We have discussed the problems pharmacies have been having with reimbursement for brand name medications for a few weeks now. The implication for pharmacy are significant: dropping plans with underwater reimbursement, not stocking some, or all, brand-name medications, closing their doors permanently (even after trying one or more of the of the previously mentioned solutions). A pharmacy intervention is desperately needed.
Short of the Federal Government stepping in and prohibiting some of the unfair business practices being used by Pharmacy Benefit Managers, what can be done at an individual pharmacy level to maintain patient access to pharmacies? For independent pharmacies, at least, there is one possible solution that comes from an unlikely source. Mail Order.
I can hear the whispers and buzz out there at my mention of Mail Order pharmacy as a solution to the difficulties currently being seen by independent pharmacies. I have not been drinking: hear me out. What if a pharmacy could, at the request of the patient, arrange for unprofitable brand name medications to be filled by the PBM’s mail order pharmacy while maintaining the patient’s home pharmacy for all other services? Sound Crazy? It isn’t. Let’s take a closer look at how this might be possible.
At first, you might think that losing the unprofitable prescription to mail order creates gateway for the patient to receive all their medications by Mail Order. The Mail Order pharmacies would certainly welcome that option. But what if the pharmacy managed the mail order experience for the patient on their behalf? Let’s outline what this might look like:
- The pharmacy gets written permission from the patient to manage their mail order benefit on their behalf.
- The pharmacy creates and manages the patient’s mail-order pharmacy account.
- During the normal Med-Sync process at the pharmacy, the pharmacy orders the patient’s off-loaded brand medications from the Mail Order Pharmacy.
- Depending on local pharmacy rules, the Mail Order prescriptions are either mailed to the Pharmacy (if allowed) for the patient to pick up with their other synced medications OR sent to the patient directly (if not allowed).
The concept is simple enough. While it requires a little footwork and coordination, the independent pharmacy can remain the patient care hub as before. The only difference is that the pharmacy doesn’t lose significant dollars on specific brand-name medications anymore.
This mechanism has non-financial benefits as well. The patient maintains a pharmacy home: a place they can interact face-to-face with a pharmacist, a place where the patient’s health and medications are managed locally. If the landscape changes–say Congress re-balances the equation and pharmacies no longer lose money on brand name medications–bringing these prescriptions back to your pharmacy is simple.
But in practice, scaling such an operation can be a challenge. Doing this for a few patients is probably manageable (and that might be all that is needed for some smaller volume stores). As the volume of the independent goes up, however, management of the workflow becomes critical. There are, however, partners that can help you manage a larger population using this strategy.
As it turns out, we have another option. An option that may be far more palatable to the independent pharmacy owner than ultimately closing shop. Independent pharmacies have a way to continue to serve their communities. Independent pharmacies can continue to Make Every Encounter with its patients COUNT.
