Please sign this...

[Doctor M]

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https://petitions.whitehouse.gov/pe...ans-leave-out-independent-pharmacies/jFrm3QNH

 

[southpharmindy]

Absolutely. This is completely unfair. From my understanding my buying group wasn't even offered the opportunity to participate in these "preferred plans". Some of the plans are also named after large pharmacy chains and/or include their logo on the patients' ID card.

I understand if somebody can get their medicine cheaper somewhere else or maybe they get better service at another pharmacy. I also understand that if the payer can get drugs cheaper somewhere else. That is the free market.

What is complete crap is when chains are able to negotiate exclusive contracts with the payer or "preferred plans" that force the patient to use a chain at no cost savings.

 

[xiphoid2010]

I empathize. However the question isn't as simple as rooting for the small business/underdog, as we all do. In a market economgy and things ultimately comes down to dollars and cents.

The real question is not whether privately owned pharmacy can afford to compete, it's whether patient care is being served in a cost-effective manner. And in many cases, economy of scale is the solution.

The old mom and pop shop all sounds wonderful and romantic, but we must not forget reality and dynamic of a deficit that can must tackled partly by cost control. Keep the sight on the goal. Monopoly is not the answer, but neither is a fragmented free market.

 

[OUTexan]

It is dollars and cents for the big corporations. How does it save the person in a rural community anything when they have to drive 30-45 minutes to the big chain just to get their drugs because the local guy isn't able to compete.

 

[xiphoid2010]

It is dollars and cents for the big corporations. How does it save the person in a rural community anything when they have to drive 30-45 minutes to the big chain just to get their drugs because the local guy isn't able to compete.

If the nearest big chain is 30-45 minutes away, do you really think the big chain will be a big competition to a local shop?

 

[OUTexan]

If the nearest big chain is 30-45 minutes away, do you really think the big chain will be a big competition to a local shop?

Of course. When I was working for Cvs in Oklahoma we would have people drive over an hour pick up their drugs because they didn't like mail order and they could no longer use the local guy in town. A lot of the 2013 part d plans will have copay differences for certain plans. Aetna and cvs, humana and walmart, and walgreens has a hook up too. So you can pay $5 at a chain or $10 at a "non-preferred" pharmacy. How is that fair exactly?

 

[southpharmindy]

It is not fair and my point is that it does not save the system money. If you don't think the chains are getting reimbursed at higher rate than independents I don't know what to tell you.

The independent organizations were not even given the chance to bid on this stuff.

The ultimate difference is not in the fact that using the chains as a preferred pharmacy saves the system money. In fact I would bet using the chains costs the system more money. The difference is that the independent stores do not have the cash and lobbying power of the chains.

And yes many people drive 1-2 hours in rural areas to get their medicine because they have Caremark and have to go to CVS/do mail order or Wal Mart has an exclusive agreement with their insurance.

 

[Ackj]

So you can pay $5 at a chain or $10 at a "non-preferred" pharmacy. How is that fair exactly?

Except the difference will not be that small, I'm sure. For $5 I wouldn't worry. Its when you get "pay two months copay get three months drugs" so you're paying $100 vs $150, or even more, like whatever 50% happens to be if it's a top tier drug.

 

[Doctor M]

I empathize. However the question isn't as simple as rooting for the small business/underdog, as we all do. In a market economgy and things ultimately comes down to dollars and cents.

The real question is not whether privately owned pharmacy can afford to compete, it's whether patient care is being served in a cost-effective manner. And in many cases, economy of scale is the solution.

The old mom and pop shop all sounds wonderful and romantic, but we must not forget reality and dynamic of a deficit that can must tackled partly by cost control. Keep the sight on the goal. Monopoly is not the answer, but neither is a fragmented free market.

Of course we can compete if given the opportunity. We can even charge less
And survive just fine.

 

[Doctor M]

I empathize. However the question isn't as simple as rooting for the small business/underdog, as we all do. In a market economgy and things ultimately comes down to dollars and cents.

The real question is not whether privately owned pharmacy can afford to compete, it's whether patient care is being served in a cost-effective manner. And in many cases, economy of scale is the solution.

The old mom and pop shop all sounds wonderful and romantic, but we must not forget reality and dynamic of a deficit that can must tackled partly by cost control. Keep the sight on the goal. Monopoly is not the answer, but neither is a fragmented free market.

U are misinformed greatly. Don't know what to say.

 

[xiphoid2010]

Of course. When I was working for Cvs in Oklahoma we would have people drive over an hour pick up their drugs because they didn't like mail order and they could no longer use the local guy in town. A lot of the 2013 part d plans will have copay differences for certain plans. Aetna and cvs, humana and walmart, and walgreens has a hook up too. So you can pay $5 at a chain or $10 at a "non-preferred" pharmacy. How is that fair exactly?

And what percentage of the customer base is that? I have no doubt a few might, but what percentage will drive 30-45 minutes one way plus cost of cost of gas and mileage to a mom and pop shop?

 

[All4MyDaughter]

And what percentage of the customer base is that? I have no doubt a few might, but what percentage will drive 30-45 minutes one way plus cost of cost of gas and mileage to a mom and pop shop?

Some of these plans make it damn near impossible to use the non-preferred pharmacy. My current Medco plan allows 2 fills at a non-preferred pharmacy. After that, if you want to use the non-preferred pharmacy, you pay FULL PRICE.

 

[xiphoid2010]

U are misinformed greatly. Don't know what to say.

I would readily admit that i'm not privy to the details of retail pharmacy. So please enlighten me.

When I read that petition, it sounded like the old plea to emotions that "mom and pop shop are at a disadvantage vs large corporations", much along the line of "support the unions and buy the more expensive stuff", "buy at your street corner grocer instead of super market". We all know how people voted with their wallets on those issues.

I like mom and pop shops and would buy something unique that can't be found in Target or Sears, but wouldn't petition more government spending more to save them. So please explain why should tax payer subsidize these cost?

 

[All4MyDaughter]

I would readily admit that i'm not privy to the details of retail pharmacy. So please enlighten me.

When I read that petition, it sounded like the old plea to emotions that "mom and pop shop are at a disadvantage vs large corporations", much along the line of "support the unions and buy the more expensive stuff", "buy at your street corner grocer instead of super market". We all know how people voted with their wallets on those issues.

I like mom and pop shops and would buy something unique that can't be found in Target or Sears, but wouldn't petition more government spending more to save them. So please explain why should tax payer subsidize these cost?

No one is asking the government to subsidize anything. These "preferred" plans make it so that patients cannot choose their pharmacy. All Doctor M and the other independent pharmacies want is the opportunity to compete for business. Instead, they are being cut out from the get-go.

 

[xiphoid2010]

Some of these plans make it damn near impossible to use the non-preferred pharmacy. My current Medco plan allows 2 fills at a non-preferred pharmacy. After that, if you want to use the non-preferred pharmacy, you pay FULL PRICE.

So does my insurance. Do I like it? No, but do I understand the logic behind it and now have doing it online? Sure. Even the VA does it and I was trained to transition patient over to the mail order sysem.

Preserving an less cost-effective method of things because "it's the way we used to do it" is not good enough of a reason by itself.

 

[xiphoid2010]

No one is asking the government to subsidize anything. These "preferred" plans make it so that patients cannot choose their pharmacy. All Doctor M and the other independent pharmacies want is the opportunity to compete for business. Instead, they are being cut out from the get-go.

Cost analysis please. I would suspect that government is doing this as a matter of cutting cost, not for the fun of creating new rules and regs to cutting small business and voter base.

 

[All4MyDaughter]

So does my insurance. Do I like it? No, but do I understand the logic behind it and now have doing it online? Sure. Even the VA does it and I was trained to transition patient over to the mail order sysem.

Preserving an less cost-effective method of things because "it's the way we used to do it" is not good enough of a reason by itself.

The VA system is barely applicable to real world PBM/mail order shenanigans. I'll let Doctor M take it from here, but there is good evidence that PBMs don't save nearly as much money as they claim, because they are basically keeping most of what they get from the health plans as profit for themselves. And there is tons of waste in mail order. tons. But I'll let Doctor M skool you on this. He is the expert. 😀

 

[All4MyDaughter]

Cost analysis please. I would suspect that government is doing this as a matter of cutting cost, not for the fun of creating new rules and regs to cutting small business and voter base.

Not exactly government, but the private insurance companies that offer Medicare Part D plans. There's lots of information out there on the problems with PBMs, including on this forum. I'm sure Doctor M will be along soon to help you learn. 🙂

 

[rxlea]

Cost analysis please. I would suspect that government is doing this as a matter of cutting cost, not for the fun of creating new rules and regs to cutting small business and voter base.

Plenty of people have looked into this...as A4MD pointed out, there is evidence showing that PBMs aren't necessarily more cost saving than community pharmacies/independents. I would argue that there are other services that independent pharmacies provide that PBMs don't, which reduce overall long term costs, especially when you consider indirect costs or otherwise intangible costs.

The aim of the government is to keep cost down by keeping people out of the hospital-- hospital costs account for over 30% of our health care expenditures. It is my experience that independent pharmacies do a really good job at that. It's the direct face to face individualized patient care that makes a difference for many reasons. St the independent pharmacies I rotated at, the patients were offered services outside of the average CVS or Walgreens. They went to those establishments because they received those services and had higher than average compliance/adherence rates, even amongst the most "difficult" patient populations.

Also, I don't think it's right that business owners don't get a fair shake at competing in the market.

 

[Doctor M]

Cost analysis please. I would suspect that government is doing this as a matter of cutting cost, not for the fun of creating new rules and regs to cutting small business and voter base.

No, the government did it cause someone got their pockets lined with something called money. Money is the currency we use to buy stuff. It is green and has many funny looking men on it.

Give me a break. cutting costs? Why would you transition people to mail order? Have you actually seen the cost of running a pharmacy? Have you ever seen the breakdown of a prescription payment to a pharmacy? How about the cost to fill a prescription? if you havent noticed, but chain pharmacies have lots and lots and lots of bills to pay. yes they are MULTIBILLION dollar companies. $4 dollar prescriptions? Yeah, we compete. AWP-16%? yeah, some PBMs offer that rate. my point? I do not need to fill 500+ prescriptions to be profitable and pay my bills. These chains are raking in the MONEY (green stuff) at the expense of tax payers. Let me into the network and i will show you cost savings. The (legit) independents are not sucking the government dry. We are asking for your signature to make it a level playing field. If the service at chains or preferred networks is SOOOOO great, why worry about preferred networks. Give me the same contract that is offered to Walmart...I can compete. I guarantee it 110%. I guarantee that i can beat walmarts AWP pricing to ins companies any day. Or sams club. We just arent given the opportunity. Everyone assumes independents are more expensive. Sign the petition...Trust me, if i could directly contract with the government, i would compete.

 

[Doctor M]

Not exactly government, but the private insurance companies that offer Medicare Part D plans. There's lots of information out there on the problems with PBMs, including on this forum. I'm sure Doctor M will be along soon to help you learn. 🙂

PBMs are the root of this problem. Yes, yes, many argue that PBMs do this and do that blah blah blah. I would rather paper bill my drug to a sponsor or government than deal with the rash of caca i get from PBMs. They are thieves. Spread pricing, MACs, audits...it is a problem. It is inconceivable to me that anyone can come along and audit me on a drug i purchased 29 months ago, dispensed it, and the pt consumed it and pooped it out and then i have to pay back the money i was paid because some idiot doctor didnt have his NPI number on the rx. BS. Not only am i no longer in the network, but now i have to give back money to a PBM that kicked me out. Level playing field. It DOES NOT exist. Sign the petition. This is not some "poor mom and pops..." BS. Level the playing field. Those pharmacies and pharmacists that want the status quo, dont read this thread. I do not expect anyone who does not understand the economics and politics of pharmacy to sign this petition. I rather urge you to go educate yourself on the economics and implications it may have on our profession. Because you never know...you might end up working for one or having your own.

And having a PBM/Pharmacy ownership only add to my headaches...WTF

 

[Doctor M]

I would readily admit that i'm not privy to the details of retail pharmacy. So please enlighten me.

When I read that petition, it sounded like the old plea to emotions that "mom and pop shop are at a disadvantage vs large corporations", much along the line of "support the unions and buy the more expensive stuff", "buy at your street corner grocer instead of super market". We all know how people voted with their wallets on those issues.

I like mom and pop shops and would buy something unique that can't be found in Target or Sears, but wouldn't petition more government spending more to save them. So please explain why should tax payer subsidize these cost?

Advair 250/50 AWP = $295.00

What im willing to accept for payment: $247.00 = AWP-16.5%

Bupropion XL 150mg 30 tabs AWP = $156.56

What Im willing to accept for payment: $33.99

Quetiapine 400mg 100 tabs AWP = $2000

What Im willing to accept : $79.00

Call Sams club, ask them what their cash price is. I guarantee my price is at or below theirs and if it is not, then i make that price. I price match. Doesnt matter. We want the pt to get the best possible price to keep them healthy and happy!!!

Independents are not there to make billions. We want to compete and make a living. Not rip people off. We want to make medication affordable. Keep people out of hospitals. Just sign the damn petition.

 

[pezdispenser]

Advair 250/50 AWP = $295.00

What im willing to accept for payment: $247.00 = AWP-16.5%

Bupropion XL 150mg 30 tabs AWP = $156.56

What Im willing to accept for payment: $33.99

Quetiapine 400mg 100 tabs AWP = $2000

What Im willing to accept : $79.00

Call Sams club, ask them what their cash price is. I guarantee my price is at or below theirs and if it is not, then i make that price. I price match. Doesnt matter. We want the pt to get the best possible price to keep them healthy and happy!!!

Independents are not there to make billions. We want to compete and make a living. Not rip people off. We want to make medication affordable. Keep people out of hospitals. Just sign the damn petition.

Why are you comparing cash prices? The cash price is intentionally set higher, at what we think is a 'fair' markup, and probably also to balance out the crappy insurance reimbursement from other patients. So you can't use cash prices to try to guess what a store's insurance reimbursement is, or what their overall operating margin is. You should know better Doctor M 🙄

About the petition, I'm afraid that I'll have to side more with xiphoid2010 in that it sounds more like an emotional plea for the mom and pop stores. And I'm very happy working for a chain so why should I sign it???

I'm not convinced that the statements in the petition are even true like:

"contracts to small independent stores that are so bad we can't afford to accept them"

"They also reimburse the PREFERRED pharmacy at much higher rates than small independents."

We are not privy to the contract details at the chains, so aren't you just speculating that the chains get offered better contracts? Well Express Scripts offered a contract to Walgreens that was so bad that they very publicly chose not to accept it. Let's see when your contract is up for renewal with Express Scripts and they offer you the SAME rates, whether you will accept them or not.

I also think some people are underestimating the economies of scale that you get with mail order. A big proportion of the cost to fill is the pharmacist's labor. How many scripts per day does 1 FTE RPh do in a store and how many do you think they do in mail order?

 

[pharmacisttobe]

https://petitions.whitehouse.gov/pe...ans-leave-out-independent-pharmacies/jFrm3QNH

I signed the petition because I used to work as a tech and saw how many patients benefited from filling their meds in an independent pharmacy compared to the busy chains.

 

[Sparda29]

PBMs are the root of this problem. Yes, yes, many argue that PBMs do this and do that blah blah blah. I would rather paper bill my drug to a sponsor or government than deal with the rash of caca i get from PBMs. They are thieves. Spread pricing, MACs, audits...it is a problem. It is inconceivable to me that anyone can come along and audit me on a drug i purchased 29 months ago, dispensed it, and the pt consumed it and pooped it out and then i have to pay back the money i was paid because some idiot doctor didnt have his NPI number on the rx. BS. Not only am i no longer in the network, but now i have to give back money to a PBM that kicked me out. Level playing field. It DOES NOT exist. Sign the petition. This is not some "poor mom and pops..." BS. Level the playing field. Those pharmacies and pharmacists that want the status quo, dont read this thread. I do not expect anyone who does not understand the economics and politics of pharmacy to sign this petition. I rather urge you to go educate yourself on the economics and implications it may have on our profession. Because you never know...you might end up working for one or having your own.

And having a PBM/Pharmacy ownership only add to my headaches...WTF

That's when you shoot the auditor in the face for trying to rob you.

 

[joetrisman]

Signed. G'luck!

 

[hotdog123789]

So does my insurance. Do I like it? No, but do I understand the logic behind it and now have doing it online? Sure. Even the VA does it and I was trained to transition patient over to the mail order sysem.

Preserving an less cost-effective method of things because "it's the way we used to do it" is not good enough of a reason by itself.

It's "less cost-effective" because big corporations are negotiating directly with politicians with the intent of shutting out these independent pharmacies so they can collect the independent's potential profits for themselves. Tell me how that's fair. While people do like cheaper prices, you have to think at the expense of what do these prices come about. Most people neglect to see the ramifications of their choices.

Monopolies are never a good thing. That's why there are supposed "regulations" against them. This is also a big reason why the international economy has been sucked dry, because wealth keeps on getting sequestered in the banks and hands of people who are purely profit-driven, instead of staying within the economy.

Monopolies within the science/health world are getting quite apparent with insurance companies, big pharmacy companies, etc. I do not like the direction it's going because it could very well compromise innovation in our field and beyond. I signed this petition, but I am pretty skeptical how much credence the government will give any of these petitions on this site.

A healthy economy needs choices. I feel as if we are losing our choices every day. An America where our only pharmacy options are a CVS, Sam's Club, or Walmart sounds pretty depressing, to be honest.

 

[Doctor M]

Why are you comparing cash prices? The cash price is intentionally set higher, at what we think is a 'fair' markup, and probably also to balance out the crappy insurance reimbursement from other patients. So you can't use cash prices to try to guess what a store's insurance reimbursement is, or what their overall operating margin is. You should know better Doctor M 🙄

About the petition, I'm afraid that I'll have to side more with xiphoid2010 in that it sounds more like an emotional plea for the mom and pop stores. And I'm very happy working for a chain so why should I sign it???

I'm not convinced that the statements in the petition are even true like:

"contracts to small independent stores that are so bad we can't afford to accept them"

"They also reimburse the PREFERRED pharmacy at much higher rates than small independents."

We are not privy to the contract details at the chains, so aren't you just speculating that the chains get offered better contracts? Well Express Scripts offered a contract to Walgreens that was so bad that they very publicly chose not to accept it. Let's see when your contract is up for renewal with Express Scripts and they offer you the SAME rates, whether you will accept them or not.

I also think some people are underestimating the economies of scale that you get with mail order. A big proportion of the cost to fill is the pharmacist's labor. How many scripts per day does 1 FTE RPh do in a store and how many do you think they do in mail order?

Those are the payments i am willing to accept. Not my cash price. Point is, it would be cheaper for an employer to directly contract with me or other indys than to negotiate with a huge chain or PBM. My cash prices are my cash prices = AWP.

This is not a matter of who is happy working where. It is a matter of principle. But hey, to each their own. Im tired of trying convince. Im happy with my salary and urge u to sign it but whatever! Red bull time!

 

[southpharmindy]

This has nothing to do with who is happy working where or if you are a retail pharmacist or not. Its about principle. An area of our profession is being attacked unfairly.

Most independent pharmacies have a much larger group negotiate their rates for them. In our case we use the good neighbor pharmacy network. Its a collection of several thousand independent stores and so we are much the same size as a chain collectively.

We only want for these preferred plans TO GIVE US A CHANCE TO BID. We were denied. We may well have been cheaper than the chains.

Again we ONLY WANT A CHANCE TO BID. We've been shutout due to backroom politics and not because there was any benefit to the system financially.

 

[pezdispenser]

This is not a matter of who is happy working where. It is a matter of principle. But hey, to each their own. Im tired of trying convince. Im happy with my salary and urge u to sign it but whatever! Red bull time!

This has nothing to do with who is happy working where or if you are a retail pharmacist or not. Its about principle. An area of our profession is being attacked unfairly.

I meant because I work for a chain, and I intend to stay here, I can't help you independents because we are competitors. Heck I'll just say outright that I want to run all you guys out of business 😛.

I also see the principles differently. I think this is very much the free market at work. All pharmacies need to use every aspect they have to their advantage, including their size, brand and reputation. And if a chain wants to partner up with a PBM to offer a preferred plan, so be it. This is a point where I think the petition is wrong, because presumably that chain would have to offer a LOWER reimbursement in order to gain exclusive rights to the patients (hoping they will buy other goods in the store). Also the PBM would have to pass on the savings by offering a LOWER plan premium to attract customers and give them an incentive to accept the restricted pharmacy network. Especially for Medicare Part D, where patients can FREELY choose their plan every year, no one is being forced to use a particular pharmacy. If they don't like the preferred pharmacy plans, they can just choose one that includes their pharmacy.

If the PBMs want to reimburse the chains at a higher rate, so be it as well, because this is still a free market. They may think it is worth paying extra for things like:

- a consistent nationwide network of pharmacies on just about every street corner, with connected prescription databases
- long opening hours at night and on weekends, and 24 hour stores (for when you just gotta get your Roxi/Xanax/Soma at 12:00 am)
- drive-thru (yeah us pharmacists hate it, but patients seem to love it)
- call-centers with pharmacists available for consultation 24/7.

So it sounds rather ironic to me when you seem to like the free market on one hand (whenever it benefits you, such as allowing you to setup your own business) but on the other hand you want to petition the White House for government intervention to level the playing field. 😕 That's not a free market anymore. That's a controlled market.

 

[southpharmindy]

Again all we want is a chance to bid on the contract. If we can't offer the same prices and services as the chains then so be it.

I'm also tired of convincing. I'm happy with what I make and regardless of what happens I'll be okay and will probably be able to retire in my 40's. I just want to preserve the profession for the future.

 

[BidingMyTime]

Both sides have good points--free market, nobody knows the exact contract, independents shouldn't be discriminated against. The big point I see,, Medicare Part D is different from private insurance, in that it is being paid for by the government. While I would agree that a PBM making a deal with a preferred pharmacy for a private ins is the free market at work, when the plan is government sponsored, I think it should be open to anyone who wants to put in a bid. The government should not be rewarding one corporation over another. Although realistically, this happens all the time, and not just in the field of pharmacy, so I don't see the situation changing anytime soon.

 

[xiphoid2010]

Both sides have good points--free market, nobody knows the exact contract, independents shouldn't be discriminated against. The big point I see,, Medicare Part D is different from private insurance, in that it is being paid for by the government. While I would agree that a PBM making a deal with a preferred pharmacy for a private ins is the free market at work, when the plan is government sponsored, I think it should be open to anyone who wants to put in a bid. The government should not be rewarding one corporation over another. Although realistically, this happens all the time, and not just in the field of pharmacy, so I don't see the situation changing anytime soon.

some will call me a cynic, others call me a realist. Personally, I am cynical just about anything that would impact the bank statement of anyone. Just like applying to pharmacy school, how many said they want to "take care of patients" when in fact it's motivated by financial reasons... If the medicare part D had favored independents, would they argue to offer a level playing field or defend it against opposition? But I see why CMS rather deal with several large chains than thousands of independents.

 

[Lubeckd]

Just signed it at work.

 

[JamesL1585]

4500 signatures out of 25,000 and deadline is tomorrow? Shows how weak pharmacist are politically.. Always breaks my heart that pharmacist never get involved and stand up for their profession.

 

[Doctor M]

4500 signatures out of 25,000 and deadline is tomorrow? Shows how weak pharmacist are politically.. Always breaks my heart that pharmacist never get involved and stand up for their profession.

Yep. We are content with the status quo as can be seen from the responses here. I always wonder why i come on to this forum...Must be the high of a possible confrontation 🙂

 

[Doctor M]

I meant because I work for a chain, and I intend to stay here, I can't help you independents because we are competitors. Heck I'll just say outright that I want to run all you guys out of business 😛.

I also see the principles differently. I think this is very much the free market at work. All pharmacies need to use every aspect they have to their advantage, including their size, brand and reputation. And if a chain wants to partner up with a PBM to offer a preferred plan, so be it. This is a point where I think the petition is wrong, because presumably that chain would have to offer a LOWER reimbursement in order to gain exclusive rights to the patients (hoping they will buy other goods in the store). Also the PBM would have to pass on the savings by offering a LOWER plan premium to attract customers and give them an incentive to accept the restricted pharmacy network. Especially for Medicare Part D, where patients can FREELY choose their plan every year, no one is being forced to use a particular pharmacy. If they don't like the preferred pharmacy plans, they can just choose one that includes their pharmacy.

If the PBMs want to reimburse the chains at a higher rate, so be it as well, because this is still a free market. They may think it is worth paying extra for things like:

- a consistent nationwide network of pharmacies on just about every street corner, with connected prescription databases
- long opening hours at night and on weekends, and 24 hour stores (for when you just gotta get your Roxi/Xanax/Soma at 12:00 am)
- drive-thru (yeah us pharmacists hate it, but patients seem to love it)
- call-centers with pharmacists available for consultation 24/7.

So it sounds rather ironic to me when you seem to like the free market on one hand (whenever it benefits you, such as allowing you to setup your own business) but on the other hand you want to petition the White House for government intervention to level the playing field. 😕 That's not a free market anymore. That's a controlled market.

fool

 

[vistaril]

Those are the payments i am willing to accept. Not my cash price. Point is, it would be cheaper for an employer to directly contract with me or other indys than to negotiate with a huge chain or PBM. My cash prices are my cash prices = AWP.

This is not a matter of who is happy working where. It is a matter of principle. But hey, to each their own. Im tired of trying convince. Im happy with my salary and urge u to sign it but whatever! Red bull time!

About 8 years ago I was in between insurances for a couple months and needed a refill on a med. So I was going to have to pay cash. I called 3 different chains(walgreens, wal mart, and cvs) and got prices that ranged from 27 to 40 dollars. Called the independent pharmacy that was closest and got a price of 109 dollars.

I guess true cash pay is such a small % of overall volume that it isn't a huge deal(I dunno?) and haven't had to cash pay since. However, that one experience crystallized it in my head that I had no use for independent pharmacies and would not use their services for anything in the future. And haven't since. Now that said the independent pharmacy in that case had every right to charge that to a self pay, so Im not complaining. Just one person's observation.

 

[Doctor M]

About 8 years ago I was in between insurances for a couple months and needed a refill on a med. So I was going to have to pay cash. I called 3 different chains(walgreens, wal mart, and cvs) and got prices that ranged from 27 to 40 dollars. Called the independent pharmacy that was closest and got a price of 109 dollars.

I guess true cash pay is such a small % of overall volume that it isn't a huge deal(I dunno?) and haven't had to cash pay since. However, that one experience crystallized it in my head that I had no use for independent pharmacies and would not use their services for anything in the future. And haven't since. Now that said the independent pharmacy in that case had every right to charge that to a self pay, so Im not complaining. Just one person's observation.

There are many reasons why his cash price may have been higher. Different supplier? I dunno. Fact is, for most drugs, we can charge less than chains if we can. Dont wanna manipulate AWP now, cause them PBMs will come knocking 🙂

 

[PharmerInPNW]

I think back to an article I read awhile back. It was talking about my state's (North Dakota) pharmacy ownership law. That is, a pharmacy has to be 51% owned by a registered pharmacist, which rules out the majority of the chain stores. I read that North Dakota is among the lowest average prescription cost in the US. If ND is 90% local pharmacies and is cheaper then the majority of the states that have upwards of 70% chain stores, why does everyone think the chains are so much cheaper? I honestly couldn't tell you how credible the article was, as I don't remember where I read it. The law has withstood several repeal attempts by Walmart and Walgreens so there must be some decent data out there supporting the good ole Ma and Pa stores.

 

[vistaril]

There are many reasons why his cash price may have been higher. Different supplier? I dunno. Fact is, for most drugs, we can charge less than chains if we can. Dont wanna manipulate AWP now, cause them PBMs will come knocking 🙂

but is the AWP price the price you quote to cash pay customers if they call with a prescription for example?

I can't speak for all patients, but I'm not someone who is going to 'hassle' with a health care professional over the price of a drug. I just assume the price the person quotes me for a drug is the price they are going to sell the drug for.

 

[Doctor M]

but is the AWP price the price you quote to cash pay customers if they call with a prescription for example?

I can't speak for all patients, but I'm not someone who is going to 'hassle' with a health care professional over the price of a drug. I just assume the price the person quotes me for a drug is the price they are going to sell the drug for.

The AWP is the price we must quote everyone. We cannot manipulate the AWP unless we charge you a yearly membership fee to join our "club" which charges you less. Trust me, we can compete and in most cases we win.

 

[vistaril]

The AWP is the price we must quote everyone. We cannot manipulate the AWP unless we charge you a yearly membership fee to join our "club" which charges you less. Trust me, we can compete and in most cases we win.

I believe you 'can'.....but how are many patients supposed to know how low you will sell a drug for? Common sense would stand to reason that there are many patients who just go elsewhere after hearing your quoted price and never get into further discussion of what you can do to compete. I have no interest in bargaining for a prescription drug like I would at a flea market. Do places like CVS do that too for cash pay patients and I may have gotten the drug even cheaper from then? Damn I probably paid way too much from them too as I just accepted their quoted price as it was the lowest of the 3.

 

[Doctor M]

I believe you 'can'.....but how are many patients supposed to know how low you will sell a drug for? Common sense would stand to reason that there are many patients who just go elsewhere after hearing your quoted price and never get into further discussion of what you can do to compete. I have no interest in bargaining for a prescription drug like I would at a flea market. Do places like CVS do that too for cash pay patients and I may have gotten the drug even cheaper from then? Damn I probably paid way too much from them too as I just accepted their quoted price as it was the lowest of the 3.

I guess all independents are created equal? shop where you will but i do not bargain my prices. I give an AWP price, look at my cost and give the lowest price possible. For example, Bupropion XL 150 AWP may be $90 for 30 tab, my cost may be, say X dollars so i can sell for $30 dollars. I win every time. I know what i pay. But again, shop where you will.

 

[tartesos]

I think back to an article I read awhile back. It was talking about my state's (North Dakota) pharmacy ownership law. That is, a pharmacy has to be 51% owned by a registered pharmacist, which rules out the majority of the chain stores. I read that North Dakota is among the lowest average prescription cost in the US. If ND is 90% local pharmacies and is cheaper then the majority of the states that have upwards of 70% chain stores, why does everyone think the chains are so much cheaper? I honestly couldn't tell you how credible the article was, as I don't remember where I read it. The law has withstood several repeal attempts by Walmart and Walgreens so there must be some decent data out there supporting the good ole Ma and Pa stores.

But then again, monopoly is never nice or fair. They could put the minimum price among themselves to whatever they want and stiff everybody.
They need some competition.
Just saying....