I know that it has been awhile since I have published anything new. For that I am sorry. COVID-19 has been a challenging time for most industries, and pharmacy has not been an exception. I have broken out my keyboard, however, because the pandemic has created an alarming sentinel event everyone in pharmacy should be aware of immediately. This is an event of significance; an event that could lead to another lost opportunity for the pharmacy industry. I am talking about point of care (POC) testing. Specifically testing related to COVID-19, but really all POC testing.
Testing in and of itself is generally regarded as an opportunity for pharmacies. We have the expertise and the resources to quickly spin up a process and be valuable assets when needed. The pandemic has been a great opportunity as many pharmacies are participating in testing for COVID-19 and the demand keeps growing.
So where is the danger you might ask. Consider this–yesterday I received a fax from a national PBM. They are a significant player, perhaps even approaching monopoly status as they are very “vertically” integrated. The PBM industry has already crippled pharmacies across the nation with significant underwater claims and overall anemic reimbursement. They do not pay pharmacies a real professional fee; $0.15 or less for most prescriptions is a joke as far as a professional fee goes.
This fax was an invitation to join their Point of Care (POC) testing network. And here is the problem. This is yet another area the company is excerpting its vertical integration and control. Does pharmacy really need to give a monopolistic juggernaut yet more control over their existence?
Now the rates being offered for the POC testing are quite reasonable. So you may ask “what is the problem with this”? To answer that, consider the infancy of the PBM industry. The PBMs priced generic and brand name items reasonably at first. With time, however, they took steeper and steeper discounts. Their own profitability, however, never sagged. The PBMs turned us from a participating provider into their virtual asset to be sold as a part of their network.
Today pharmacies have little to no negotiation power in this arrangement. If you don’t like it, you can leave it. But your patients won’t be able to use you if you leave. Leaving the “network” is suicide for most pharmacies. To make matters worse, the PBMs are already pushing pharmacies out of business gradually through manipulating their network contracts. Don’t forget, the PBMs either own or operate their own pharmacies, and they only need so many to maintain their measures of network adequacy required by some states.
Which brings me back to POC testing. If you are doing POC testing, you likely are either charging cash or you are set up to do billing to the medical insurance. Testing is really a medical service, and the PBM is not needed here. The medical third party administrators (TPAs) already oversee pricing. Bringing a PBM into this is a disservice to the testing and a disservice to the profession of pharmacy.
So I am asking you a favor. Share this article. Be sure all pharmacy owners understand that they don’t need a PBM involved in POC testing. Get registered as an independent laboratory and credential on the MEDICAL side of the field. This is so important to the future professional status of pharmacy and pharmacists. Let’s not let our industry fall prey to another PBM hostile takeover. I mean it. Make this encounter count!
