multiple states.

My point again was this. DIR fees are affecting ALL pharmacies, CVS included. Low reimbursements are affecting ALL pharmacies, CVS included. If you're working at CVS, you don't see this because it's all hidden from you. You don't know how much you're getting reimbursed vs how much the drug is going to cost you after rebates.

Caremark is reimbursing CVS 1000% more than other pharmacies, other PBMs, to counter and level the playing field is doing the same to CVS. Now, this is all going to stop once the legislation to regulate PBMs occur. Some states already implemented them and will take affect 1/1/2021. At which point, CVS isn't going to be able to profit from pure thievery. Imagine what would happen to your staffing then.

To drive my point home, even with these unethical DIR fees, independents still make more profit per script with equal reimbursements, which has been the case until a few years ago when what I mentioned above started happening. And yes, EVEN WITH THESE FEES, @Old Timer, most indies are profitable. The ones that close are the ones that recently opened and do not have wide range of clientele. Yes, indie could be a lucrative business just filling 1000 scripts a week. How, again, you ask? Buying groups and wholesale rebates. All, from the way you're talking, you should know much about.

So you agree, DIR fees are a cost of doing business? Got it!

 

[VictorOfHungerGames]

So you agree, DIR fees are a cost of doing business? Got it!

lol who said it wasn't? The entire time I was trying to make the point of... nevermind. sigh. Cognitive dissonance is a powerful thing. You win. Enjoy your time at... where ever miserable chain youre at lol

 

[sfachine]

If all of you were right then how come retail (all levels)are contracting.Stock for both CVS and Walgreens are going nowhere.Rite Aid is up but still a shell of what used be

CVS had a free cash flow of over 10 billion dollars in 2019. I think that says it all. If you think indy buying groups have the same clout in the market as CVS, well you are entitled to your opinion. I prefer clarity to agreement. You don't need to agree with me. I sleep well at night. I don't think all of the indies in the USA times 10 generates 10 billion in free cash flow. Now that is not all from stores, but still it is an impressive financial machine. Remember, they are buying for 10,000 stores, the mail order division Omnicare as well as for Silverscript. They are probably the largest purchaser of drugs in the USA. I don't know about the VA, as that is also a large operation. But outside of that, who buys more drugs than CVS?
[/QUOTE

Yes - and at some point it becomes reckless and hazardous to the population. Which is why regulation is appropriate.

I can think of many regulations similar to this. Truckers can only drive x amount of hours before stopping to sleep. Truckers also have to have a certain blood pressure. If they are outside of these regulatory parameters they put the public at risk. This is just one example of an appropriate regulation that does not entirely overthrow the principles of free market capitalism.

I believe that x amount of prescriptions in a community pharmacy should equal y amount of hours (both pharmacist and tech).

OK.You pass it.How are you going to enforce it?PIC loses license?Pharmacy loses license?How do you account for technology?Remote Processing?Do immunizations count?How do you account for seasonal variations or weekly, daily,or even hourly variations?Who gets access to stores data?How do you know it will remain confidential?
II agree more staffing is needed but this one size fits all is cumbersome.There are too many variables.