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Does Caremark tell a pharmacy they can't accept express scripts? I don't think your examples are solid at all. Does my SAMs club membership entitle me to shop at Costco?
Walmart Wrestles With Reality of Preferred Networks
- Thread starter BF7
- Start date
Does Caremark tell a pharmacy they can't accept express scripts? I don't think your examples are solid at all. Does my SAMs club membership entitle me to shop at Costco?
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I've gotten my payoff already.
But I'm not yet 40 and genuinely fear for the future of our profession and the ability to practice independently as an owner holds great weight when it comes to professional satisfaction and value to the communities that we serve.
I care for the poor working conditions that are created for all pharmacists that are generated by PBMs profiteering off of the sweat and liability of every prescription that we pharmacists fill.
The pendulum has swung WAY too far in the PBMs direction and it's important that every pharmacist recognizes the implications of that.
WTF....You should try to be aware of all risks and rewards in any new business/employment venture.
It's not even a business. You're doing charity work on behalf of the PBMs!
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It's easy to look at it as a microcosm of PBM vs. community pharmacy. But the larger picture is the strong desire to cut down on all healthcare expenditures. PBMs are feeling the pinch further upstream with Health Plan consolidation and Health Plans are directly feeling the impact of ACA. No one is immune to the changes in the healthcare environment. I get advocating to protect your lions share but the reality is everyone's lions share will likely feel the pinch.
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I don't think people genuinely understand what the ramifications of these policies mean for them... Filling 400 rxs with 1.5 techs ( maybe) followed by negative productivity reports going to your DM followed by letters of reprimand that are then followed job losses with a huge surplus of Pharmacists waiting in the wings to take their jobs while working for $35/ hour...if dispensing robots( more accurate, never call our sick, don't require benefits -- all the talking points of MBAs and investment bankers) don't eventually replace us.
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If you don't want to do the charity work, don't.
Do you even work in retail?
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The solution is a single payer modeled after the Canadian system. The real savings will be realized by capping what big pharma can charge for medications and not by decreasing the average gross profit per prescription below $9; that would be BILLIONS in savings versus millions.
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Ironic but the current system is broken and to the detriment of patients and providers.
Besides, I've gotten a very good first hand account of the model and I'm greatly impressed. It benefits patients and providers and saves the government billions.
I'm sorry your emotional involvement is preventing you from comprehending what I'm trying to tell you.
This is what I'm getting at. Stating something is "anti-American" is a type of argument that adds no real value, but attempts to discredit anyone who may disagree with you. It diminishes what you are saying when you use this type of argument. If this concept is above you just be a spectator where you likely belong while the big boys try and have a reasoned discourse.
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Ultimately what BF7 is trying to say is that pharmacists, as a profession, are providing a valuable service and deserve to be fairly paid for their risk/level of education. Doctors deserve to be paid a fair amount based on a service they provide. Even the drug manufacturers deserve to be paid fairly. All are taking care OF THE PATIENT. This is a professional environment.
The PBMs contribute absolutely nothing. Zilch. They don't see patients, they don't treat patients, they don't provide a service to patients. All we hear is about how much money they save the system which is akin to the story of the emperor with no clothes. We keep hearing about all of the money they're going to save but health care costs continue to skyrocket along with PBM profits. WITHOUT PHARMACISTS these clown wouldn't even exist. That is the same whether you work in chain retail/hospital/independent.
When you take into account spread pricing, retail pharmacy is cheaper and serves the patient better. Without "preferred networks", DIR fees, and bottom of the barrel MAC prices, we beat those clowns like a drum on an even playing field. We provide better service, we're cheaper, and ppl prefer us. That is why you need these mandatory mail order and preferred networks to tilt the game artificially in their favor.
Oh yeah. So we've never had a victory on the legislative level huh? Check this out. http://www.ncpa.co/pdf/ncpa-state-leg-update.pdf The tide is turning.
The PBMs contribute absolutely nothing. Zilch. They don't see patients, they don't treat patients, they don't provide a service to patients. All we hear is about how much money they save the system which is akin to the story of the emperor with no clothes. We keep hearing about all of the money they're going to save but health care costs continue to skyrocket along with PBM profits. WITHOUT PHARMACISTS these clown wouldn't even exist. That is the same whether you work in chain retail/hospital/independent.
When you take into account spread pricing, retail pharmacy is cheaper and serves the patient better. Without "preferred networks", DIR fees, and bottom of the barrel MAC prices, we beat those clowns like a drum on an even playing field. We provide better service, we're cheaper, and ppl prefer us. That is why you need these mandatory mail order and preferred networks to tilt the game artificially in their favor.
Oh yeah. So we've never had a victory on the legislative level huh? Check this out. http://www.ncpa.co/pdf/ncpa-state-leg-update.pdf The tide is turning.
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http://www.ncpanet.org/newsroom/new...lawsuit-against-drug-pricing-transparency-law
The PBM's fought that one hard. It is a huge victory for pharmacy. Not just independent pharmacy but our entire profession.
The PBM's fought that one hard. It is a huge victory for pharmacy. Not just independent pharmacy but our entire profession.
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And you guys attacking my buddy BF7, saying hes just a sore loser pharmacy owner, need to know that the guy doesn't even work anymore. He had a business, was successful, and cashed out. He doesn't even have a dog in this fight anymore.
He is here simply to defend the future of our profession.
He is here simply to defend the future of our profession.
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Sold in July🙂
Now I own 2 beach rentals and I'm working on getting my Fl RPh license. I'd been coming here to the Emerald coast for years and decided I'd get in on the weekly beach rental business with the sale of my store. Between the 2 properties they'll generate almost a full years Rph salary in revenue and obviously grow in equity. It's my retirement and my kids college fund all rolled into one🙂
Re: my pharmacy
I'd grown it by $2 million in sales over the course of 5 years that I owned it and the timing worked out well for me and the buyer who was part of my buying group.
Once I pass the MPJE I'm going to open another store here in Fl with a smoothie shop and sports supplement front end of roughly 600 square feet. the 90:10 model ( Rx:OTC) is a losing proposition with PBMs profiteering as noted above. The sports supplememts and smoothies will make that mix more like 75:25 to 70:30. A drive thru is essential for the smoothie shop.
I'm also a certified personal trainer and I always get asked by patients about tips on working out and dieting so it fits well with me and my lifestyle too.
Congrats! I must have missed the selling part when I didn't check forum regularly over the summer. I'd much rather live in FL than Odessa, TX. You shouldn't have trouble recruiting once you start expanding there. But then again, sounds like you don't need to.
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Why is Walmart putting drive thrus in all their new pharmacies? Don't they want customers in the store so they'll buy all their cheap China junk and groceries.
People still came in when I worked there in Arizona. The only problem is the tube system has to come from the other side of the store to the pharmacy in the supercenters. It literally took like 4 minutes each way if it was a really big supercenter. The neighborhood markets in Tucson all have it. There was one neighborhood walmart that one that had a one lane island built in the parking lot with a tube attached to it.
Grant and Alvernon....good times.
you a pharmacist now or a student???....
4th year.
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Maybe...maybe not. It all hinges on getting regulations passed eliminating the PBM scam.
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How long have you guys been saying that? 15 years already?
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The reality is this:
The only thing that will remove for profit PBMs who create this artificial marketplace from our current marketplace is single payer. That's it. And it's coming... Mark this post.
The current system certainly doesn't resemble an open and free market either. In fact, it's being manipulated by corporatism to the detriment of free market principles which runs directly counter to the American beliefs of free market capitalism.
Let me give you an example of FREE MARKET principles:
My Rental homes will each have competitive rental rates and will also feature amenities like Golf Carts, Smart TVs, coupon books for local dining and a fully furnished kitchen, etc.
I/ my marketing agency will all be easily accessible to potential customers which will hopefully set me apart. I'm competing based upon service levels and customer perceptions of my product and service.
My price isn't being limited by a third party nor do I have a significant % of the population restricted from renting my home from me. It's truly a FREE MARKET.
I deal in reality; government intervention is the only force that will remove the parasite of our profession, the PBMs, from shaping and dictating the marketplace in Pharmacy.
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I was 2 years into my pharmacy career and didn't know better. What's your excuse?
Bitter? Not at all. I took that severance and turned it into a $1.2 million profit in 5 years.
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Your point?
They set their own fees by the way. I don't dictate what they can charge and I don't limit who they can market for.
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5 years at the most. There has finally been some meaningful legislation passed recently. I guess the PBMs finally pushed too far. It's a matter of time now.
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What's funny is prescription costs are only 10-15% of healthcare, it's a relatively small piece of the pie that is always being squeezed on.
I think single payer is nice, but sometimes I don't trust the government with all the power of the payer and regulator. Healthcare workers in Canada make less and honestly their healthcare labor laws don't seem any better than here. I support forcing all insurance plans to be non-profit driven meeting government standards and full transparency for payment model and structure. It would allow consumers to still chose and have ownership of their healthcare, with one national standard being mandatory catastrophic coverage so if you get cancer or need a transplant you aren't going to go completely broke paying off bills. Regardless though, I think a for profit healthcare payer model is about the worst you can have, and is unethical as well.
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The average RPh in Ontario makes about $50/hour while a pharmacist working in Rural Canada will make around $60 as an employee. As an owner, instead of having 22% gross profit margins they are making 40%, albeit with lower gross sales numbers due to price caps put on big pharma ( which ultimately reduces the pharmacy's dollars being tied up in inventory).
If we could copy the Canadian pharmacy reimbursement system in its entirety it would be a boon for patients, employers ( employees would cost less due to not having to insure them) and pharmacy providers.
I've gotten a very detailed look at it from a pharmacy owner in Ontario. It's a very even playing field for all pharmacy providers which improves patient access to medications and pharmacy services. Pharmacies are able to compete in much more of a free market than what we have on America, that's for sure.
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I talked to a pharmacist in Ontario when I was up there and have friends in Toronto, they said you do make around 85k-100k a year, but that's also considering that the Canadian dollar is usually weaker than the US dollar and prices reflect that. As far as wealth is concerned 100k Canadian is about 77k USD. That being said I wouldn't mind adopting some of their system, if I could make more money in Canada as a pharmacist I'd probably try to immigrate there.
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You're just about hopeless.......here goes nothing.
A1 ) I own my rental property
A2) Pharmacies own the medications that they dispense to patients
B1) I set my own rental rates dictated solely by ME as the owner of that property; the property management agency does not.
B2) PBMs set the price that Pharmacies can charge for dispensing product that the PHARMACY OWNS.
C1) I can offer my rental property to anyone who wants to rent from me (because of my great product or service) at the SAME PRICE FOR EVERYONE with no limitations placed on me by the management agency.
C2) Pharmacies are forced to charge patients a PRE-determined copay that may be different from Pharmacy to Pharmacy( if they even have access to that patient life at all.) that is dictated solely by the PBM.
So how exactly are PBMs like the property management agency again????
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The Underdog Lands a Punch
Dear Colleague,
Last week a U.S. District Court granted Iowa's motion to dismiss all remaining claims challenging the state's recently enacted maximum allowable cost (MAC) transparency law. Earlier this year, the same court dismissed four other claims made by the Pharmaceutical Care Management Association (PCMA).
This case and others will be examined at NCPA's Annual Meeting, Oct. 10-14, just outside of Washington, D.C., in a session titled, "Top 10 Recent Legal Developments Impacting Community Pharmacy Practice." That's one of many programs and activities that will be at the Annual Meeting to benefit your business and even more so, will benefit you. There's still time to register for the whole program or even for just one day if your schedule is tight.
For background, the Iowa state legislature unanimously passed HF 2297, and it went into effect June 1, 2014. The law requires that PBMs be transparent about their methodology for determining MAC reimbursement for generic drugs to the state Insurance Commissioner and utilize nationally recognized data when setting MACs. The law also requires PBMs to disclose which data they use in calculating reimbursement amounts in any contracts with Iowa pharmacies and gives pharmacies a chance to contest the reimbursement amount.
The corporate PBM lobby with their deep pockets has been battling against state MAC legislation throughout the country for the last several years. Nevertheless, 24 states have enacted MAC legislation.
We believe that success is due to the hard work of the pharmacists in those states and their state associations with support from NCPA and other pharmacy stakeholder groups. Perhaps even more importantly, we think that state legislators have passed these bills because the business relationship between the PBMs and community pharmacies is so incredibly one-sided that it raises concerns about the PBM business model and the long-term ability of pharmacies to continue to provide necessary and valuable health care services and products to patients in those states.
The PBM corporations are nothing if not clever (or maybe just plain sneaky), and in most states they have found work-arounds, inserted neutralizing language in some of the bills, or just simply chose to ignore the legislation. NCPA is continuing to work with state partners to not only enact effective legislation, but also ensure that previously enacted legislation is reasonably enforced by state officials.
But Iowa's legislation was a little different than most. Different enough that the PBM lobby filed a lawsuit. And the court dismissed all of PCMA's claims.
A tip of the hat goes to the Iowa Pharmacy Association's (IPA) Board and Kate Gainer, the association's CEO, for their leadership and willingness to support the state's defense of its law. NCPA worked closely with IPA supporting its efforts and assisted with unifying and coordinating the efforts of other community pharmacy stakeholders who contributed to the cause.
Don't be surprised if the PBM lobby tries to keep the case going in Iowa by appealing the decision. They have also filed a lawsuit last month against Arkansas, challenging that state's MAC legislation that gives it some modicum of oversight over the PBMs. Also, in Ohio, which enacted MAC disclosure legislation to both the pharmacy and plan sponsors, some PBMs have taken preemptive steps to work around the intent of the law through particular contracting terms.
Litigation is expensive. It's also nerve-wracking because there is always an element of uncertainty as to how a judge or jury may rule. "Right" is on pharmacy's side, though. It's on the side of patients as well.
Perhaps the judge in the Iowa case said it best when he concluded that ". . . the State has an established interest in protecting and promoting the health of its citizens." Yes, it does. And so does community pharmacy. Both won last week.
Best,
Doug Hoey
Dear Colleague,
Last week a U.S. District Court granted Iowa's motion to dismiss all remaining claims challenging the state's recently enacted maximum allowable cost (MAC) transparency law. Earlier this year, the same court dismissed four other claims made by the Pharmaceutical Care Management Association (PCMA).
This case and others will be examined at NCPA's Annual Meeting, Oct. 10-14, just outside of Washington, D.C., in a session titled, "Top 10 Recent Legal Developments Impacting Community Pharmacy Practice." That's one of many programs and activities that will be at the Annual Meeting to benefit your business and even more so, will benefit you. There's still time to register for the whole program or even for just one day if your schedule is tight.
For background, the Iowa state legislature unanimously passed HF 2297, and it went into effect June 1, 2014. The law requires that PBMs be transparent about their methodology for determining MAC reimbursement for generic drugs to the state Insurance Commissioner and utilize nationally recognized data when setting MACs. The law also requires PBMs to disclose which data they use in calculating reimbursement amounts in any contracts with Iowa pharmacies and gives pharmacies a chance to contest the reimbursement amount.
The corporate PBM lobby with their deep pockets has been battling against state MAC legislation throughout the country for the last several years. Nevertheless, 24 states have enacted MAC legislation.
We believe that success is due to the hard work of the pharmacists in those states and their state associations with support from NCPA and other pharmacy stakeholder groups. Perhaps even more importantly, we think that state legislators have passed these bills because the business relationship between the PBMs and community pharmacies is so incredibly one-sided that it raises concerns about the PBM business model and the long-term ability of pharmacies to continue to provide necessary and valuable health care services and products to patients in those states.
The PBM corporations are nothing if not clever (or maybe just plain sneaky), and in most states they have found work-arounds, inserted neutralizing language in some of the bills, or just simply chose to ignore the legislation. NCPA is continuing to work with state partners to not only enact effective legislation, but also ensure that previously enacted legislation is reasonably enforced by state officials.
But Iowa's legislation was a little different than most. Different enough that the PBM lobby filed a lawsuit. And the court dismissed all of PCMA's claims.
A tip of the hat goes to the Iowa Pharmacy Association's (IPA) Board and Kate Gainer, the association's CEO, for their leadership and willingness to support the state's defense of its law. NCPA worked closely with IPA supporting its efforts and assisted with unifying and coordinating the efforts of other community pharmacy stakeholders who contributed to the cause.
Don't be surprised if the PBM lobby tries to keep the case going in Iowa by appealing the decision. They have also filed a lawsuit last month against Arkansas, challenging that state's MAC legislation that gives it some modicum of oversight over the PBMs. Also, in Ohio, which enacted MAC disclosure legislation to both the pharmacy and plan sponsors, some PBMs have taken preemptive steps to work around the intent of the law through particular contracting terms.
Litigation is expensive. It's also nerve-wracking because there is always an element of uncertainty as to how a judge or jury may rule. "Right" is on pharmacy's side, though. It's on the side of patients as well.
Perhaps the judge in the Iowa case said it best when he concluded that ". . . the State has an established interest in protecting and promoting the health of its citizens." Yes, it does. And so does community pharmacy. Both won last week.
Best,
Doug Hoey
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Get more mad.
First of all again you are reaching on your FACTS. PBMs set the rate in which they will pay you for the product you dispense to a covered patient (who the patient gets to pay a much cheaper cost directly to you). Is a PBM dictating your U&C?!
But sure lets entertain your idea of eliminating PBMs. Let's force patients to pay the ridiculous costs of medications on their own. Whether the money is coming from the PBM or the Health Plan it's going to be the same story. Everyone wants to recieve more and everyone wants to pay less. It's business. "Fair" is subjective or regulated and if it's regulated it's constantly fought over.
I'm all about entertaining alternative healthcare reimbursement alternatives but the fact is we aren't in a single payer system, so again as I said learn to adapt in the system, influence the legislation, or get out.
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It's clear that you have an agenda.
I gave to you 2 examples of businesses that I participate in.
One is a free market, one is not.
It was spelled out for you in clear and uncertain terms.
Like trying to housebreak a puppy who continually sh*ts all over the house, I literally put your nose in it while telling you to do that outside and you're still sh*tting all over the house.......
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If you want to talk about how you think you're getting unfavorable rates then stick to that. When you start mixing YOUR agenda with false information that's when I do, and will speak up for any side. I'm all for healthy debates as long as it's the facts that are being used. Stating a PBM controls who you can dispense to is factually incorrect. Dispensing a prescription and receiving payment are two distinct activities although they do typically always occur hand in hand.
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Broke my examples?
What planet do you live on?
Pharmacy reimbursement is dictated by AWP-a percentage ( plus a minuscule dispense fee) or MAC'd out. ( or utilizing WAC)
I could submit $1,000,000 per tablet of atenolol 100mg #30 and guess what? I get paid the PBM MAC'd rate of $1.82
A pharmacy's U&C is as worthless of a number as AWP. You don't know what you don't know.
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PBMs dictate the market.
( and yes they DO dictate who a pharmacy can dispense too; caremarks maintenance program whereby patients HAVE TO go to a CVS or their mail order operation is a prime example)
And with more patients than ever having insurance they are coming closer to dictating 100% of the market. See the 1st post article in this very thread.
If a typical community pharmacy wants to you know, PRACTICE PHARMACY, they HAVE to deal with PBMS.
Your inability to grasp this concept is what's distorting your whole misguided perspective
