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[NorthTexasPharmacist]

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APhA Names Antonio Ciaccia Senior Advisor for Disruptive Innovation and Practice Transformation

CONTACT: Frank Fortin 202.223.7189; [email protected] The American Pharmacists Association (APhA) announced today that it has named Antonio Ciaccia, Chief Strategy Officer of 3 Axis Advisors, as APhA’s Senior Advisor for Disruptive Innovation and Practice Transformation. This addition will...

www.pharmacist.com

2020-2021 could be the all out war against PBMs. This along with Rutledge hearing. Rutledge v. Pharmaceutical Care Management Association - SCOTUSblog

"Ciaccia and 3AA President Eric Pachman were instrumental in exposing the drug pricing distortions and supply chain inefficiencies embedded in Ohio’s Medicaid managed care program, which led to the discovery of $244 million in hidden PBM spread pricing in just one year."

Extorting $244 million in one year from ONE STATE. Imagine how much PBMs extorted out of all the states. Why do they cut hours? how could they be lowering pharmacist salary? why is there -3% growth in our profession in the next decade? well there is your answer.

 

[Marzapan]

APhA Names Antonio Ciaccia Senior Advisor for Disruptive Innovation and Practice Transformation

CONTACT: Frank Fortin 202.223.7189; [email protected] The American Pharmacists Association (APhA) announced today that it has named Antonio Ciaccia, Chief Strategy Officer of 3 Axis Advisors, as APhA’s Senior Advisor for Disruptive Innovation and Practice Transformation. This addition will...

www.pharmacist.com

2020-2021 could be the all out war against PBMs.

"Ciaccia and 3AA President Eric Pachman were instrumental in exposing the drug pricing distortions and supply chain inefficiencies embedded in Ohio’s Medicaid managed care program, which led to the discovery of $244 million in hidden PBM spread pricing in just one year."

Extorting $244 million in one year from ONE STATE. Imagine how much PBMs extorted out of all the states. Why do they cut hours? how could they be lowering pharmacist salary? why is there -3% growth in our profession in the next decade? well there is your answer.

LoL keep fighting the PBMs when the real issue is saturation due to the pharmacy schools. With the quality of new grads getting crappier every year the best path forward for this profession is to string them out to dry, not "create jobs for everyone" (which killing PBMs won't do).

 

[NorthTexasPharmacist]

LoL keep fighting the PBMs when the real issue is saturation due to the pharmacy schools. With the quality of new grads getting crappier every year the best path forward for this profession is to string them out to dry, not "create jobs for everyone" (which killing PBMs won't do).

I think I said this before. Yes, there are too many schools. Statistics show that quality of students are going down. There is a saturation. No one is denying this but it is a problem that cannot be fixed right away. It will take time. Fixing PBMs could literally happen over night.

 

[Marzapan]

I think I said this before. Yes, there are too many schools. Statistics show that quality of students are going down. There is a saturation. No one is denying this but it is a problem that cannot be fixed right away. It will take time. Fixing PBMs could literally happen over night.

I stand to differ. In the other thread we were arguing whether the #1 issue in pharmacy is too many students or poor PBM reimbursements. And like I said in the other thread, only a minority of pharmacists (aka independents) will benefit from PBM reforms. Not chain retail pharmacists, not hospital pharmacists or any other non-traditional pharmacists. If this is a reimbursement issue then you're better off lobbying for wholesale reforms on what services the government will recognize as billable from pharmacists, not quibbling over a few extra bucks here and there for dispensing or DIR fees. Still, I suppose ANY change is positive change at this point for this profession but it just goes to show the sad state of reality...

 

[sfachine]

I think I said this before. Yes, there are too many schools. Statistics show that quality of students are going down. There is a saturation. No one is denying this but it is a problem that cannot be fixed right away. It will take time. Fixing PBMs could literally happen over night.

It will not replace the biggest issue.The entire pharmacy retail dispensing business model is dying. Look at the stocks.Brutal.

 

[NorthTexasPharmacist]

I stand to differ. In the other thread we were arguing whether the #1 issue in pharmacy is too many students or poor PBM reimbursements. And like I said in the other thread, only a minority of pharmacists (aka independents) will benefit from PBM reforms. Not chain retail pharmacists, not hospital pharmacists or any other non-traditional pharmacists. If this is a reimbursement issue then you're better off lobbying for wholesale reforms on what services the government will recognize as billable from pharmacists, not quibbling over a few extra bucks here and there for dispensing or DIR fees. Still, I suppose ANY change is positive change at this point for this profession but it just goes to show the sad state of reality...

Not sure if I ever said reimbursement issue is a greater issue than saturation issue but my point wasnt to rank issues.

If you feel strongly about number of schools causing saturation and you want to fight for it, more power to you. No one is stopping you.

Not sure how you could know ONLY indies will benefit from PBM reforms though. Based on much of literature ive read so far, pharmacy in general will have a huge benefit financially from this reform.

Anywho, I am extensively involved in this issue and am advocating for it because i am passionate and convinced that this could single handily change the profession.

You should also do the same with whatever you strongly believe in. No need to discourage. We are all on the same side.

 

[ValeRx]

PBMs are absolutely the primary issue. Staffing problems? It's not due to too many new grads, it's due to the fact that pharmacies are making cents, rather than dollars for every script filled. That wasn't always the case and staffing wasn't always an issue. It wasn't until PBMs starting paying major chains in peanuts that all the big box pharmacy chains had to start cutting back hours for pharmacists in order to remain profitable. Now, does that mean fixing it will automatically increase wages and put hours back? Probably not.

Chains now know they can operate at bare bones staffing so they will stand to make that much more money operating with this minimal staffing.

 

[Sparda29]

New York is removing Managed Medicaid (PBMs) and placing them on regular Medicaid.

What does this also mean? Pharmacies who cannot get approved for Medicaid are fked. We are already seeing rejections to Medicaid applications with no reason other than "The Medicaid OIG believes that there are already a sufficient amount of providers to meet the needs of patients in this area."

 

[JustFillIt]

All I can say is it’s about damn time that Apha does something. At this point, all resources need to be diverted to saving this profession and advancing pharmacy. No more hosting parties or these stupid student poster circle *****... every last penny should be spent on legal council and lobbying legislators.

 

[BackRowChi]

Chains now know they can operate at bare bones staffing so they will stand to make that much more money operating with this minimal staffing.

I was thrilled to hear about Ciaccia this morning. That guy is sharp and I think a hire like that proves that Knoer is out for blood. It's sad that APhA was asleep at the wheel this long (along with AACP. It doesn't matter if there was no legal way to stop accreditation. AACP should have sounded the alarm bells early and often as the gatekeeper for this profession.), but the board knew APhA had a bleak future unless they hired a true advocate. I'm giving Knoer the benefit of the doubt.

Concerning bare bones staffing, you're right. The chains won't turn back the clock on that unless they have to. That's why it's so important independent pharmacies can become profitable again. If Indies can turn a profit, the best retail pharmacists will jump ship and the chains will have to provide incentives to compete for (competent) talent and business. It certainly wouldn't happen overnight, but the right market forces would be in play.

BUT, if you've listened to Ciaccia in any of his interviews, he doesn't think PBM reform alone will create more jobs and job security. By its nature, the current reimbursement model was always susceptible to arbitrage and exploitation. Provider status has to happen or pharmacy is dead.

Regarding schools, the contraction is visibly underway. Our area schools' P1 classes are smaller and the number of applications for next year are dismal. I hate to see good schools fight over scraps, but man am I ready for the diploma mills to die.

 

[Marzapan]

Correct me if I am wrong.
There are about 320000 pharmacist jobs in US.
Assume 10 percent leave the profession yearly.
Assume 0 percent job growth.Latest stats are even worse.
That leaves a equilibrium figure of 3200 jobs annually.
We are graduating 15000 annually. Even the old graduation numbers of about 7200 are double the replacement rate.
I hope someone proves me wrong but we are screwed.

Nope, you're right. We are screwed.

Don't know exactly what Ciaccia will do but I will say this... one man alone cannot win a war. Any strategy that doesn't involve closing down schools is not going to advance the profession, and I highly doubt APhA will go in that direction because they need $$$ from membership dues. So, what are the remaining options? Fight the PBMs, fight the corporate chains or fight the government (for provider status), all of which are dynamic and will react to what APhA does. Good luck against the lobbyists employed by those entities...

Furthermore, what is the strategy that APhA will likely deploy due to their lack of manpower compared to above? Uncover/publish a series of exposes? We've seen in the last year articles in the NYT exposing poor work conditions in retail pharmacies, but despite the press on the "negative" aspects of pharmacies, nobody cares. Why? Because the general public doesn't even know what a pharmacist does, so you won't have "public outrage" on your side. Same with politicians and judges -- NOBODY knows what a pharmacist does so we're not going to get a lot of empathy...

 

[Marzapan]

I was thrilled to hear about Ciaccia this morning. That guy is sharp and I think a hire like that proves that Knoer is out for blood. It's sad that APhA was asleep at the wheel this long (along with AACP. It doesn't matter if there was no legal way to stop accreditation. AACP should have sounded the alarm bells early and often as the gatekeeper for this profession.), but the board knew APhA had a bleak future unless they hired a true advocate. I'm giving Knoer the benefit of the doubt.

Concerning bare bones staffing, you're right. The chains won't turn back the clock on that unless they have to. That's why it's so important independent pharmacies can become profitable again. If Indies can turn a profit, the best retail pharmacists will jump ship and the chains will have to provide incentives to compete for (competent) talent and business. It certainly wouldn't happen overnight, but the right market forces would be in play.

BUT, if you've listened to Ciaccia in any of his interviews, he doesn't think PBM reform alone will create more jobs and job security. By its nature, the current reimbursement model was always susceptible to arbitrage and exploitation. Provider status has to happen or pharmacy is dead.

Regarding schools, the contraction is visibly underway. Our area schools' P1 classes are smaller and the number of applications for next year are dismal. I hate to see good schools fight over scraps, but man am I ready for the diploma mills to die.

I looked Ciaccia up. The brother isn't even a pharmacist. Just another empty suit looking for ways to make a quick buck in the business of pharmacy. Already have major doubts about what exactly they're going to fight for...

 

[TheBlaah]

Correct me if I am wrong.
There are about 320000 pharmacist jobs in US.
Assume 10 percent leave the profession yearly.
Assume 0 percent job growth.Latest stats are even worse.
That leaves a equilibrium figure of 3200 jobs annually.
We are graduating 15000 annually. Even the old graduation numbers of about 7200 are double the replacement rate.
I hope someone proves me wrong but we are screwed.

10 percent of 320,000 is 32,000 jobs annually.

But 10 percent is a bit of an overestimate. For most job professions, around 3% leave the job force annually.

 

[WorthlessOxygen]

New York is removing Managed Medicaid (PBMs) and placing them on regular Medicaid.

What does this also mean? Pharmacies who cannot get approved for Medicaid are fked. We are already seeing rejections to Medicaid applications with no reason other than "The Medicaid OIG believes that there are already a sufficient amount of providers to meet the needs of patients in this area."

Do you know anything more about this? I see PSSNY's emails but they haven't had a whole lot of detail. Is there any sort of timeline? Any guess as to what billing will look like?

I've asked my coworkers but they don't/didn't even know that anything was going on.

 

[NorthTexasPharmacist]

Correct me if I am wrong.
There are about 320000 pharmacist jobs in US.
Assume 10 percent leave the profession yearly.
Assume 0 percent job growth.Latest stats are even worse.
That leaves a equilibrium figure of 3200 jobs annually.
We are graduating 15000 annually. Even the old graduation numbers of about 7200 are double the replacement rate.
I hope someone proves me wrong but we are screwed.

Not sure about the exact number but from what I've read on different articles, less than 5% of pharmacists are retiring each year. Even then, alot of them come back to work part time. 15,000 new grads each year, less than 16,000 or 5% of 320,000 retiring each year, there goes your zero or negative growth.

It's impossible to predict how we can fix this without thinking about increasing revenue generated for and by the profession. In a free market where the supply and demand curve can be applied, this problem should not exist considering number of patients and prescriptions are increasing exponentially. But we are dealing with PBMs and their most jacked up payout model in modern history. We don't even know why or how they're reimbursing. This whole movement is to 1. be able to look into how reimbursements are justified, 2. create an agency to oversee PBMs abuse and be able to audit.

Once this is under control, maybe we could even justify number of schools.

I mean, wouldn't you agree that you could probably use an extra pharmacist or two at your pharmacy? Why can't you get more? because you don't got no money...

Going further, I think each state should implement a law stating that for certain number of scripts a pharmacy fills, it requires to hire a certain number of pharmacists.

 

[NorthTexasPharmacist]

New York is removing Managed Medicaid (PBMs) and placing them on regular Medicaid.

What does this also mean? Pharmacies who cannot get approved for Medicaid are fked. We are already seeing rejections to Medicaid applications with no reason other than "The Medicaid OIG believes that there are already a sufficient amount of providers to meet the needs of patients in this area."

Cuomo is a cancer. Among many things he has done to sabotage state of new york, Cuomo vetoes bill to regulate pharmacy benefit managers

 

[NorthTexasPharmacist]

I looked Ciaccia up. The brother isn't even a pharmacist. Just another empty suit looking for ways to make a quick buck in the business of pharmacy. Already have major doubts about what exactly they're going to fight for...

He doesn't need to be a pharmacist to advocate for us and fight the legal battles. He has fought and won before.

 

[mentos]

I don't understand the title of this thread. When Sam told Captain America, "On your left" - all of the Avengers were resurrected and assembled to defend the universe against Thanos. What does this have to do with PBMs?

 

[Marzapan]

I don't understand the title of this thread. When Sam told Captain America, "On your left" - all of the Avengers were resurrected and assembled to defend the universe against Thanos. What does this have to do with PBMs?

Somehow OP thinks that pharmacists are the Avengers and PBMs = Thanos.

 

[mentos]

Somehow OP thinks that pharmacists are the Avengers and PBMs = Thanos.

Does Iron Man get told what to do by a front store manager with a high school diploma?

 

[Marzapan]

Does Iron Man get told what to do by a front store manager with a high school diploma?

Apparently killing Thanos will solve this problem

 

[NorthTexasPharmacist]

I don't understand the title of this thread. When Sam told Captain America, "On your left" - all of the Avengers were resurrected and assembled to defend the universe against Thanos. What does this have to do with PBMs?

Don't be jealous just because the title was too perfect 😎😆

 

[NorthTexasPharmacist]

Apparently killing Thanos will solve this problem

Thanos is a made up character from a comic book... not sure how killing Thanos, that doesn't even exist, will solve any real life problem but okay...

 

[NorthTexasPharmacist]

I stand to differ. In the other thread we were arguing whether the #1 issue in pharmacy is too many students or poor PBM reimbursements. And like I said in the other thread, only a minority of pharmacists (aka independents) will benefit from PBM reforms. Not chain retail pharmacists, not hospital pharmacists or any other non-traditional pharmacists. If this is a reimbursement issue then you're better off lobbying for wholesale reforms on what services the government will recognize as billable from pharmacists, not quibbling over a few extra bucks here and there for dispensing or DIR fees. Still, I suppose ANY change is positive change at this point for this profession but it just goes to show the sad state of reality...

Rutledge v. Pharmaceutical Care Management Association

www.scotusblog.com

45 states and a bunch of other people think it's kinda important that they signed a petition to regulate PBMs... so I'm gonna say it's kinda important. If you don't think it's important then that's okay. You do you.

 

[Marzapan]

Rutledge v. Pharmaceutical Care Management Association

www.scotusblog.com

45 states and a bunch of other people think it's kinda important that they signed a petition to regulate PBMs... so I'm gonna say it's kinda important. If you don't think it's important then that's okay. You do you.

This is becoming a circular argument. I never said this wasn't important, I only said that closing down schools are more important than this. It isn't 1a vs. 1b, it's 1 vs 2.

 

[NorthTexasPharmacist]

This is becoming a circular argument. I never said this wasn't important, I only said that closing down schools are more important than this. It isn't 1a vs. 1b, it's 1 vs 2.

Right. This thread wasnt about arguing which is important. I just wanted to share and inform the latest update. You're the one who is keep on making these comparisons. Like I said, we get it. We get that you don't think reimbursement isn't as important as closing down schools. If that is your opinion, that's great. Go join an advocacy group and keep on pushing your agenda.

 

[mentos]

Don't be jealous just because the title was too perfect 😎😆

The title doesn't make sense at all. Is one pharmacist about to fight all of Thanos' army alone?

 

[NorthTexasPharmacist]

The title doesn't make sense at all. Is one pharmacist about to fight all of Thanos' army alone?

If you get it, you get it. If you don't, you don't. It's not that serious.

 

[JustFillIt]

Does Iron Man get told what to do by a front store manager with a high school diploma?

I just wanna say I have never worked with a store manager that I did not make my b****. This all has to do with testicular fortitude.

When I quit on my last store manager - he started crying. True story....

 

[Sparda29]

Getting rid of PBMs does help pharmacists. It means more of the profit gets passed along to the pharmacy instead of being taken by the PBM.

Also, PBM "dispensing fees" are **** tier. Example: filling a script of Aspirin 81mg #30. With PBMs in NYS, you'll be paid less than a dollar probably. With straight Medicaid, you'll get a few cents plus a $10 dispensing fee.

That's the good part about straight Medicaid, they pay $10 dispensing fees for every regular prescription. Doesn't matter if it's an OTC item or not. If you fill 100 aspirin prescriptions, you're gonna make $1000 in dispensing fees that day.

 

[Marzapan]

Getting rid of PBMs does help pharmacists. It means more of the profit gets passed along to the pharmacy instead of being taken by the PBM.

Also, PBM "dispensing fees" are **** tier. Example: filling a script of Aspirin 81mg #30. With PBMs in NYS, you'll be paid less than a dollar probably. With straight Medicaid, you'll get a few cents plus a $10 dispensing fee.

That's the good part about straight Medicaid, they pay $10 dispensing fees for every regular prescription. Doesn't matter if it's an OTC item or not. If you fill 100 aspirin prescriptions, you're gonna make $1000 in dispensing fees that day.

That's an example of why a dispensing fee model for reimbursement doesn't work. Why would I pay you $10 or more to fill an OTC med? It's the same thing as a hairdresser charging $100+ for a haircut or a gym charging $200/month for membership -- talk about a hustle. Sure, you may still attract some clientele at a high price point (in pharmacy terms, win contracts with insurers/PBMs), but most of your potential business will be undercut by others in your industry who can provide the same core services that you can but for cheaper. The $10 barber shops. The Planet Fitnesses of the world. etc. That being said, the difference is that the "high end" version of hair salons and gyms do come with their perks while highly priced pharmacy products do not because there isn't a difference in quality of service or product if a pharmacist, pharmacy technician or homeless person was filling your prescription. So it's ludicrous to think that anyone with half a brain will pay good money to dispense meds (the temporary solution to this is to use cheaper labor -- i.e. fire pharmacists and replace them with techs -- but the long term solution is to fire techs and automate everything -- which is what mail order is all about).

 

[mentos]

LoL at thinking getting rid of PBMs would help pharmacists. The extra profit will go straight into the CEO's pocket, not pharmacists'.

 

[NorthTexasPharmacist]

LoL at thinking getting rid of PBMs would help pharmacists. The extra profit will go straight into the CEO's pocket, not pharmacists'.

This is why there is an effort to create an agency to oversee reimbursements. Either with PBMs or without, insurance companies need to abide by the rules. Right now there is zero accountability as far as how we are reimbursed.

 

[mentos]

This is why there is an effort to create an agency to oversee reimbursements. Either with PBMs or without, insurance companies need to abide by the rules. Right now there is zero accountability as far as how we are reimbursed.

Unless you own an independent pharmacy, "we" are not reimbursed. Our employers are. Pharmacists are simply expensive overhead.

 

[NorthTexasPharmacist]

Unless you own an independent pharmacy, "we" are not reimbursed. Our employers are. Pharmacists are simply expensive overhead.

Right. Since your employers pay you, shouldnt you worry about how much they are reimbursed? Whether it is indie or chain or hospital or ltc, all get reimbursed by PBMs. We are ALL affected.

Well unless youre one of those cash only pharmacies. Theyre banking right now.

 

[Marzapan]

This is why there is an effort to create an agency to oversee reimbursements. Either with PBMs or without, insurance companies need to abide by the rules. Right now there is zero accountability as far as how we are reimbursed.

How do you think this oversight agency will be funded? Taxpayer dollars to continue jacking up overall healthcare spend? Or, if not a government-funded entity, relying on costs saved from regulating PBMs to be passed back to fund their organization? In other words, creating another middleman to middleman a middleman... Either way, it's going to drive up costs and pharmacies won't see the benefit of this. You do also realize that there are already third-party organizations that audit different components of the claims/payment process right? Trying to squeeze another entity into monitoring/evaluating not just internal business operations but also all outsourced work is going to be a headache...

 

[mentos]

Right. Since your employers pay you, shouldnt you worry about how much they are reimbursed? Whether it is indie or chain or hospital or ltc, all get reimbursed by PBMs. We are ALL affected.

Well unless youre one of those cash only pharmacies. Theyre banking right now.

I think you're still missing the point that the big wigs already figured out they can run a pharmacy with a skeleton crew. The CVS where I used to work had 3 pharmacists at a time before 2008. After the recession they figured out that only 1 pharmacist is needed to run the place, despite all time high profits from 2010-2016. None of that extra profit trickled down. There is no going back to the way things were.

 

[Gombrich12]

I think you're still missing the point that the big wigs already figured out they can run a pharmacy with a skeleton crew. The CVS where I used to work had 3 pharmacists at a time before 2008. After the recession they figured out that only 1 pharmacist is needed to run the place, despite all time high profits from 2010-2016. None of that extra profit trickled down. There is no going back to the way things were.

I'll say upfront that I think retail pharmacy or almost any job where you're selling small amounts of a commodity out of a retail shop is dead in the future. That being said, if there was a way to get reimbursement rates back to the point where an independent pharmacy could survive off say 125 rx/day it would give a lot of people the option to leave chain retail. With the falling salaries and horrible work environment in chain pharmacies I'm sure a lot of people would be ok running an independent at that level making $80-90k/year as the owner.

 

[NorthTexasPharmacist]

Loving the pessimism yall. Of course, none of these arguments will matter since none of you are involved in supporting this movement. Lets see how things turn out after all these maga law suits and hearings are finished. If things dont change then you can keep on being your miserable selves. If things do change, im sure youll still be miserable lol. Either way, you win.

 

[mentos]

Loving the pessimism yall. Of course, none of these arguments will matter since none of you are involved in supporting this movement. Lets see how things turn out after all these maga law suits and hearings are finished. If things dont change then you can keep on being your miserable selves. If things do change, im sure youll still be miserable lol. Either way, you win.

Not miserable, just being honest.

 

[Marzapan]

Funny how you think everyone else is miserable when you're the one posting rants about how terrible PBMs are. Pessimism =/= being miserable. I am a pessimist because I see 15,000 surplus new grads being pumped into the market each year so real talent is getting diluted over warm bodies. But I have an extremely cush job so "miserable" is not in my vernacular.

 

[NorthTexasPharmacist]

Funny how you think everyone else is miserable when you're the one posting rants about how terrible PBMs are. Pessimism =/= being miserable. I am a pessimist because I see 15,000 surplus new grads being pumped into the market each year so real talent is getting diluted over warm bodies. But I have an extremely cush job so "miserable" is not in my vernacular.

Okay chief. Whatever you say.

 

[quickpic007]

Loving the pessimism yall. Of course, none of these arguments will matter since none of you are involved in supporting this movement. Lets see how things turn out after all these maga law suits and hearings are finished. If things dont change then you can keep on being your miserable selves. If things do change, im sure youll still be miserable lol. Either way, you win.

How does the average chain rph support? I am hesitant to donate due to the lackluster history.

Not all chain rph are too negative! I am just waiting to get laid off first, then open/buy independent if the time is right. Hopefully by then gross margin improves and pbm regulation improves

 

[Marzapan]

So like, the problem with reimbursements for retail/community pharmacists is bigger than just a PBM issue. It's also the fact that literally every other avenue for pharmacy practice/pharmacy specialty and pharmacy schools have abandoned the "dispense drugs to make money" model and are trying to focus on bringing value through "clinical" or "cognitive" type services so they wouldn't have incentives to "support" reforms to rules/regulations tied to dispensing a drug, because to them it would be taking a step backwards. The whole point to push for "clinical pharmacy" is to dissociate a pharmacist from dispensing duties.

 

[VA77]

I think you're still missing the point that the big wigs already figured out they can run a pharmacy with a skeleton crew. The CVS where I used to work had 3 pharmacists at a time before 2008. After the recession they figured out that only 1 pharmacist is needed to run the place, despite all time high profits from 2010-2016. None of that extra profit trickled down. There is no going back to the way things were.

I will agree with this point. The chains aren't going to go back to overlap even if the the PBMs were dissolved and reimbursements shot thru the roof. It doesn't make business sense to pay labor cost when you don't have to. However, if reimbursement rates went up then you would see more entrepreneurial pharmacists create ways of working for themselves and the chains would have to compete with them.

 

[sfachine]

It is not a bad idea .The trouble is the academics prepared students before the jobs were even created.This arrogance that they can predict or guide the profession is common for intellectuals.

 

[Marzapan]

However, if reimbursement rates went up then you would see more entrepreneurial pharmacists create ways of working for themselves and the chains would have to compete with them.

Why will chains need to compete? If 20% of pharmacists created ways to work for themselves then that's still 12,000 new grads per year competing for the 0 new jobs being made.

 

[PharFromNormal]

This whole PBMs can be dissolved and then we live in magic land fairytale needs to honestly stop. Sure you can create regulation on these business entities you can try to create law on what they can or can’t do etc. you can even try to dissolve all businesses you identify as a “PBM” but here’s the fundamentals that we can never change.

1) there will be some agency (or multiple) government or private business(es) that will always be in charge of the financing and reimbursement of the provision of covered healthcare goods and services
2) that agency will always face extreme pressure to continually lower the cost while improving the “quality” (as defined by the public sentiment not by pharmacists.)
3) there will always be hard pressure to lower reimbursement rates over time
4) the general public and government agencies aren’t going to magically want to increase their expenditures, and any rational budget hawk will want to work to understanding what’s your breaking point and then maybe add one cent.

we can all point to PBMs now and say they are the devil but the hard reality is there will always be “the man” that we complain about that doesn’t pay us enough. Whether that be for the prescription we dispense, the bs we deal with from customers, or the chemo IV bags we cranked out. People always want more money and often look to blame someone on why they aren’t getting it rather than trying to create value for the marketplace and organically receive it. Let’s cry to try to make regulation to be treated fair, and in a year when we still aren’t happy we will complain that they aren’t following the rules or the government didn’t make the right rules. Meanwhile others are delivering organic value to the marketplace and being rewarded withoutthe need to cry to politicians

 

[PharFromNormal]

To me APhA has an identity crises. They don’t know who or what they are trying to serve. Is there first interest the practice or business of pharmacy, the pharmacists themselves, pharmacy as the institution (which in some models can be run almost entirely by technicians), and/or just everything that’s related to anything pharmacy.

Reimbursement rates are a fine focus but that’s in the interest of the business of pharmacy. I have no hard evidence that I’ve been able to find to say that increasing revenues to the business entity that employees pharmacists translates to better working conditions for the practicing pharmacist. Business owners (which I’ll include shareholders as) may certainly benefit from this and those business owners might be but not required to be pharmacists, let alone “practicing” ones. In fact if I look at the pharmacy businesses with the biggest revenues those are the ones that commonly get associated with the worst working conditions.

Don’t make me go on how nadac is actually a wolf in sheep’s clothing and if we actually fixed the problems with it, the big guys could easily tank nadac rates to still be below some small Indy’s acquisition. Since nadac reporting is optional Pharmacies can and are just not submitting cost info that would be detrimental to better rates. Since it’s invoice cost only the rebate and off invoice monetary arrangements get more complex and more creative where the invoices cost is just another meaningless figure manipulated for someone’s advantage and the same transparency we are so desperately claiming to be fighting for is actually getting worse by our own doing.

 

[mentos]

To me APhA has an identity crises. They don’t know who or what they are trying to serve. Is there first interest the practice or business of pharmacy, the pharmacists themselves, pharmacy as the institution (which in some models can be run almost entirely by technicians), and/or just everything that’s related to anything pharmacy.

Reimbursement rates are a fine focus but that’s in the interest of the business of pharmacy. I have no hard evidence that I’ve been able to find to say that increasing revenues to the business entity that employees pharmacists translates to better working conditions for the practicing pharmacist. Business owners (which I’ll include shareholders as) may certainly benefit from this and those business owners might be but not required to be pharmacists, let alone “practicing” ones. In fact if I look at the pharmacy businesses with the biggest revenues those are the ones that commonly get associated with the worst working conditions.

Don’t make me go on how nadac is actually a wolf in sheep’s clothing and if we actually fixed the problems with it, the big guys could easily tank nadac rates to still be below some small Indy’s acquisition. Since nadac reporting is optional Pharmacies can and are just not submitting cost info that would be detrimental to better rates. Since it’s invoice cost only the rebate and off invoice monetary arrangements get more complex and more creative where the invoices cost is just another meaningless figure manipulated for someone’s advantage and the same transparency we are so desperately claiming to be fighting for is actually getting worse by our own doing.

That's easy, APhA serves themselves. They just take naive pharmacist's and student's money.