Obamacare and Pharmacy

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i still don't get how obamacare effects places like kaiser or non- profit pharmacies?

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Really? What happens if there isn't a corner Walgreens? What happens when the law that mandates a pharmacist be in the pharmacy is changed to let "super" techs count the pills and read the patient counseling sheet off the label to the patient?



Boy you don't see much do you? The public could give a rats ass who fills thier prescription. You know what the public cares about? Getting thier Vicodin filled as fast as possible. As long as it is done thier way right away prisoners on work relese could fill the prescriptions and they could care less.



This proves you have no clue what you are talking about......

I think the problem we have here is that you two are on opposite sides of the spectrum, the typical right wing/left wing argument. Granted MountainPharmD I firmly believe that most of what you predict will come true within the future, the problem is that people have the Y2K reaction. They tend to believe that the retail pharmacist will either not be impacted at all, or wiped off the job market.

Yes, as a profession, we must stand up for our place in the healthcare community and strengthen our voice. Automated dispensing machines, or more likely, techs alone in the community with a "supervising" pharmacist at a "remote" location will begin to be the norm. This position will be scarce and will be running multiple stores. Also you are correct, if retail tanks, the whole profession will tank.

The only side I tend to disagree with you on, is the clinical pharmacist role. I am going to assume that we are talking about strictly inpatient duties due to the nature of this thread, but I assure you that they do a job that is fairly well absorbed by other healthcare professionals with no increase in pay. Outside of MTM, they will not be reimbursed for their services through insurance and so we must "save" the hospital at minimum our salary to even break even.

My question for you is, do you honestly believe that your typical inpatient clinical pharmacist will save the hospital 100K a year? Now, your answer could very well be yes and that may even be true. My father is a hospitalist and he can calculate his vanc dose just fine, which ANY physician should be able to do. He inputs his own orders, AND takes responsibility for them and can look up renal dosing on his phone if he doesn't happen to know it off hand. The tasks inpatient clinical pharmacist due are rarely outside of what any qualified physician SHOULD be able to do. Yet technology is not only biting retail its biting clinical too, any physician can carry around any number of resources (lexi-comp, dynamed etc) on their phone.

I know some physicians, for God know's what reason, cannot accomplish many of the aforementioned duties but in that sector of clinical duties I do not see much that we could not be stripped of. Again, take my opinion how you may, just my thoughts.

Cheers!
 
I think the problem we have here is that you two are on opposite sides of the spectrum, the typical right wing/left wing argument. Granted MountainPharmD I firmly believe that most of what you predict will come true within the future, the problem is that people have the Y2K reaction. They tend to believe that the retail pharmacist will either not be impacted at all, or wiped off the job market.

Yes, as a profession, we must stand up for our place in the healthcare community and strengthen our voice. Automated dispensing machines, or more likely, techs alone in the community with a "supervising" pharmacist at a "remote" location will begin to be the norm. This position will be scarce and will be running multiple stores. Also you are correct, if retail tanks, the whole profession will tank.

The only side I tend to disagree with you on, is the clinical pharmacist role. I am going to assume that we are talking about strictly inpatient duties due to the nature of this thread, but I assure you that they do a job that is fairly well absorbed by other healthcare professionals with no increase in pay. Outside of MTM, they will not be reimbursed for their services through insurance and so we must "save" the hospital at minimum our salary to even break even.

My question for you is, do you honestly believe that your typical inpatient clinical pharmacist will save the hospital 100K a year? Now, your answer could very well be yes and that may even be true. My father is a hospitalist and he can calculate his vanc dose just fine, which ANY physician should be able to do. He inputs his own orders, AND takes responsibility for them and can look up renal dosing on his phone if he doesn't happen to know it off hand. The tasks inpatient clinical pharmacist due are rarely outside of what any qualified physician SHOULD be able to do. Yet technology is not only biting retail its biting clinical too, any physician can carry around any number of resources (lexi-comp, dynamed etc) on their phone.

I know some physicians, for God know's what reason, cannot accomplish many of the aforementioned duties but in that sector of clinical duties I do not see much that we could not be stripped of. Again, take my opinion how you may, just my thoughts.

Cheers!

Clearly you don't understand physician-pharmacist relationship at least in the hospital setting. Your father does not do vancomycin dosing not because he is not able to do, but because pharmacists can do (or at least they are supposed to do) as good as your father - the physician can do. So the physician can do other things (things that pharmacists cannot or are not allowed to do). It's about saving money. Based on your logic, we shouldnt have midlevels at all, because physicians can do everything and so much more compared to midlevels. Because there is a shortage of physicians, midlevels found their niche. They can take some load off by doing easier, less complicated physician work.
 
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Clearly you don't understand physician-pharmacist relationship at least in the hospital setting. Your father does not do vancomycin dosing not because he is not able to do, but because pharmacists can do (or at least they are supposed to do) as good as your father - the physician can do. So the physician can do other things (things that pharmacists cannot or are not allowed to do). It's about saving money. Based on your logic, we shouldnt have midlevels at all, because physicians can do everything and so much more compared to midlevels. Because there is a shortage of physicians, midlevels found their niche. They can take some load off by doing easier, less complicated physician work.

I am not sure "clearly" is the correct way to start that statement. I may not see the relationship the way you do. First and foremost pharmacists are NOT mid-level practitioners. You use pharmacist and mid-level interchangeably and this is an error. Mid-level practitioners can do basically anything the physician will allow, so your statement that this allows physicians to do things mid-levels cannot is incorrect (in the majority of cases), outside of surgery.

Mid-levels get reimbursed, we do not. If we are talking about an inpatient clinical pharmacist, based on what I have seen, they typically do renal dose adjustment, ID consults, chart reviews, research, and basically looking after the physicians for mistakes. None of these items will be billable through insurance. Now, which of these items truly takes so much time that a 100k a year position is necessary?

If physicians happen to not know an interaction or dose adjustment, or hell even the most up to date empiric therapy all they have to do is use any of the resources available. Let's take a common example: MD's orders rph ID consult, rph looks a culture/sensitivity, renal function, and medications, then makes a recommendation. How does this save the hospital money? What did physicians do before rph's did consults?

Just some food for thought, I never claim to be all knowing but I do not see your statement as gospel. In my opinion, we have an amazing opportunity to save the hospital money. Though we do not have the authority, or if we do, cannot be reimbursed for our services because we are not classified appropriately. Time will tell how this will play out, but I know for sure if we do not get unified in our approach it will not fair well.

Cheers
 
I am not sure "clearly" is the correct way to start that statement. I may not see the relationship the way you do. First and foremost pharmacists are NOT mid-level practitioners. You use pharmacist and mid-level interchangeably and this is an error. Mid-level practitioners can do basically anything the physician will allow, so your statement that this allows physicians to do things mid-levels cannot is incorrect (in the majority of cases), outside of surgery.

Mid-levels get reimbursed, we do not. If we are talking about an inpatient clinical pharmacist, based on what I have seen, they typically do renal dose adjustment, ID consults, chart reviews, research, and basically looking after the physicians for mistakes. None of these items will be billable through insurance. Now, which of these items truly takes so much time that a 100k a year position is necessary?

If physicians happen to not know an interaction or dose adjustment, or hell even the most up to date empiric therapy all they have to do is use any of the resources available. Let's take a common example: MD's orders rph ID consult, rph looks a culture/sensitivity, renal function, and medications, then makes a recommendation. How does this save the hospital money? What did physicians do before rph's did consults?

Just some food for thought, I never claim to be all knowing but I do not see your statement as gospel. In my opinion, we have an amazing opportunity to save the hospital money. Though we do not have the authority, or if we do, cannot be reimbursed for our services because we are not classified appropriately. Time will tell how this will play out, but I know for sure if we do not get unified in our approach it will not fair well.

Cheers


I'm curious why you went into pharmacy if your dad is a doctor and you see the pharmacy profession as being useless basically.
 
I am not sure "clearly" is the correct way to start that statement. I may not see the relationship the way you do. First and foremost pharmacists are NOT mid-level practitioners. You use pharmacist and mid-level interchangeably and this is an error. Mid-level practitioners can do basically anything the physician will allow, so your statement that this allows physicians to do things mid-levels cannot is incorrect (in the majority of cases), outside of surgery.

Mid-levels get reimbursed, we do not. If we are talking about an inpatient clinical pharmacist, based on what I have seen, they typically do renal dose adjustment, ID consults, chart reviews, research, and basically looking after the physicians for mistakes. None of these items will be billable through insurance. Now, which of these items truly takes so much time that a 100k a year position is necessary?

If physicians happen to not know an interaction or dose adjustment, or hell even the most up to date empiric therapy all they have to do is use any of the resources available. Let's take a common example: MD's orders rph ID consult, rph looks a culture/sensitivity, renal function, and medications, then makes a recommendation. How does this save the hospital money? What did physicians do before rph's did consults?

Just some food for thought, I never claim to be all knowing but I do not see your statement as gospel. In my opinion, we have an amazing opportunity to save the hospital money. Though we do not have the authority, or if we do, cannot be reimbursed for our services because we are not classified appropriately. Time will tell how this will play out, but I know for sure if we do not get unified in our approach it will not fair well.

Cheers
I know that midlevels can bill Medicare, and pharmacists - cant. That has nothing to do with what Im talking about. The point is that pharmacists save money by doing clinical stuff. For example, let's say it takes 30 min for an ID physician to assess and diagnose the patient. And it would probably take another 15 min to start vancomycin monitoring profile, to come up with a dose, to order trough level etc. Instead, after 30 min this ID guy can move onto another patient just by writing vancomycin pharmacy to dose. Pharmacists proved that they can manage vancomycin not worse or maybe even better than physicians. So now this ID guy can see 16 pts in 8 hours, versus 10.6 if he would have to do everything by himself. At the end everybody is happy - ID guy can see more pts = more money, pharmacists have work to do.
 
I know that midlevels can bill Medicare, and pharmacists - cant. That has nothing to do with what Im talking about. The point is that pharmacists save money by doing clinical stuff. For example, let's say it takes 30 min for an ID physician to assess and diagnose the patient. And it would probably take another 15 min to start vancomycin monitoring profile, to come up with a dose, to order trough level etc. Instead, after 30 min this ID guy can move onto another patient just by writing vancomycin pharmacy to dose. Pharmacists proved that they can manage vancomycin not worse or maybe even better than physicians. So now this ID guy can see 16 pts in 8 hours, versus 10.6 if he would have to do everything by himself. At the end everybody is happy - ID guy can see more pts = more money, pharmacists have work to do.
I agree. The key concept is delegation. And you also want to delegate the responsibilities to someone who is suitably qualified. That way you also transfer the liability. I mean, a physician can delegate a secretary to write up a vanc script if they really wanted to, but if the secretary makes a mistake, they aren't suitably qualified so the liability will still fall on the physician. But by having pharmacists who are suitably qualified, physicians can be comfortable to delegate responsibilities to them along with the liability, so that they have more time to do their own thing.

Think of it this way: do physicians really want to be bogged down with the things pharmacists do, like worrying about drug formularies, cost effectiveness, billing, renal dosing, etc?
 
I have been telling you all for awhile. If you are a retail pharmacist now is the time to get out. The best time to get off a sinking ship is before anyone else knows it is sinking. A lot of pharmacists are starting to figure out retail is sinking. Jump off the ship now while there are still lifeboats.

I have been waiting for you to explain who are going to replace all these Pharmacist- Super Techs??????? Or do you honestly think most people are going to turn to Mail-order????? What next are they going to have Super NP's or Super PA's that will replace MD's? Hell why stop there- let's have Super Minor leaguers- to replace MLB players with their high salaries. Let's have Super College athletes to replace NBA players and NFL players.
And for those who said automation will replace Pharmacist- a Script Pro machine cost about 500k to 1 million dollars, but most Pharmacies lease them and the rate per hour to operate a Script pro is $10 hr but consider it runs 24/7- when my Scip Pro machine was down for 2 weeks- we were allowed 35 extra hours even if it included OT. The Script Pro and other automated machines basically can do the work of a tech but not a Pharmacist- since they can't counsel or verify DUR rejects.
Each year prescriptions prescribed have increased dramatically- in my area alone they are buiding 2 new CVS's, 1 Walgreens and a Krogers is being built- this are all within a 10 to 15 mile radius- apparently these CEO's have not got the Memo that MPD knows so much about. If Pharmacist in the retail setting is becoming obsolote than why are they stll building new stores???
Also, if it were possible that people could get stop using mail order and go to a pharmacy of their choice- I would say 9 out of 10 people would go to retail. In the past 5 years I can honestly say that every customer and I mean EVERY customer whom we had to call or tell in person that we apologize but your insurance is requiring Mandatory Mail order- all of the ones I dealt with were visibly or vocally pissed- even if they were getting a better deal through mail order. Just as if with all the technology advances most people still want to talk to a human- this is no different in pharmacy- how many customers bypass the automation prompt and hit "0" in order to speak to a live person? How many of you get annoyed speaking to an automated computer when trying to pay a bill or contact your bank???
 
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I have been waiting for you to explain who are going to replace all these Pharmacist- Super Techs??????? Or do you honestly think most people are going to turn to Mail-order????? What next are they going to have Super NP's or Super PA's that will replace MD's? Hell why stop there- let's have Super Minor leaguers- to replace MLB players with their high salaries. Let's have Super College athletes to replace NBA players and NFL players.
And for those who said automation will replace Pharmacist- a Script Pro machine cost about 500k to 1 million dollars, but most Pharmacies lease them and the rate per hour to operate a Script pro is $10 hr but consider it runs 24/7- when my Scip Pro machine was down for 2 weeks- we were allowed 35 extra hours even if it included OT. The Script Pro and other automated machines basically can do the work of a tech but not a Pharmacist- since they can't counsel or verify DUR rejects.
Each year prescriptions prescribed have increased dramatically- in my area alone they are buiding 2 new CVS's, 1 Walgreens and a Krogers is being built- this are all within a 10 to 15 mile radius- apparently these CEO's have not got the Memo that MPD knows so much about. If Pharmacist in the retail setting is becoming obsolote than why are they stll building new stores???
Also, if it were possible that people could get stop using mail order and go to a pharmacy of their choice- I would say 9 out of 10 people would go to retail. In the past 5 years I can honestly say that every customer and I mean EVERY customer whom we had to call or tell in person that we apologize but your insurance is requiring Mandatory Mail order- all of the ones I dealt with were visibly or vocally pissed- even if they were getting a better deal through mail order. Just as if with all the technology advances most people still want to talk to a human- this is no different in pharmacy- how many customers bypass the automation prompt and hit "0" in order to speak to a live person? How many of you get annoyed speaking to an automated computer when trying to pay a bill or contact your bank???

One of the core savings touted with the new healthcare law was the cost savings by bringing more efficiencies to the healthcare system. You should be very familiar with the concept working for CVS. This means doing the same work with 1/4th the people you actually need because some idiot MBA in the corporate office started a program that made you more "efficient" when in reality it did nothing and possibly made the job more difficult.

Mail Order. The dreaded dirty word of the pharmacy world. A central cost saving efficiency to the new healthcare law is the use of mandatory mail order. When the law was being crafted the CEO's of Medco, Express Scripts and Caremark were all consulted on the cost savings of mail order. It will be a central part of the new law and will dramatically lessen the impact of all these new scripts everyone thinks is going to hit the system and save retail pharmacy. A fact that cannot be disputes is mail order is a cheaper and more efficient way to distribute drugs to a patient.

I can throw the same amount of anecdotal evidence at you that the majority of the people I talk to, Mother, father, close family friends, customers when I was at retail, at first bristled at the idea of mail order but like it once it got going. Plus with deals like Express scripts and no copay for some medications if you go mail order, they love it. Free is free dude and trumps everything always. To counter your claim that 9 out of 10 people would go retail if they had the choice? Really? 9 out of 10 would choose to go to crappy CVS, waiting line for 30 minutes after having to come back 4 times because the prescription they were told would be ready in an hour still isn't ready a day later? I do not think so. Hell I would say 9 out of 10 people would choose to go somewhere else other than CVS. They go because they were forced to or its the closest pharmacy and they are to lazy to drive 2 minutes down the street to go to a different pharmacy. Here's some more anecdotal evidence for you...Do you know how many people bitched and complained to me when Caremark started forcing people to go to CVS to get a 90 day supply or use mail order? Hundreds!
 
Agree with MountainPharmD. More scripts, but the push is also to lower costs, and public opinion could very easily go against pharmacists if they think they can cut us out to save a buck. Just think of what the public already thinks about us? They think we're er... dispensing pez... Plus now the chain pharmacies are getting inventive and squeezing us hard for more efficiency and productivity.

Also look to what happened when they introduced Medicare Part D.
 
Agree with MountainPharmD. More scripts, but the push is also to lower costs, and public opinion could very easily go against pharmacists if they think they can cut us out to save a buck. Just think of what the public already thinks about us? They think we're er... dispensing pez... Plus now the chain pharmacies are getting inventive and squeezing us hard for more efficiency and productivity.

Also look to what happened when they introduced Medicare Part D.

You my friend are a genius!

Med D was the beginning of the end for retail pharmacy. Obamacare will finish it off.
 
I've thought about this, until people turn into robots we should still be okay. I think most people still like to have some human interactions. We may not be just filling prescriptions, we may become more like healthcare educators.

The same could be said for cashiers, and people are still flocking to Amazon. I can't remember ever having a conversation with my pharmacist anyway, except possibly questions about my insurance.

If insurance and medication distribution become more streamlined, I can't imagine jobs like those at the local CVS will continue to exist for much longer.

Cheaper to automate in a central location and use the mail I would imagine, maybe with an automatic dispenser in the stores for the really common meds.
 
The same could be said for cashiers, and people are still flocking to Amazon. I can't remember ever having a conversation with my pharmacist anyway, except possibly questions about my insurance.

If insurance and medication distribution become more streamlined, I can't imagine jobs like those at the local CVS will continue to exist for much longer.

Cheaper to automate in a central location and use the mail I would imagine, maybe with an automatic dispenser in the stores for the really common meds.

Yep....I agree.

Sad that an insurance question may be the only reason you ever have a conversation with anyone in the pharmacy.
 
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Yep....I agree.

Sad that an insurance question may be the only reason you ever have a conversation with anyone in the pharmacy.

I guess I've also asked if something was in stock and where to get it if it wasn't. That would usually be more frustrating than helpful and could easily be posted on a web page for the bigger chains.
 
One of the core savings touted with the new healthcare law was the cost savings by bringing more efficiencies to the healthcare system. You should be very familiar with the concept working for CVS. This means doing the same work with 1/4th the people you actually need because some idiot MBA in the corporate office started a program that made you more "efficient" when in reality it did nothing and possibly made the job more difficult.

Mail Order. The dreaded dirty word of the pharmacy world. A central cost saving efficiency to the new healthcare law is the use of mandatory mail order. When the law was being crafted the CEO's of Medco, Express Scripts and Caremark were all consulted on the cost savings of mail order. It will be a central part of the new law and will dramatically lessen the impact of all these new scripts everyone thinks is going to hit the system and save retail pharmacy. A fact that cannot be disputes is mail order is a cheaper and more efficient way to distribute drugs to a patient.

I can throw the same amount of anecdotal evidence at you that the majority of the people I talk to, Mother, father, close family friends, customers when I was at retail, at first bristled at the idea of mail order but like it once it got going. Plus with deals like Express scripts and no copay for some medications if you go mail order, they love it. Free is free dude and trumps everything always. To counter your claim that 9 out of 10 people would go retail if they had the choice? Really? 9 out of 10 would choose to go to crappy CVS, waiting line for 30 minutes after having to come back 4 times because the prescription they were told would be ready in an hour still isn't ready a day later? I do not think so. Hell I would say 9 out of 10 people would choose to go somewhere else other than CVS. They go because they were forced to or its the closest pharmacy and they are to lazy to drive 2 minutes down the street to go to a different pharmacy. Here's some more anecdotal evidence for you...Do you know how many people bitched and complained to me when Caremark started forcing people to go to CVS to get a 90 day supply or use mail order? Hundreds!
MPD the idea of doing the same work with 1/4 has nothing to do with the healthcare law it's actually a concept from a Busines model called Six Sigma I believe it was first used in the auto industry. A lot of other business models use a similar model, but other's don't.

I am not going to go back and forth with you AGAIN on retail is crappy blah blah- Yes you do have many people who would prefer to go to their local drugstore whether it's CVS, Walgreens, Wal-Mart etc because they don't get their meds on time- biggest complaint- every week I would say 3 out of 7 days I have someone come from either Medco or CVS caremark mail order asking for loaners because their meds have not arrived and I do myself personally at least 4 to 5 bridge supplies a week.
MPD you are at it again with this oh my Company is great and everyone loves it B.S which everyone knows is not true. Everyone doesn't love Mail-order- when you ask the average what the Pharmacy model is- most would say they drop off thir prescription or MD calls it in and they pick it up later.

If you read this article which came out today: http://www.chaindrugreview.com/front-page/newsbreaks/pharmacy-customer-satisfaction-a-closer-look
If you scroll down to the 9th paragraph it states the following: Independent pharmacies led the field, with 76% of customers saying they were very satisfied and 14% being somewhat satisfied. Supermarket pharmacy customers also expressed a high level of satisfaction (68% very satisfied, 21% somewhat satisfied).

Compared with chain drug stores, a greater percentage of clinic pharmacy patients were very satisfied (65%). Pharmacy customers of mass merchants (61% very satisfied, 24% somewhat satisfied) and mail order/online services (55% very satisfied, 26% somewhat satisfied) exhibited a lower level of satisfaction than did those of chain drug stores.
This Clearly indicates that people are more statisfied with retail pharmacies than mail order- now you claim about this crappy CVS- if CVS gives them crappy service than they can their prescription and business to Walgreens, Independent, Wal-Mart or even another CVS- if they don't like Caremark/Medco service guess what they are stuck with the service!!! That alone would irk a customer.

Now, again I am not going to go back and forth with oh retail is so much better than Mail order or vice versa- I have produced data from a poll that registered customer satisfaction with Retail/Independents/Mail Order and Mail order finished last in customer satisfaction now produce your data that proves people love mail order so much better than retail- perhaps you should get those hundreds of customers to take part in next years poll.
 
That post hurts my little blue eyeballs.
 
Now, again I am not going to go back and forth with oh retail is so much better than Mail order or vice versa- I have produced data from a poll that registered customer satisfaction with Retail/Independents/Mail Order and Mail order finished last in customer satisfaction now produce your data that proves people love mail order so much better than retail- perhaps you should get those hundreds of customers to take part in next years poll.
The problem is it's not going to be the patients' choice for retail or mail-order. Yes, Obamacare is going to bring lots of uninsured patients onboard, but just like Medicare Part D, they are all going to come with managed care insurance. So under managed care, who gives a **** if the patients love retail. To reduce costs, and still achieve the same outcomes, the insurance will probably make it mandatory to go mail-order.
 
The problem is it's not going to be the patients' choice for retail or mail-order. Yes, Obamacare is going to bring lots of uninsured patients onboard, but just like Medicare Part D, they are all going to come with managed care insurance. So under managed care, who gives a **** if the patients love retail. To reduce costs, and still achieve the same outcomes, the insurance will probably make it mandatory to go mail-order.

Well until we see the details if it ever comes to play than no one knows until the bill gets here. I remember all the stories I heard about how the Medicare Part D program wouldn't work blah blah blah- no system is going to satisfied everyone, but keep in mind- you guys act as if every prescription a person gets is going to have to be mail order- think of how many scripts that are filled from ER rooms that can't go mail order.
 
Well until we see the details if it ever comes to play than no one knows until the bill gets here. I remember all the stories I heard about how the Medicare Part D program wouldn't work blah blah blah- no system is going to satisfied everyone, but keep in mind- you guys act as if every prescription a person gets is going to have to be mail order- think of how many scripts that are filled from ER rooms that can't go mail order.
No, all scripts can't be mail-order, but there is still more pressure for retail to fill as cheaply as mail-order so that retail can compete for the customers. Now the people in corporate are already working on ways to fill scripts cheaper, but let's just say most of their ideas are NOT beneficial to the pharmacist's health or prosperity...
 
I'm wondering why all the discussion has only centered on retail. What about hospital pharmacy? Any thoughts Its Z?

Does anyone see Obamacare or whatever you want to call it, as a huge boost for managed care insurance in patient numbers and also public opinion?

Is managed care and its overall goal of reducing costs good for us as providers?

Doesn't managed care have a greater focus on medical costs, so is hospital pharmacy, being tied to medical treatments, more affected?
 
No, all scripts can't be mail-order, but there is still more pressure for retail to fill as cheaply as mail-order so that retail can compete for the customers. Now the people in corporate are already working on ways to fill scripts cheaper, but let's just say most of their ideas are NOT beneficial to the pharmacist's health or prosperity...

However, where do you see compete- most mail order plans are mandatory and/or contracted by your employer. Their have been many court cases about whether mail order can be mandatory of course the courts ruled in the favor of mail order, but I think MPD- and until he produces his data, are overall not satisfied with Mail order- Retail is still the ideal choice for most people. If the co-pays were the same I doubt very seriously that most people would choose Mail order over retail.
 
However, where do you see compete- most mail order plans are mandatory and/or contracted by your employer.
- Lowering the cash price on cheap generics like the Wal-Mart $4 thing, so that customers do not have to use their insurance mail order at all and can go to retail 'for just a few dollars'.
- 90 day supply at retail, which could be seen as a concession made by retail to the PBMs, so that we could still keep customers from going mail order, but also reduce costs and receive lower dispensing fees.
are overall not satisfied with Mail order- Retail is still the ideal choice for most people. If the co-pays were the same I doubt very seriously that most people would choose Mail order over retail.
Yes, but the copays are not the same, and they are being used by the PBMs/plan sponsors to give patients a large financial incentive to use mail order.

I think one of the aspects of managed care is to remove subjective reasons to choose providers, such as patients choosing retail only because of greater satisfaction, and instead to focus on objective quality measures and reducing costs. So if patients can get all their exact same maintenance meds from mail order for cheaper, managed care insurance will mandate this or provide a financial incentive such as $0 copay, so that patients will forget about customer satisfaction.
 
- Lowering the cash price on cheap generics like the Wal-Mart $4 thing, so that customers do not have to use their insurance mail order at all and can go to retail 'for just a few dollars'.
- 90 day supply at retail, which could be seen as a concession made by retail to the PBMs, so that we could still keep customers from going mail order, but also reduce costs and receive lower dispensing fees.

Yes, but the copays are not the same, and they are being used by the PBMs/plan sponsors to give patients a large financial incentive to use mail order.

I think one of the aspects of managed care is to remove subjective reasons to choose providers, such as patients choosing retail only because of greater satisfaction, and instead to focus on objective quality measures and reducing costs. So if patients can get all their exact same maintenance meds from mail order for cheaper, managed care insurance will mandate this or provide a financial incentive such as $0 copay, so that patients will forget about customer satisfaction.
Yes, you make some good point- however Wal-marts $4 program was not designed to stop people from using Mail-Order. when Wal-Mart fist started the $4 program I think they were like number 7 or 8 in prescription sales. The $4 gimmick as I called it was designed to get consumers in their stores and hey it actually worked but it was not created s a response to Mail Order- if anything it has hurt Independent Chain stores.
 
First please go back and find where I said everyone loves mail order! I said I have spoken to many people most with Express scripts to include my mother and father, who switched over to mail order because the co-pays were zero and they like it. It makes sense. Go stand in line forever at CVS or Walgreens or get it for a zero copay at mail order....the choice is easy.

This Clearly indicates that people are more statisfied with retail pharmacies than mail order- now you claim about this crappy CVS- if CVS gives them crappy service than they can their prescription and business to Walgreens, Independent, Wal-Mart or even another CVS- if they don't like Caremark/Medco service guess what they are stuck with the service!!! That alone would irk a customer.

Now, again I am not going to go back and forth with oh retail is so much better than Mail order or vice versa- I have produced data from a poll that registered customer satisfaction with Retail/Independents/Mail Order and Mail order finished last in customer satisfaction now produce your data that proves people love mail order so much better than retail- perhaps you should get those hundreds of customers to take part in next years poll.[/B]

What does the poll you quoted prove? It proves people are lazy, stupid and irresponsible. It proves people like to wait until they are out of pills, 5 mintes before you close on a Sunday to get thier medication refilled. Mail order works like clock work if you are a halfway resposible person. Sure the idiots who act all surprised when they open their pill bottle and see no pills left are going to hate mail order!

I said the big insurance companies are going to force people to go mail order because it is the only way they will be able to squeak out a profit when the government gets involved. They won't give a crap what people want. They will do it to save money and maximize thier profits. If you can't see that then there is no help for you. Keep running the mill right up to the day they let you go because they found someone to do it cheaper and faster. Wake up dude!
 
First please go back and find where I said everyone loves mail order! I said I have spoken to many people most with Express scripts to include my mother and father, who switched over to mail order because the co-pays were zero and they like it. It makes sense. Go stand in line forever at CVS or Walgreens or get it for a zero copay at mail order....the choice is easy.



What does the poll you quoted prove? It proves people are lazy, stupid and irresponsible. It proves people like to wait until they are out of pills, 5 mintes before you close on a Sunday to get thier medication refilled. Mail order works like clock work if you are a halfway resposible person. Sure the idiots who act all surprised when they open their pill bottle and see no pills left are going to hate mail order!

I said the big insurance companies are going to force people to go mail order because it is the only way they will be able to squeak out a profit when the government gets involved. They won't give a crap what people want. They will do it to save money and maximize thier profits. If you can't see that then there is no help for you. Keep running the mill right up to the day they let you go because they found someone to do it cheaper and faster. Wake up dude!

I love a good MPD/Nupe argument on a warm September night.

:love:
 
I love a good MPD/Nupe argument on a warm September night.

:love:

I don't get arguing over the same s*** over and over again. It's just wasting one's breath and is like talking to a wall as neither will never get the other person's view.
 
First please go back and find where I said everyone loves mail order! I said I have spoken to many people most with Express scripts to include my mother and father, who switched over to mail order because the co-pays were zero and they like it. It makes sense. Go stand in line forever at CVS or Walgreens or get it for a zero copay at mail order....the choice is easy.



What does the poll you quoted prove? It proves people are lazy, stupid and irresponsible. It proves people like to wait until they are out of pills, 5 mintes before you close on a Sunday to get thier medication refilled. Mail order works like clock work if you are a halfway resposible person. Sure the idiots who act all surprised when they open their pill bottle and see no pills left are going to hate mail order!

I said the big insurance companies are going to force people to go mail order because it is the only way they will be able to squeak out a profit when the government gets involved. They won't give a crap what people want. They will do it to save money and maximize thier profits. If you can't see that then there is no help for you. Keep running the mill right up to the day they let you go because they found someone to do it cheaper and faster. Wake up dude!
This is exactly what I was expecting from you- so people who use Retail are lazy, stupid and irresponsible and those who use Mail Order are outgoing, intelligent, and responsible? Sorry, but I know very responsible, educated people who have complained that they were supposed to get their order on the 10th and now it's the 15th and they have got their meds- so maybe the people at the Mail order are lazy, stupid, and irresponsible? Or maybe they just don't know how to mail out meds on time????
By the way, I know many, many, people both techs/pharmacist/supervisors, who work at your facility- although they all agree it's a helluva lot less stressful than retail however it's not paradise as you try to make it out to be MPD.
 
This is exactly what I was expecting from you- so people who use Retail are lazy, stupid and irresponsible and those who use Mail Order are outgoing, intelligent, and responsible? Sorry, but I know very responsible, educated people who have complained that they were supposed to get their order on the 10th and now it's the 15th and they have got their meds- so maybe the people at the Mail order are lazy, stupid, and irresponsible? Or maybe they just don't know how to mail out meds on time????
By the way, I know many, many, people both techs/pharmacist/supervisors, who work at your facility- although they all agree it's a helluva lot less stressful than retail however it's not paradise as you try to make it out to be MPD.

First off where I work has nothing to do with mail order. I don't even know where the mail order facility is. I have zero experience with mail order as a pharmacist.

My comments about mail order are based on my own personnel experience, experiences of my close family members and talking with customers when I used to work retail.

Mail order is not for everyone. However, there is no reason someone on a maintance medication needs to go to a retail pharmacy evey month and pick up their medication. I have used mail order with the VA and it could not be any easier. It beats the hell out of going to a retail pharmacy and waiting in long lines and dealing with rude uncaring employees.

The world is changing 'Nupe. You can either anticipate the changes and be prepared or bury you head in the sand and get blind sided. The United States has the most expensive and inefficient drug distribution system in the world. It is an unsustainable model. You are a fool if you think the governmnet is going to get invloved in healthcare and not change it.

The days of having a pharmacy on every corner are soon going to be long gone. Just like the days of having a butcher and a baker on every corner is long gone.
 
A central cost saving efficiency to the new healthcare law is the use of mandatory mail order. [???] When the law was being crafted the CEO's of Medco, Express Scripts and Caremark were all consulted on the cost savings of mail order. It will be a central part of the new law and will dramatically lessen the impact of all these new scripts everyone thinks is going to hit the system and save retail pharmacy. A fact that cannot be disputes is mail order is a cheaper and more efficient way to distribute drugs to a patient.

Just to clarify, you are trying to say that the ACA may encourage mail order as a cost-saving measure, rather than that it mandates mail order? I couldn't find anything requiring mail order anywhere in the text of the law.
 
Just to clarify, you are trying to say that the ACA may encourage mail order as a cost-saving measure, rather than that it mandates mail order? I couldn't find anything requiring mail order anywhere in the text of the law.

There isn't anything that explicit in the law.

If you remember when the debate was going on about ACA one of the ways it will be payed for is by reducing fraud, waste and abuse AND improving efficiencies.

From http://www.whitehouse.gov/healthreform/timeline

Improving Health Care Quality and Efficiency. The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients that improve the quality of care, and reduce the rate of growth in health care costs for Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Additionally, by January 1, 2011, HHS will submit a national strategy to improve the quality of care provided by these programs.

To lower costs, the Affordable Care Act sets up a new competitive private health insurance market -- through state Exchanges -- giving millions of Americans and small businesses access to affordable coverage and the same choices of insurance that members of Congress will have. It holds insurance companies accountable by keeping premiums down and preventing insurance industry abuses and denial of care, and it will end discrimination against Americans with pre-existing conditions

We are all smart educated people. Think about it for a minute. Insurance companies exisit to make money just like any other for profit company. This law squeezes them really hard. They are now going to have to cover millions of people that will cost them money. Think about ways an insurance company can reduce fraud, waste and abuse. Think about ways insurance companies can improve efficiecy. It is not hard to come up with answers. You have to think like a corporate MBA suit who is intereted in maximizing profit. Do not think like a healthcare provider. That has nothing to do with it. This is about money and how to make as much as possible.

One thing we are already seeing (ask Doctor M) is insurance companies auditing the **** out of everyone in order to recover as much money as possible under the guise of "preventing fraud, waste and abuse". Ask Doctor M how much fraud, waste and abuse has been uncovered during his numerous audits....None! They are taking money back for clerical errors and technicalities.

The insurance companies will squeeze every dollar of profit they can by using the lowest cost option when there is one. Prescription drugs are a huge expense for insurance companies. They will now be required to cover millions of people's prescriptions that they will lose money on. A logical conclusion is mail order will be a central part of their efforts to reduce costs and improve efficiencies. No one can argue it is much cheaper and thus more profitable to fill presciptions via mail order. You better believe there will be incentives, reduced co-pays ect. to get people to use mail order. Express scripts all ready does with Tricare by filling generic mail order Rx's for zero co-pay.

You all need to open your eyes and see what is coming. If you were around when Medicare D hit then you have a clue about what is ready to happen. Only this will be 1000 times worse than Med D.
 
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There isn't anything that explicit in the law.

If you remember when the debate was going on about ACA one of the ways it will be payed for is by reducing fraud, waste and abuse AND improving efficiencies.

From http://www.whitehouse.gov/healthreform/timeline





We are all smart educated people. Think about it for a minute. Insurance companies exisit to make money just like any other for profit company. This law squeezes them really hard. They are now going to have to cover millions of people that will cost them money. Think about ways an insurance company can reduce fraud, waste and abuse. Think about ways insurance companies can improve efficiecy. It is not hard to come up with answers. You have to think like a corporate MBA suit who is intereted in maximizing profit. Do not think like a healthcare provider. That has nothing to do with it. This is about money and how to make as much as possible.

One thing we are already seeing (ask Doctor M) is insurance companies auditing the **** out of everyone in order to recover as much money as possible under the guise of "preventing fraud, waste and abuse". Ask Doctor M how much fraud, waste and abuse has been uncovered during his numerous audits....None! They are taking money back for clerical errors and technicalities.

The insurance companies will squeeze every dollar of profit they can by using the lowest cost option when there is one. Prescription drugs are a huge expense for insurance companies. They will now be required to cover millions of people's prescriptions that they will lose money on. A logical conclusion is mail order will be a central part of their efforts to reduce costs and improve efficiencies. No one can argue it is much cheaper and thus more profitable to fill presciptions via mail order. You better believe there will be incentives, reduced co-pays ect. to get people to use mail order. Express scripts all ready does with Tricare by filling generic mail order Rx's for zero co-pay.

You all need to open your eyes and see what is coming. If you were around when Medicare D hit then you have a clue about what is ready to happen. Only this will be 1000 times worse than Med D.

This is why we are headed toward compounding and Long Term Care. Retail will lose the battle.
 
This is why we are headed toward compounding and Long Term Care. Retail will lose the battle.

You are exactly correct except retail has lost the battle. Retail pharmacy is over. Its headed for a 0.5% profit margin game that only the highest volume corporate retail chains will even bother to stay in. Then they will do it mostly as a loss leader to get people to buy the profitable stuff in the rest of the store.

Wake up people. Doctor M is living it right now and can see the writting on the wall. If you sit down and really think about so will you.
 
You are exactly correct except retail has lost the battle. Retail pharmacy is over. Its headed for a 0.5% profit margin game that only the highest volume corporate retail chains will even bother to stay in. Then they will do it mostly as a loss leader to get people to buy the profitable stuff in the rest of the store.

Wake up people. Doctor M is living it right now and can see the writting on the wall. If you sit down and really think about so will you.

With Managed care pushing Mail order (this includes commercial plans and Medicaid HMOs), Obamacare in the works, the only way to make it is in LTC, cash compounding, infusion pharmacy. The Retail Pharmacy business plan is high risk with low to moderate rewards. I say low, because your moderate returns sometimes get diminished via audits and charge backs. Our company is looking for other avenues of revenue. We look at short term gains and long term gains. How long can we sustain a certain amount of revenue before the PBMs come knocking? We have ideas in the works and we just need to implement. We try to beat the clock with these PBMs. At any moment, they can come knocking and we have to be ready. And then we move on to the next plan. It is a game. A long and arduous game. Any of you who plan on opening an independent, all i have to say is be ready to play a long and dirty game!
 
This is why we are headed toward compounding and Long Term Care. Retail will lose the battle.

Lovin this real talk, and how you discuss your business and the positives/negatives. I don't work retail and all of the retail people I know don't have that entrepreneurial thought process, can't see the forest for the trees so to speak.

I'm wondering why all the discussion has only centered on retail. What about hospital pharmacy? Any thoughts Its Z?
...
Doesn't managed care have a greater focus on medical costs, so is hospital pharmacy, being tied to medical treatments, more affected?

I too would love to hear Z's thoughts on this and the future of hospital pharmacy in an environment of declining reimbursements and possibly the ACO model.

I work at a not-for-profit academic medical center. My impression so far (and it's already started at my AMC prior to "Obamacare") is that more coverage with lower insurance profits will lead to lower private insurance drug reimbursements and flat/lower medicaid/medicare DRG reimbursement. As a result, 1.) it's going to be all about cost savings (moreso than it already is) and more importantly 2.) if you can prove that you save money and/or improve outcomes, you will get funding.

For #1, since pharmacy is a cost center we will always be scrutinized for high cost drugs and waste but it's really getting serious now. 5 years ago the hospital I worked at monitored stuff but everything seemed like a soft intervention. Nowadays there's serious business ID stewardship, IV to PO, waste prevention, more stringent formulary with restrictions, etc.

In terms of #2, things like fully integrated CPOE/EMAR/EHR will come into play; even though it's initially expensive, it's so much more efficient and thus will lower costs long term. Discharge/med rec pharmacists are the new black and are being published about everywhere to justify the costs. Somewhat discouraging results so far but IMO for high-needs patients a good RPh is essential to prevent avoidable rehospitalization. In any event, at my AMC I am seeing a lot of new ideas and innovative trials, and if you have a good idea you will get funding.

In summation, is it good for the country? I think so; as a society we need lower healthcare costs without going full ****** with rationing of care. As pharmacists, we should be working towards improving outcomes and lowering costs when we can.

Is it good for pharmacy? Nope, unless you can adapt. Anything that creates greater efficiency and transparency will lower profits unless you have an edge (NB: doctor m's business plan). Story of any business anywhere.
 
So our big revelation is that independent or otherwise small time retail pharmacy is dead and only the giant chains will survive due to decreasing reimbursement rates and economy of scale?

Wow, welcome to 1996, guys. :laugh:

"Obamacare" isn't forcing that to happen. This has been happening as insurance companies have grabbed more and more power and have since used said power to leverage pharmacies into lower rates. This has been happening since freaking forever. Gimme a break. Squeezing more and more profit out of anything imaginable no matter the potential ethical cost is the American Corporate M.O.

Of course, as this lowering keeps happening, only a few pharmacy corporations will be able to survive. At some point, in this hypothetical future, a retail pharmacy oligopoly will form. With a consolidation of power on the retail side will also create a bit of power for those few megapowerful corporations to then leverage more powerful rates as they then would have the power to better collude with each other.

**** could go anywhere...who knows...we might wind up with a single payer system and your assumptions would go out the window. MPD would find himself being a telemarketer for the American equivalent to the NHS rather than a telemarketer for his private PBM. Maybe Hilary will be his boss. Or that weird Indian guy from Mississippi or wherever he's from. Whatever his name is. Bobby Jingle, maybe? I dunno, dude's voice creeps me out, anyway.

Maybe CVS will shut down and I'll move to the UK and actually get a job with the real NHS.
 
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So our big revelation is that independent or otherwise small time retail pharmacy is dead and only the giant chains will survive due to decreasing reimbursement rates and economy of scale?

Wow, welcome to 1996, guys. :laugh:

"Obamacare" isn't forcing that to happen. This has been happening as insurance companies have grabbed more and more power and have since used said power to leverage pharmacies into lower rates. This has been happening since freaking forever. Gimme a break. Squeezing more and more profit out of anything imaginable no matter the potential ethical cost is the American Corporate M.O.

Of course, as this lowering keeps happening, only a few pharmacy corporations will be able to survive. At some point, in this hypothetical future, a retail pharmacy oligopoly will form. With a consolidation of power on the retail side will also create a bit of power for those few megapowerful corporations to then leverage more powerful rates as they then would have the power to better collude with each other.

**** could go anywhere...who knows...we might wind up with a single payer system and your assumptions would go out the window. MPD would find himself being a telemarketer for the American equivalent to the NHS rather than a telemarketer for his private PBM. Maybe Hilary will be his boss. Or that weird Indian guy from Mississippi or wherever he's from. Whatever his name is. Bobby Jingle, maybe? I dunno, dude's voice creeps me out, anyway.

Maybe CVS will shut down and I'll move to the UK and actually get a job with the real NHS.

My partner and I briefly discussed this this evening. Essentially you will have this privatized system lowering reimbursement to an unsustainable level, whereas you will have
these large corporations lobbying to make reimbursement to a level where retail will be able to survive. If you are an independent, yes, you have struggled since HMOs and PBMs have started to exist, but it will force you to find other means of revenue. Just today, I filled 7 prescriptions for a patient, all generics, through a managed care medicaid HMO and i averaged, NO FREAKING LIE, $1.50 profit per prescription. I lose big time and that is where these state funded plans are headed. These reimbursements are the same for independents and chains. State funded plans pretty much have the same rate schedule for all pharmacies. So the chains are affected. So, yes this is nothing new, but it is getting worse. The past 2 years i have seen state medicaid MAC everything. Everything is MAC. We are preparing now because we believe it will get worse.
 
To give you all an idea of where independent is headed and also where we are at, here is an except of a contract between a PBM and Sponsor;

"-----will, via pharmacy audits, return to the sponsor 85% of recouped funds from a said pharmacy and we will keep 15% of any recouped funds for administrative costs."

now, in a said pharmacy contract, the same PBM makes the pharmacy sign stating:

"If we recoup funds betweem $X dollars and Y dollars, the pharmacy shall pay us 10% for the cost of the audit. if we recoup between $XY dollars and $XX dollars, the pharmacy shall pay us 25% for the cost of the audit"

WTF?? This is robbery. this PBM can collect anywhere between 25% and 35% of the recoupment. This is the fundamental problem with independent pharmacy, we have NO leverage, We have no say. This, along with reimbursements is what drives us out of business. So fuked up at so many levels.
 
So our big revelation is that independent or otherwise small time retail pharmacy is dead and only the giant chains will survive due to decreasing reimbursement rates and economy of scale?

Wow, welcome to 1996, guys. :laugh:

"Obamacare" isn't forcing that to happen. This has been happening as insurance companies have grabbed more and more power and have since used said power to leverage pharmacies into lower rates. This has been happening since freaking forever. Gimme a break. Squeezing more and more profit out of anything imaginable no matter the potential ethical cost is the American Corporate M.O.

Of course, as this lowering keeps happening, only a few pharmacy corporations will be able to survive. At some point, in this hypothetical future, a retail pharmacy oligopoly will form. With a consolidation of power on the retail side will also create a bit of power for those few megapowerful corporations to then leverage more powerful rates as they then would have
the power to better collude with each other.

**** could go anywhere...who knows...we might wind up with a single payer system and your assumptions would go out the window. MPD would find himself being a telemarketer for the American equivalent to the NHS rather than a telemarketer for his private PBM. Maybe Hilary will be his boss. Or that weird Indian guy from Mississippi or wherever he's from. Whatever his name is. Bobby Jingle, maybe? I dunno, dude's voice creeps me out, anyway.

Maybe CVS will shut down and I'll move to the UK and actually get a job with the real NHS.

What do you know about pharmacy in 1996 ? Weren't you were in middle school in 1996? Hell 1996 was awesome. Salaries were just starting to really take off, the big shortage was just starting, ****.....1996 was freaking great!

It would have made sense if you said 2004 or later. When the government got into prescription drugs with Medicare D and everything really started turn to crap.
 
What do you know about pharmacy in 1996 ? Weren't you were in middle school in 1996? Hell 1996 was awesome. Salaries were just starting to really take off, the big shortage was just starting, ****.....1996 was freaking great!

It would have made sense if you said 2004 or later. When the government got into prescription drugs with Medicare D and everything really started turn to crap.

:thumbup::thumbup: I was a sophmore in college...i didnt even know what Pharmacy was!
 
What do you know about pharmacy in 1996 ? Weren't you were in middle school in 1996? Hell 1996 was awesome. Salaries were just starting to really take off, the big shortage was just starting, ****.....1996 was freaking great!

It would have made sense if you said 2004 or later. When the government got into prescription drugs with Medicare D and everything really started turn to crap.

+1 I think pops shutdown our independent in '01 or so as he said reimbursements were turning to crap already by that time
 
So you are saying that independents didn't start feeling the crunch until 2004?

Either way...its not like Obamacare is causing this or that its anything new.
 
With Managed care pushing Mail order (this includes commercial plans and Medicaid HMOs), Obamacare in the works, the only way to make it is in LTC, cash compounding, infusion pharmacy.

For now, yes...but I can't help but wonder how long it will be until the payers set their sights on these lines of business? It will just be the next step in the realm of cost-containment.
 
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