Underpayment from insurers for Harvoni

Started by farmadiazepine
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farmadiazepine

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Check this out,

We spent 2 weeks signing contracts with an NJ Medicaid HMO (Horizon NJ Health) to be able to dispense Harvoni. They promised reimbursement of AWP minus 2 percent or something like that. The doctor's office worked very hard to get the approval, and as soon as they did, they let us know, as well as the insurer. I get to finally run the Harvoni through. Horizon NJ Health forces us to dispense only 14 tablets for the first fill. Fine, no problem. I'll buy that $31,500 drug, and dispense only half the bottle. I run through the claim for 14 tablets, and finally get to see what we made.

We were paid $15,500 for 14 tablets of Harvoni. WTF!? It cost us $15,750 to buy 14 tablets of it, and now the insurer is not even paying enough for the medication?

We called Horizon NJ Health, and they asked us to send over invoices. I send over everything immediately. They call back and say, "You have to get the drug cheaper somewhere else." That was it. We called our friends at different specialty pharmacies, and no one could get it any cheaper around the area.

It makes me think, CVS/Caremark with its deal with Gilead to obtain Harvoni and get rebates, and Express Scripts with its deal with Abbvie for the new heptatis C treatment. Whose the one winning? Is it the patient? No. Is it the independent community pharmacy? No. Is it the independent specialty pharmacy? No.

There is something hugely wrong with our profession, and the health care system in the US, and a lot of it stems from the third party payor model. Private insurance companies are dictating who gets what and who doesn't get anything. The winners are always the companies themselves and their subsidiaries. Things need to change, and I'm just getting sick and tired of this system.

I still love my independent job, though! Never a day I hate it! I'm thankful for everyday I never have to step foot into the Devil's lair.
 
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According to redbook, awp is 37800 per package or 1350 per tablet. If they do awp-2%, they're still under reimbursing you. Where are they getting their awp figure from? I thought awp was only updated a few times per year? Unless I was misinformed. The
 
farmadiazepine said:
Check this out,

We spent 2 weeks signing contracts with an NJ Medicaid HMO (Horizon NJ Health) to be able to dispense Harvoni. They promised reimbursement of AWP minus 2 percent or something like that. The doctor's office worked very hard to get the approval, and as soon as they did, they let us know, as well as the insurer. I get to finally run the Harvoni through. Horizon NJ Health forces us to dispense only 14 tablets for the first fill. Fine, no problem. I'll buy that $31,500 drug, and dispense only half the bottle. I run through the claim for 14 tablets, and finally get to see what we made.

We were paid $15,500 for 14 tablets of Harvoni. WTF!? It cost us $15,750 to buy 14 tablets of it, and now the insurer is not even paying enough for the medication?

We called Horizon NJ Health, and they asked us to send over invoices. I send over everything immediately. They call back and say, "You have to get the drug cheaper somewhere else." That was it. We called our friends at different specialty pharmacies, and no one could get it any cheaper around the area.

It makes me think, CVS/Caremark with its deal with Gilead to obtain Harvoni and get rebates, and Express Scripts with its deal with Abbvie for the new heptatis C treatment. Whose the one winning? Is it the patient? No. Is it the independent community pharmacy? No. Is it the independent specialty pharmacy? No.

There is something hugely wrong with our profession, and the health care system in the US, and a lot of it stems from the third party payor model. Private insurance companies are dictating who gets what and who doesn't get anything. The winners are always the companies themselves and their subsidiaries. Things need to change, and I'm just getting sick and tired of this system.

I still love my independent job, though! Never a day I hate it! I'm thankful for everyday I never have to step foot into the Devil's lair.
Click to expand...

You're preaching to the choir! I'm so sick of being reimbursed less than cost on drugs, especially brand name drugs. With published wholesale acquisition cost data readily available there is no reason or excuse for PBMs to reimburse less than cost.
 
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You sound just like the owner of the indy I work at part time. Calls them up to demand to know why they're paying below cost, they said find it cheaper somewhere else, and turns out they can't find it cheaper anywhere else. **** **** **** PBMs.
 
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farmadiazepine said:
Check this out,

We spent 2 weeks signing contracts with an NJ Medicaid HMO (Horizon NJ Health) to be able to dispense Harvoni. They promised reimbursement of AWP minus 2 percent or something like that. The doctor's office worked very hard to get the approval, and as soon as they did, they let us know, as well as the insurer. I get to finally run the Harvoni through. Horizon NJ Health forces us to dispense only 14 tablets for the first fill. Fine, no problem. I'll buy that $31,500 drug, and dispense only half the bottle. I run through the claim for 14 tablets, and finally get to see what we made.

We were paid $15,500 for 14 tablets of Harvoni. WTF!? It cost us $15,750 to buy 14 tablets of it, and now the insurer is not even paying enough for the medication?

We called Horizon NJ Health, and they asked us to send over invoices. I send over everything immediately. They call back and say, "You have to get the drug cheaper somewhere else." That was it. We called our friends at different specialty pharmacies, and no one could get it any cheaper around the area.

It makes me think, CVS/Caremark with its deal with Gilead to obtain Harvoni and get rebates, and Express Scripts with its deal with Abbvie for the new heptatis C treatment. Whose the one winning? Is it the patient? No. Is it the independent community pharmacy? No. Is it the independent specialty pharmacy? No.

There is something hugely wrong with our profession, and the health care system in the US, and a lot of it stems from the third party payor model. Private insurance companies are dictating who gets what and who doesn't get anything. The winners are always the companies themselves and their subsidiaries. Things need to change, and I'm just getting sick and tired of this system.

I still love my independent job, though! Never a day I hate it! I'm thankful for everyday I never have to step foot into the Devil's lair.
Click to expand...

Yeah, reimbursements on brands are a joke. My cost is 30.6k but I would never fill, let alone open the bottle unless I adjudicated first to see the payment. Are they thinking you're on a 340b or something?

If they really did promise you 0.98awp and shafted you with $3k less (for the #14), well... I'm sure the owner knows what to do.
 
What do we do? First, we try and see if we can get the drug from anyone else. When that doesn't work, we have to make an embarassing phone call back to the HIV clinic that's been working on this for weeks, and explain to them exactly The situation. It ends with us not being able to fill it and sending it elsewhere. The MD will have to call this into CVS Specialtiy or somewhere else.
 
BenJammin said:
You sound just like the owner of the indy I work at part time. Calls them up to demand to know why they're paying below cost, they said find it cheaper somewhere else, and turns out they can't find it cheaper anywhere else. **** **** **** PBMs.
Click to expand...

That's it right there. The PBM's reimburse some drugs based on market conditions and whole sale costs that don't exist. There's nothing that can be done about it...
 
farmadiazepine said:
Check this out,

We spent 2 weeks signing contracts with an NJ Medicaid HMO (Horizon NJ Health) to be able to dispense Harvoni. They promised reimbursement of AWP minus 2 percent or something like that. The doctor's office worked very hard to get the approval, and as soon as they did, they let us know, as well as the insurer. I get to finally run the Harvoni through. Horizon NJ Health forces us to dispense only 14 tablets for the first fill. Fine, no problem. I'll buy that $31,500 drug, and dispense only half the bottle. I run through the claim for 14 tablets, and finally get to see what we made.

We were paid $15,500 for 14 tablets of Harvoni. WTF!? It cost us $15,750 to buy 14 tablets of it, and now the insurer is not even paying enough for the medication?

We called Horizon NJ Health, and they asked us to send over invoices. I send over everything immediately. They call back and say, "You have to get the drug cheaper somewhere else." That was it. We called our friends at different specialty pharmacies, and no one could get it any cheaper around the area.

It makes me think, CVS/Caremark with its deal with Gilead to obtain Harvoni and get rebates, and Express Scripts with its deal with Abbvie for the new heptatis C treatment. Whose the one winning? Is it the patient? No. Is it the independent community pharmacy? No. Is it the independent specialty pharmacy? No.

There is something hugely wrong with our profession, and the health care system in the US, and a lot of it stems from the third party payor model. Private insurance companies are dictating who gets what and who doesn't get anything. The winners are always the companies themselves and their subsidiaries. Things need to change, and I'm just getting sick and tired of this system.

I still love my independent job, though! Never a day I hate it! I'm thankful for everyday I never have to step foot into the Devil's lair.
Click to expand...

Is that before or after rebates? Using your figures and my wholesale acquisition cost minus rebates I would make a small profit on this drug. Not a big enough profit to make a $15,000 investment.
 
PBMs have always been ****ing with hard working, independently owned pharmacies. They reimburse whatever they want, and that's end of story. Even when it comes to compounds, the figures they come up with are ridiculous and fluctuate constantly. A large part of that problem is the pharmacist (who the PBM hires) that works for them and has detailed knowledge on costs and pricing. I have seen a few PBMs who are owned by a pharmacist. Said pharmacist approached me asking to fill his scripts for cost plus one dollar.
Let me think about that one. NO.
 
accordman83 said:
What, gray market drugs?
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no.. billing excessively.... it is common here in independents here in NYS... especially if it is for Medicaid patient where they commonly reimburse less than costs. For Artificial tears, we bill 15 for 30...

but I don't know how that would apply here. The patient would then be too early for his meds....
 
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Aznfarmerboi said:
no.. billing excessively.... it is common here in independents here in NYS... especially if it is for Medicaid patient where they commonly reimburse less than costs. For Artificial tears, we bill 15 for 30...

but I don't know how that would apply here. The patient would then be too early for his meds....
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Not exactly. A guy I know told me that he had a deal with the doctors who sent him patients that in case a medicine a patient needed was not covered or reimbursement was too low to just write up a telephone Rx for some sort of topical cream/ointment that was covered. The patient would only get the meds that were originally prescribed but they would sign for both. Patient would also be informed about the need to do something like that.
 
You can only get away with stuff like that in immigrant communities, anyways why bother dispensing Harvoni at all? Even if you were making a gross of say $500, it seems like a massive potential chargeback. We have no protection from PBMs so you have to minimize your liability.
 
So my owner was on the phone today with Cardinal, aggressively telling them that the price has to be lowered. It seemed promising in the morning, but by the end of the day even Cardinal was telling us they don't make enough money on Harvoni. How much of this do I really believe? I don't know.

The question came up how do CVS and Walgreens and other speciality pharmacies make money on Harvoni and other hepatitis C drugs? CVS made a deal with Gilead and they don't have to go through a wholesaler to obtain the drug. They get it directly from the manufacturer for a huge discount.

Why do we want to dispense this drug? I want to serve my community to the best of my ability. Yes, seems like a potential for a massive chargeback, but we dispense so many HIV prescriptions and high cost drugs, that every prescription is audit ready by the time it's filed away at the end of the day, and every hardcopy reviewed again. Of course we would have an original hardcopy and make sure nothing is missing.

It just totally sucks.
 
farmadiazepine said:
So my owner was on the phone today with Cardinal, aggressively telling them that the price has to be lowered. It seemed promising in the morning, but by the end of the day even Cardinal was telling us they don't make enough money on Harvoni. How much of this do I really believe? I don't know.

The question came up how do CVS and Walgreens and other speciality pharmacies make money on Harvoni and other hepatitis C drugs? CVS made a deal with Gilead and they don't have to go through a wholesaler to obtain the drug. They get it directly from the manufacturer for a huge discount.

Why do we want to dispense this drug? I want to serve my community to the best of my ability. Yes, seems like a potential for a massive chargeback, but we dispense so many HIV prescriptions and high cost drugs, that every prescription is audit ready by the time it's filed away at the end of the day, and every hardcopy reviewed again. Of course we would have an original hardcopy and make sure nothing is missing.

It just totally sucks.
Click to expand...


Just like sams club and walmart. CVS/Walgreens will buy these drugs in bulk so theres a deal to be made.
 
What is the exact price you're getting from cardinal? I know for a fact that cardinal is cheaper than the figure originally cited. Give me some time and I can get one of my spies in the field, buddy in chain retail, to report back to me (not kidding at all).
 
Sparda29 said:
Not exactly. A guy I know told me that he had a deal with the doctors who sent him patients that in case a medicine a patient needed was not covered or reimbursement was too low to just write up a telephone Rx for some sort of topical cream/ointment that was covered. The patient would only get the meds that were originally prescribed but they would sign for both. Patient would also be informed about the need to do something like that.
Click to expand...

Do you think you'll like prison?
 
Exact price from Cardinal: $30,712.00
Exact price from HD Smith: $31,500.00

With Cardinal, after dispensing 14 tablets we take a $150 loss. That means Horizon NJ Health (NJ Medicaid HMO) is paying $15,206 for 14 tablets whereas it costs us $15,356. Even though we are required to only dispense 14 tablets on the first fill, we were planning to dispense the other 14 tablets for the second fill no matter what. There is no way we are going to buy a $31,000 drug and leave half the bottle on the shelf.

My friend down the street gets it from McKesson for $30,300. With a price like that, we can dispense it and still make a BS $56 profit. That is not even worth a $30k investment.

We sent the prescription to CVS Specialty today. From the moment we got approval on Friday 1/23 to now 1/28 (5 days) it has been quite a circus asking everyone we know, calling up consultants for specialty, calling up friends, being aggressive with our wholesalers, and at the end of the day, we can't let this patient go without medication after a week of approval.

It sucks that we worked very closely with the HIV clinic to get all the paperwork done, all the lab tests done, sign contracts with the HMO, etc., and at the end of the day the insurance doesn't pay. Like I say time and time again, its not the independents that suffer, but the patient and the community really. Specialty is code work for expensive and most PROFITABLE prescriptions. They go to a facility where there is zero patient-pharmacist relationship, and the customer gets a UPS label shipped to them with instructions to call a phone number if questions. Seriously.

I won't stop fighting though. I sent letters to my legislators. I tell my customers in our community to tell their employers and HR to switch insurance carriers. I try to make FCC complaints. I am now planning to get in touch with the BOP in NJ, and I have to make some noise. It's gotta start somewhere.
 
farmadiazepine said:
Exact price from Cardinal: $30,712.00
Exact price from HD Smith: $31,500.00

With Cardinal, after dispensing 14 tablets we take a $150 loss. That means Horizon NJ Health (NJ Medicaid HMO) is paying $15,206 for 14 tablets whereas it costs us $15,356. Even though we are required to only dispense 14 tablets on the first fill, we were planning to dispense the other 14 tablets for the second fill no matter what. There is no way we are going to buy a $31,000 drug and leave half the bottle on the shelf.

My friend down the street gets it from McKesson for $30,300. With a price like that, we can dispense it and still make a BS $56 profit. That is not even worth a $30k investment.

We sent the prescription to CVS Specialty today. From the moment we got approval on Friday 1/23 to now 1/28 (5 days) it has been quite a circus asking everyone we know, calling up consultants for specialty, calling up friends, being aggressive with our wholesalers, and at the end of the day, we can't let this patient go without medication after a week of approval.

It sucks that we worked very closely with the HIV clinic to get all the paperwork done, all the lab tests done, sign contracts with the HMO, etc., and at the end of the day the insurance doesn't pay. Like I say time and time again, its not the independents that suffer, but the patient and the community really. Specialty is code work for expensive and most PROFITABLE prescriptions. They go to a facility where there is zero patient-pharmacist relationship, and the customer gets a UPS label shipped to them with instructions to call a phone number if questions. Seriously.

I won't stop fighting though. I sent letters to my legislators. I tell my customers in our community to tell their employers and HR to switch insurance carriers. I try to make FCC complaints. I am now planning to get in touch with the BOP in NJ, and I have to make some noise. It's gotta start somewhere.
Click to expand...
Can't you just sue for breach of contract if they aren't paying 98% of AWP?
 
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zelman said:
Reimbursement shortage plus time spent on this mess plus legal fees would.
Click to expand...

A few things- you're going to spend a lot more time before seeing any money (if any). You'll also have to invest your own money up front to have the lawyer work for you. Furthermore, I doubt you'll find a decent lawyer to go after what, $7,000? Lawyers aren't in the not-for-profit market; their time is precious too. You'll probably hire a lawyer with pharmacy experience or knowledge, which will be proportional to revenue. Gross between 1 and 10 million per annum ranges $450-$700 per hour. Reputation costs money and firms cash in on this. If you feel like putting nothing up front, the terms will not be in your favor.

If the PBM stiffed you $70k or $700k, that'd be a different story and you'd have an easier time finding a lawyer, and legal action would definitely be an option. Do you really think PBMs haven't been sued before? If the aforementioned PBM is already telling the OP in that manner to "find the drug cheaper somewhere else," my prediction is they will not cough up a single cent, even when threatened with legal action. If PBMs simply paid up whenever a pharmacy demanded them to, they'd go broke. They live off your labor and money, and they will be resistant in giving anything back.

The OP's boss can run his or her business however they want, but I don't think they did due diligence before dispensing the drug. Like I said, I would have ran the script first to see the reimbursement before opening any bottle.

BTW it actually isn't $7,000 you could claim, it's only one adjudication for 0.98 * (AWP/2), which comes out to $3,022. Don't take my word for it zelman, you should use this example and call up a lawyer for a consult and see what they say.
 
ExpressMaiL said:
A few things- you're going to spend a lot more time before seeing any money (if any). You'll also have to invest your own money up front to have the lawyer work for you. Furthermore, I doubt you'll find a decent lawyer to go after what, $7,000? Lawyers aren't in the not-for-profit market; their time is precious too. You'll probably hire a lawyer with pharmacy experience or knowledge, which will be proportional to revenue. Gross between 1 and 10 million per annum ranges $450-$700 per hour. Reputation costs money and firms cash in on this. If you feel like putting nothing up front, the terms will not be in your favor.

If the PBM stiffed you $70k or $700k, that'd be a different story and you'd have an easier time finding a lawyer, and legal action would definitely be an option. Do you really think PBMs haven't been sued before? If the aforementioned PBM is already telling the OP in that manner to "find the drug cheaper somewhere else," my prediction is they will not cough up a single cent, even when threatened with legal action. If PBMs simply paid up whenever a pharmacy demanded them to, they'd go broke. They live off your labor and money, and they will be resistant in giving anything back.

The OP's boss can run his or her business however they want, but I don't think they did due diligence before dispensing the drug. Like I said, I would have ran the script first to see the reimbursement before opening any bottle.

BTW it actually isn't $7,000 you could claim, it's only one adjudication for 0.98 * (AWP/2), which comes out to $3,022. Don't take my word for it zelman, you should use this example and call up a lawyer for a consult and see what they say.
Click to expand...
And that's why PBMs will continue to treat their contractual obligations as optional. Maybe a more practical strategy would be to start a class action suit and contact independent pharmacies who have placed orders for this product nationwide and ask them to review their reimbursement and contract. Might seem like a bigger fish to a pharmacy law firm, but will net less cash.
 
zelman said:
And that's why PBMs will continue to treat their contractual obligations as optional. Maybe a more practical strategy would be to start a class action suit and contact independent pharmacies who have placed orders for this product nationwide and ask them to review their reimbursement and contract. Might seem like a bigger fish to a pharmacy law firm, but will net less cash.
Click to expand...

Yeah, welcome to the eternal war of PBM vs. pharmacy. Organizations like NCPA are in this fight too and pharmacies really need to work together, regardless of specialty/niche. I signed on to start doing business with PBMs this year and I don't like it already.
 
ExpressMaiL said:
Yeah, welcome to the eternal war of PBM vs. pharmacy. Organizations like NCPA are in this fight too and pharmacies really need to work together, regardless of specialty/niche. I signed on to start doing business with PBMs this year and I don't like it already.
Click to expand...

What we need is someone on the inside to blow a whistle. The only way PBM's will be exposed is from an insider.

PBMs are for profit companies. They don't give a crap about lowering costs and all that other BS they claim to do. Express Scripts had a PROFIT of 1.8 billion dollars in 2013. How does a company claim to save money and at the same time justify a $1.8 billion profit? It's easy...they don't have to! The entire PBM business process is cloaked in secrecy. There is no transparency so there is no need to explain themselves.

Express Scripts along with their mail order operations has all the data they need to determine what the wholesale acquisition cost of drugs are. There is absolutely no excuse for them to feign otherwise. Since no one knows exactly what they do or how they do it we are stuck taking their word for it.

It will take an insider to expose it but I guarantee you the majority of PBM's are reimbursing pharmacies for the absolute lowest acquisition cost they can find for a drug regardless of its availability to the majority of pharmacies. In turn they are billing plan sponsors for the maximum cost a drug can be purchased for and pocketing the spread between the two. This is how you rake in $1.8 billion dollars in profit.
 
Last edited:
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farmadiazepine said:
Check this out,

We spent 2 weeks signing contracts with an NJ Medicaid HMO (Horizon NJ Health) to be able to dispense Harvoni. They promised reimbursement of AWP minus 2 percent or something like that. The doctor's office worked very hard to get the approval, and as soon as they did, they let us know, as well as the insurer. I get to finally run the Harvoni through. Horizon NJ Health forces us to dispense only 14 tablets for the first fill. Fine, no problem. I'll buy that $31,500 drug, and dispense only half the bottle. I run through the claim for 14 tablets, and finally get to see what we made.

We were paid $15,500 for 14 tablets of Harvoni. WTF!? It cost us $15,750 to buy 14 tablets of it, and now the insurer is not even paying enough for the medication?

We called Horizon NJ Health, and they asked us to send over invoices. I send over everything immediately. They call back and say, "You have to get the drug cheaper somewhere else." That was it. We called our friends at different specialty pharmacies, and no one could get it any cheaper around the area.

It makes me think, CVS/Caremark with its deal with Gilead to obtain Harvoni and get rebates, and Express Scripts with its deal with Abbvie for the new heptatis C treatment. Whose the one winning? Is it the patient? No. Is it the independent community pharmacy? No. Is it the independent specialty pharmacy? No.

There is something hugely wrong with our profession, and the health care system in the US, and a lot of it stems from the third party payor model. Private insurance companies are dictating who gets what and who doesn't get anything. The winners are always the companies themselves and their subsidiaries. Things need to change, and I'm just getting sick and tired of this system.

I still love my independent job, though! Never a day I hate it! I'm thankful for everyday I never have to step foot into the Devil's lair.
Click to expand...


A couple of things:

1) AWP is $37,800 for #28 as noted above

2) paid: $15,500 for #14= $31,000 for #28

3) $31,000/$37,800= 82%---the contract wasn't AWP-2 (This isn't 1998)..it was AWP-18%.

In Summary:

Your Pharmacy owner is probably too far removed from his wholesaler to know his actual brand COGs and whether he gets a discount on specialty meds (I don't and I STILL would have made money on this transaction). He really needs to leave Cardinal as they are Phucking him royally.--In Summary, send this patient MY WAY. I'd gladly take it while making $500 a fill.

Hell, if I could, all I'd ever fill are 4-5 of these a day and make a VERY nice living. I have the good fortune of filling Enbrel, Pulmozyme and some Gleevec and make around $300 per fill on Enbrel, $900 on Pulmozyme and about $1700 per fill on Gleevec. You people suffering from "deflated balls" can have all of my lisinopril/ HCTZ RXs for $1.29 over my Aq price......
 
BenJammin said:
Cardinal price for Harvoni is $30397.50 so 14 tabs is 15198.75.
Click to expand...


That's not every Cardinal customer....some are part of buying groups and they get a better COGs....just like my McKesson group gets a better COGs than some posters on here.......
 
I checked Cardinal today, #28 was $30,400 +/- change. Price definitely will vary for every client and contract.
 
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Did some people on here really think that pricing was standardized? McK alone has 38 different indices, not including my direct purchasing through committed GPO contracts for specialized clients. One rx going the wrong way is insta-diversion in the manufacturer's eyes.
 
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BF7 said:
A couple of things:

1) AWP is $37,800 for #28 as noted above

2) paid: $15,500 for #14= $31,000 for #28

3) $31,000/$37,800= 82%---the contract wasn't AWP-2 (This isn't 1998)..it was AWP-18%.

In Summary:

Your Pharmacy owner is probably too far removed from his wholesaler to know his actual brand COGs and whether he gets a discount on specialty meds (I don't and I STILL would have made money on this transaction). He really needs to leave Cardinal as they are Phucking him royally.--In Summary, send this patient MY WAY. I'd gladly take it while making $500 a fill.

Hell, if I could, all I'd ever fill are 4-5 of these a day and make a VERY nice living. I have the good fortune of filling Enbrel, Pulmozyme and some Gleevec and make around $300 per fill on Enbrel, $900 on Pulmozyme and about $1700 per fill on Gleevec. You people suffering from "deflated balls" can have all of my lisinopril/ HCTZ RXs for $1.29 over my Aq price......
Click to expand...

How is retail going?
 
ExpressMaiL said:
How is retail going?
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A little better than in 2014.Scriptcare and United Health really F'd me in 2014 (17% Gross margin)...now those employers have switched PBMS so my Rx count for those 2 PBMs are way down.....but even then I was still doing A LOT BETTER financially and personally as an owner than I ever did as an EMPLOYEE. (and my last excursion as an employee was working from home for a PBM).

I figure I've got about 3-5 years left of REALLY making a good living (2.5-3 times what an average employee RPh makes so far) and then the margin pressures and access to lives will likely make our profession mostly a realm for only the Big Chains and PBM owned pharmacies...That'll put me in my early 40's so I'm actually trying to diversify a little bit while paying off my personal assets (a couple of homes).

Then I'll likely be following you in your compounding footsteps my man🙂
 
BF7 said:
A little better than in 2014.Scriptcare and United Health really F'd me in 2014 (17% Gross margin)...now those employers have switched PBMS so my Rx count for those 2 PBMs are way down.....but even then I was still doing A LOT BETTER financially and personally as an owner than I ever did as an EMPLOYEE. (and my last excursion as an employee was working from home for a PBM).

I figure I've got about 3-5 years left of REALLY making a good living (2.5-3 times what an average employee RPh makes so far) and then the margin pressures and access to lives will likely make our profession mostly a realm for only the Big Chains and PBM owned pharmacies...That'll put me in my early 40's so I'm actually trying to diversify a little bit while paying off my personal assets (a couple of homes).

Then I'll likely be following you in your compounding footsteps my man🙂
Click to expand...

Right on, glad to hear that you're on the upswing. Definitely need to plan for the future...absolutely nothing is secure. But we already know that. Every day I catch myself thinking about starting a retail side and how to do things differently. Props to you for handling such a tough market. I'm beginning to learn about plasma/biologics just in case an opportunity arises. Compounding is great; a fun little niche but it is little when compared to those factors... if you get my drift.
 
Compounding? Seriously? I figured that niche would be going downhill once the FDA cracks down thanks to NECC. I really hope there is a future for independent pharmacy.
 
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BenJammin said:
Compounding? Seriously? I figured that niche would be going downhill once the FDA cracks down thanks to NECC. I really hope there is a future for independent pharmacy.
Click to expand...

Yeah, compounding is beginning to have some of the worst margins in the industry. Personally, I would stay away if I could have a fresh start. It simply isn't worth it.
 
I know everyone's prices are different and everyone has a different contract, and may or may not be in a purchasing group, etc. I just want to know what price everyone is getting Harvoni for if you had to buy it?

On another note. We transfered to CVS Specialty. CVS lied to the patient and said the medication will be shipped in 24 hours. 3 days later CVS tells the patient they can't fill the medication. It turns out big CVS Specialty is not even contracted with NJ Horizon Health Medicaid HMO. These as*holes. So we now transfered the prescription to another specialty pharmacy, one in Florida.

So this pharmacy in Orland, Florida, is allowed to fill specialty prescriptions, ship them to NJ, and bill NJ Medicaid and receive payment?

Is it possible to start a specialty pharmacy or become a specialty hub for a bigger specialty pharmacy, and fill speciality RX's for medicaid patients throughout the United States, and receive payment for it? Cool idea maybe.
 
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BenJammin said:
Compounding? Seriously? I figured that niche would be going downhill once the FDA cracks down thanks to NECC. I really hope there is a future for independent pharmacy.
Click to expand...
MANY and I mean MANY compounding pharmacies do not accept assignment from insurance companies. "CASH MONEY homey"--- Google drug crafters in Frisco, tx. (They actually beat me to a commercial pad site in the new hospital that was built there. -- phuckers)

http://drugcrafters.com/
 
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farmadiazepine said:
I know everyone's prices are different and everyone has a different contract, and may or may not be in a purchasing group, etc. I just want to know what price everyone is getting Harvoni for if you had to buy it?

On another note. We transfered to CVS Specialty. CVS lied to the patient and said the medication will be shipped in 24 hours. 3 days later CVS tells the patient they can't fill the medication. It turns out big CVS Specialty is not even contracted with NJ Horizon Health Medicaid HMO. These as*holes. So we now transfered the prescription to another specialty pharmacy, one in Florida.

So this pharmacy in Orland, Florida, is allowed to fill specialty prescriptions, ship them to NJ, and bill NJ Medicaid and receive payment?

Is it possible to start a specialty pharmacy or become a specialty hub for a bigger specialty pharmacy, and fill speciality RX's for medicaid patients throughout the United States, and receive payment for it? Cool idea maybe.
Click to expand...

I just had a GREAT phone conversation this week with an industry guy who now works with IPC. The specialty market is already heading towards consolidation by virtue of how much $$$ It takes to even be able to partake in insurance networks ( the PBMS have quotas on minimum inventory dollars on hand, make you get URAC. ($80k) and some other certification, 24/7 Rph call center etc) ... Further many manufacturers are bringing new products to market bypassing wholesalers altogether; striking up deals directly with pharmacies ( limited distribution under the guise of their product needing special oversight for patient monitoring etc) thereby limiting their own exposure to price ceilings in 340b, medicare/Medicaid etc... I was honestly pretty disheartened after the 30 minute phone call.
 
Plus I'm not sure you all are aware of this fact, but private equity investors are investing money in new and existing compunding pharmacies; they are absolutely not looking to invest in traditional dispensing pharmacies.

Why is that? Because in traditional dispensing we don't truly have control over our profit margins. It's not like a pizza restaurant who faces an increase in the price of cheese that can then leverage their sales prices upward. When our costs for drugs go up, 3rd party payers are very latent in making adjustments if they make them at all ( catamaran).
 
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