The other day, my business partner and I had a conference call with our wholesaler and our PSAO about the impact that DIR fees were having on our bottom line. The representative from our PSAO kept emphasizing that the reason why they signed the contracts with some preferred networks (with very low pharmacy reimbursement) is because they wanted to make sure that their network of pharmacies had access to lives. We do not disagree with this statement, but where our priorities began to diverge from our PSAO is when the PSAO representative described ways to increase revenue for those patients in the store. The emphasis was on selling them other items to make up for the losses on the drug product. The emphasis was not on clinical services, but what other products you may be able to offer patients coming to your practice.
What?! We were in disbelief! From our perspective, access to lives means that we have an opportunity to provide clinical services that impacts the care of these patients. If clinically we did our job, then patients should attain their therapeutic outcomes through safe and effective drug therapy regimens. Those patients who achieve their therapeutic outcomes should be healthier and have less health care spend than those patients who do not achieve their therapeutic outcomes. It is our contention that pharmacists SHOULD be paid a FAIR fee for high performance. Obviously, with underwater MACs, DIR fees, claw-backs, and other PBM business practices, the payment for product has rapidly become insufficient to cover the costs associated with dispensing. Product reimbursement certainly leaves nothing to pay for a pharmacist’s clinical activities and cognitive services. To add insult to injury, the performance payment from one PBM for our performance on pharmacy performance measures was extremely anemic. This is unacceptable, and as a profession we should demand more from our strategic partners, which include our wholesaler, our PSAO, our network, our buying group, and the PBMs themselves. At this point, the partnership seems to be benefiting everyone but the community pharmacist who is in the trenches taking care of patients (and who is getting paid less to do this). It makes no sense. But to have one of the strategic partners verbalize that we have to do more than just offer clinical services and look at other products that we can sale to patients as a way to enhance our revenue was enough to put us over the edge.
We want to be good community pharmacists. We offer an extensive list of clinical services. We have partnered with a local payer, who has stayed committed to us because of the outcomes we have been able to generate with their clients (our patients), and we consistently achieve a high performance on our pharmacy performance measures on the EQuiPP platform. We own two professional pharmacies that have small front ends. We only sell medical related items and we already have a flourishing DME business. So if our strategic partners are suggesting that we are suppose to sell paint and hardware or milk and eggs as a way to generate new revenue, then question if they are truly our partner. It should be about patient care. It should be about the services we provide. It should be about the outcomes we achieve. We have worked hard to change the paradigm of our practice, but now we are working just as hard to change the paradigm on how community pharmacist are paid. It seems everyone within the drug distribution system is “making their money” including the all the strategic partners that have been mentioned previously, but the community pharmacist is left to provide the care, identify and resolve drug therapy problems, take calls from patients 24/7, be responsible for patient outcomes, and not paid sufficiently for any of it. Access to lives should not be about finding new ways of selling products to improve the bottom line, but rather it should be about quality patient care, fair reimbursement for that care, and bonus incentives if expectations are met. How can anyone rationally look at the current system and say that it is fair and that pharmacist are reimbursed sufficiently? The financial viability and survivability of independent community pharmacist is on the line.
As we move forward, we will continue to fight for what we believe is fair reimbursement for services rendered. We will continue to put pressure on our strategic partners to help us in our quest for fair and equitable reimbursement. In the short term, we also will continue to put pressure on our strategic partners to make sure that we are receiving the best price for our costs of good sold, including rebates. We will continue to communicate with our legislators about fair reimbursement for pharmacists. And we will continue to support our local, state, and national professional organizations as they continue to fight for pharmacists recognition as providers. It has been a tough year, and next year looks to bring the same. We also realize that we are not alone, as other owners have expressed similar concerns. All of us can make a difference, but we have to be willing to challenge the status quo and our help strategic partners to change.