The average CVS or Walgreens pharmacist wouldn't survive in an independent.
Phil is actually about to be the victim of the latest CVS Caremark provider update, which states that "any pharmacists who receive copay card information from a hub versus the patient themselves will be subject to the recoupment of any and all funds" which basically is going to put them out of business if I'm interpreting this update correctly.
I don't think you understand how contracts work. CVS sends out a contract saying "you cannot accept copay card information from a hub" and surprise, you now cannot accept copay card information from a hub. I don't care what kind of logic pretzels you twist yourself into in saying "we're acting as a patient representative (CVS likes to call patients and ask if they know the person that is acting as their representative. That should go well), unless Phil is going to actually put some skin in the game, no pharmacy is going to be willing to take that risk over the extra $25/script for 40 scripts a month that Phil gives them when a single script chargeback will negate that.
Phil isn't even a mail order pharmacy. They're not even a pharmacy. They partner with a manufacturer for discounted self pay cost and have their sales reps tell the doctors to send the prescriptions for the drug into PhilRx. If it's covered by the insurance, they apply a copay card and call the patient to confirm they're okay with the price, then transfer the information to an independent affiliate to fill and deliver. If it's not covered by the insurance, they do the same thing only using their limited proprietary copay card *~*only available to Phil pharmacies*~* (which is anticipated to be the next addendum to the CVS Provider manual) to bypass the insurance. They don't actually fill any prescriptions, but they collect the data from all the prescriptions being sent to them and sell it back to pharma in exchange for the data. All of the liability is placed on the dispensing pharmacy, and being as it's 70% straight copay card claims, they make about $30 per prescription for however many scripts get sent in. If that's the forward-thinking pharmacy processes of the future, then we should probably just retire now.
In a normal business model where you're comparing Fred's Rx vs. Smith's apothecary, you're absolutely right. But like I said before, Phil is not actually doing much of anything. They're acting as a hub to accumulate data, collecting the data, and sending the dirty work to the pharmacies to be taken care of. Which is fine if the pharmacy is just getting the prescription sent to them and gets to fill it and collect whatever marginal profit comes from the script. But if the addendum to the Caremark manual works as expected, Caremark is going to come after these pharmacies for whatever funds they were paid for these (probably $600 drugs), not to Phil, because they did not pay a dime to Phil. So now you're liable for a prescription that you acted as a hub for, that you actually are paying for the right to receive (because of course you pay Phil for their software) and Phil is defending it as "CVS can't do that" when CVS is, in fact, doing that.
Here's your CVS Contract addendum. My analysis is based off the conversation I've had with my audit protection agency, PAAS National. My understanding of their business model is because they approached me to be part of their "independent pharmacy network" and I turned them down after hearing their spiel, because they did not offer anything that I could not provide myself and it fact their haphazard handling of customers would be deleterious to the reputation of my pharmacy.
PBMs are very much under siege, and I'll agree with that. Pillpack is a false equivalence though, because Pillpack was actually a pharmacy, and was the sole person impacted by any contractual problems with Express Scripts - so any decision made at the table impacted only Pillpack. Phil relies on thousands of pharmacies to do their dirty work for them, and doesn't actually negotiate for any of them. So Phil can't negotiate with CVS on behalf of the PhilRx network unless they evolve and become a full fledged PSAO, which is way more complex than they are ready to handle.
Phil's not the only program who has the business model. Look up 42 North Rx. It's the exact same thing. It's a bunch of manufacturers hopping from company to company hoping to find a way to bypass the need for prior authorizations, and companies looking for pharmacies willing to take on all the liability for them.
If you'd like me to send you the "working with Phil" powerpoint hype machine I was sent as well to prove that I do in fact know what I'm talking about, I'll happily do that as well. It's really weird to me that you're trying to sell them as this pharmacy oasis of the future, and when I refuted that idea, you combined both "I don't think you're right" with "I don't know much about their business model" - I don't understand why you're trying to vehemently defend this business model against my criticism if you don't actually know how they work.
Here's your CVS Contract addendum. My analysis is based off the conversation I've had with my audit protection agency, PAAS National. My understanding of their business model is because they approached me to be part of their "independent pharmacy network" and I turned them down after hearing their spiel, because they did not offer anything that I could not provide myself and it fact their haphazard handling of customers would be deleterious to the reputation of my pharmacy.
PBMs are very much under siege, and I'll agree with that. Pillpack is a false equivalence though, because Pillpack was actually a pharmacy, and was the sole person impacted by any contractual problems with Express Scripts - so any decision made at the table impacted only Pillpack. Phil relies on thousands of pharmacies to do their dirty work for them, and doesn't actually negotiate for any of them. So Phil can't negotiate with CVS on behalf of the PhilRx network unless they evolve and become a full fledged PSAO, which is way more complex than they are ready to handle.
Phil's not the only program who has the business model. Look up 42 North Rx. It's the exact same thing. It's a bunch of manufacturers hopping from company to company hoping to find a way to bypass the need for prior authorizations, and companies looking for pharmacies willing to take on all the liability for them.
If you'd like me to send you the "working with Phil" powerpoint hype machine I was sent as well to prove that I do in fact know what I'm talking about, I'll happily do that as well. It's really weird to me that you're trying to sell them as this pharmacy oasis of the future, and when I refuted that idea, you combined both "I don't think you're right" with "I don't know much about their business model" - I don't understand why you're trying to vehemently defend this business model against my criticism if you don't actually know how they work.
Respect your courage to open your own store! Wish you the best! I'm looking to open my own independent as well.
Just don't do anything illegal. This was before your time, but there was another poster here who opened his own pharmacy and kept us updated on how things were going for several years.....then he was arrested for major insurance fraud-and hasn't come back to update us anymore.
So keep on the straight and narrow.
Just don't do anything illegal. This was before your time, but there was another poster here who opened his own pharmacy and kept us updated on how things were going for several years.....then he was arrested for major insurance fraud-and hasn't come back to update us anymore.
So keep on the straight and narrow.
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