What we are saying is that it is getting worse and will get much worse. As Business owners, you just come up with different ways to make money. And if it means shutting down the retail portion of the business in order to salvage the business, then so be it. When PBMs came into the picture, it made independent pharmacy tough. When Medicare D came, it made it even tougher. Now with Obama care, it may make it near impossible to survive on prescriptions alone. But who knows, maybe Obama care will make it more profitable. What we are hoping for is that the large chains will lobby along the independents for fair pricing and access to networks. Obama care will only increase fraud waste and abuse audits to more than we can handle today. We will need a whole department dedicated to only audits and FWA training and the charge backs may be significant. Again, this aspect of the business is not new. Obama care just adds to the headaches and thorns in my rear end to todays business.
Obamacare and Pharmacy
- Thread starter thedave
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What we are saying is that it is getting worse and will get much worse. As Business owners, you just come up with different ways to make money. And if it means shutting down the retail portion of the business in order to salvage the business, then so be it. When PBMs came into the picture, it made independent pharmacy tough. When Medicare D came, it made it even tougher. Now with Obama care, it may make it near impossible to survive on prescriptions alone. But who knows, maybe Obama care will make it more profitable. What we are hoping for is that the large chains will lobby along the independents for fair pricing and access to networks. Obama care will only increase fraud waste and abuse audits to more than we can handle today. We will need a whole department dedicated to only audits and FWA training and the charge backs may be significant. Again, this aspect of the business is not new. Obama care just adds to the headaches and thorns in my rear end to todays business.
This is where we are headed:
http://www.mysanantonio.com/opinion...nder-state-s-Medicaid-plan-3848316.php#src=fb
and this is a reality. Believe it. I suspect obama care will be similar in nature
http://www.mysanantonio.com/opinion...nder-state-s-Medicaid-plan-3848316.php#src=fb
and this is a reality. Believe it. I suspect obama care will be similar in nature
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Any chance the transparencies will show how little pharmacy is being reimbursed and the nearly lack of profitability and lead to sustainable reimbursement rates? /dreaming
I dont think so. We will adapt or be thrifty and crafty. Either accept lower reimbursement, lower salary, less jobs, or find other ways to make money. My partner and I are already moving toward the latter. There is something about accepting defeat with us. It is not so much the money, rather the time and effort it took to get where we are at. Long hours, disagreements, ups and downs, and for what? For 1 man to say we didnt build our business, someone was responsible for that? We do not think so. Our views and opinions on healthcare are quite different than most. We believe in capitalism, and we pay our dues. Any more transparency in the pharmacy world is not going to cause any pity form anyone paying the bills. It will drop it even more. Besides, why should a pharmacist make what they make? That will be their thinking.
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Jim Plagakis has been talking about this on his website. This is real and happening right now. Doctor M is correct that this is the future under Obama Care. Its what happened when Medicare Part D came along....there is plenty of precedent to go on. You don't have to stretch your imagination very far to see what will happen.
Call me Mr. Doom and Gloom, the enternal pessimist, whatever. I am a realist. Open your eyes....the future of our profession is in the balance.
Id like to see what a PBM does when someday, if it ever comes, the Govt stops what they do. I doubt they ever will. As long as you dont cause harm to the consumer, nothing will ever be done. It is like falling into a hole, an endless long hole that never ends, with sharp spears protruding from the ground waiting for you when you hit... Yes, I am cynical...
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Not cynical...realistic.
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That's sort of how I see it too, but Obamacare is moving 50 million uninsured patients to managed care insurance plans, so it is another HUGE boost in power for the insurance companies.
Some people still seem to think this is great for pharmacy because we'll have 50 million 'new' patients. These patient are not 'new' at all. They were there all along. Just that before they were cash paying patients, and in fact this was probably better for us because we could charge them whatever we wanted.
This is the similarity to Medicare Part D. Before that, over 65s had to pay cash for their prescriptions and we had no problem charging $11.99 for #30 HCTZ. At the time, RPhs were also saying how MPD would be great for pharmacy to have all these 'new' patients with insurance which would boost our script numbers. And it did... but the insurance also slashed reimbursement to like $1.50 per script so we had to work like dogs to maintain profitability.
This was also when Wal-Mart and various grocery store pharmacies started their $4 or free generics thing. I guess they were thinking if insurance was only reimbursing us $1.50, may as well lower the U&C to $4 to use it for marketing and as a loss leader to get people in the door and buy groceries/merchandise.
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The pressure is on retail to reduce costs. Walgreens has their Power thing. What does CVS have? Is the readyfill thing getting ready for central fill? I even heard some grocery store pharmacies are doing central fill.
You pretty much have it dead on. No more cash prescriptions. Unless there is a product not covered. In essence, you will see gross margin go from 16-20% to 10-13%. For those pharmacies depending on cash prescriptions, they will suffer and possibly close. I dont see how obamacare is any good for business. For the citizens and illegals with no Ins, yes, great, for us trying to make a living, well, not so much.
Our president needs to fix his syntax. I know what his point was, but he said what he said and I know what was conveyed. So if you think im misinterpreting, i understood what he conveyed. Either way, he needs to go. and how is it that my knee-jerk hyperreflexia is gonna hurt someone? The only way i can see it hurt someone is some sensitive ***** who thinks socialized healthcare is great for us and believes it wont bankrupt us sooner than we are headed.
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Obamacare also sucks for pharmacists (income>$100,000). I do think a lot of employers are going to be as cheap as possible and offer crappy benefits because they think you can buy your own.
And, if you do decide to get your own insurance, because you are making more than $100k, you are going to pay full premium with no subsidized help of ~15,000/year for a family of 4.
And, if you do decide to get your own insurance, because you are making more than $100k, you are going to pay full premium with no subsidized help of ~15,000/year for a family of 4.
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Has anyone found a legitimate summary of the changes that will result from the ACA? The actual document is too thick to go through page by page (said every congressman), and I don't like relying on biased statements.
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I was told that the law will probably set hospital reimbursement rates for a condition and not so much for procedures. Someone that had a heart attack will go to a hospital and the hospital will be given a set amount of money to preform all tests and therapies. It's supposedly going to benefit hospital/clinical pharmacy since billions are wasted on drugs and more inclusion of pharmacists on a healthcare team making drug selections and drug monitoring will save a hospital money. That's about all I know and even then I'm not sure. It's hard finding any source that isn't biased. The ACA is either going to kill all sick patients and decrease salaries by 75% or it's going to be the greatest thing ever devised and heart disease is just going to vanish in awe of how wonderful the healthcare system is going to be.
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CMS should have one.
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Wikipedia seems pretty reasonable: http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act
[ducks for cover...]
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POWER got shut down a while ago, unfortunately. It seemed promising.
