An recent informal poll asked pharmacy owners to decide between two choices for their pharmacy practices:
- Being in as many preferred networks as possible, regardless of the financial reimbursement, OR
- Not participating in preferred networks that charge Direct / Indirect Renumeration (DIR) fees, regardless of the volume decrease my business will see.
Ignoring any middle ground for a moment, neither of these options are particularly appealing. I would venture that most independent pharmacy owners would have a difficult time answering the question. Both options are difficult roads that have the potential to bankrupt a pharmacy in the long-term. I do not see preferred networks becoming less popular, and expect that they will become even more prevalent in years to come.
If I have to choose, I will always choose access. I feel that access will offer the most likely path to the long-term survival of the profession of pharmacy. I am not alone in my thoughts on this, either. This question is essentially the one that Pharmacy Services Administrative Organizations (PSAO) have to make on behalf of their constituents. And looking at the current landscape of preferred networks and independent pharmacies in the United States, PSAOs have, more often than not, chosen access to lives.
If I have to choose, I will always choose access.
Yet I hear pharmacy owners wanting to opt out of preferred networks giving them access. I have heard some owners argue that their patients are so loyal to them that they would not lose their customers if they were not in the preferred networks: their patients will pay more to continue to support “their” pharmacy and pharmacist. I am certain that I have a large contingent of very loyal patients, but I am unwilling risk my business on this type of experiment. Even if all of my current customers were completely committed to my stores without respect to price, I would gradually lose business thru natural attrition. Attracting new customers would be a significant challenge as a provider outside the preferred network. Potential patients without previous experience with my practice would need to be willing to pay more for what they may otherwise perceive as the same product. Without ready access to new customers, there is virtually no hope for growth and sustainability.
The way I see it, the Pharmacy Benefit Managers (PBMs) are driving pharmacy to a stripped down model. As pharmacists and pharmacy owners, we can either we can accept this model, or fight back to change the future of pharmacy. At least if I have access, I can work with my current and new patients to generate other streams of revenue, to grow the practice, and to define what pharmacy is and why it is important to patients and the health care system. This fight will be difficult given the anemic reimbursement and DIR fees offered by preferred networks. In my opinion, though, being in the game and working to change the profession of pharmacy is a lot more likely to be successful in the long run. The alternative is downright frightening.
I don’t like the current landscape of pharmacy and healthcare, and it is going to take hard work to change it. Giving up access, to me, is simply wrong. Micheal Lefoeuf once said “Every company’s greatest assets are its customers, because without customers there is no company.” Access to our patients is our lifeline!
