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). … Continue reading Catching 22?
Today, it is possible that a pharmacy can be penalized for the mixture of patients they serve. Given the exact same contract with a PBM, a pharmacy might be paid less on average than another pharmacy solely based on the mix of plans and products billed to the PBM. These things are entirely out of … Continue reading Short end of the Stick?
Over the years, the patient base of our pharmacies has changed dramatically. When I started in pharmacy, for example, we had a significant cash business. The percentage of our business that went thru insurance was growing steadily: the number was near zero not that many years before. Then came Medicare Part D, and cash customers … Continue reading Know your Payer Mix
Since its inception in back in the early 2000’s, Medicare Part D has become firmly entrenched as a fixture in the pharmacy landscape. The U.S population age 65 and over has grown nearly 5 times faster than the total population over the last century and represents nearly 17% of the population. A vast number of … Continue reading Reimagining Open Enrollment
If you have been following the Thriving Pharmacist, you undoubtedly saw an abrupt halt in the posting of content. One could have attributed this to Covid. While the crisis did contribute to the dearth of written content, we also put our efforts into a podcast during that period to support pharmacies called Thrive Subscribe. As … Continue reading Hello Again!
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 … Continue reading Danger!
If you have successfully interested with an employer to self-insure and consider a direct pharmacy services contract, the next step is to understand the landscape, devise a benefit, and put the logistical parts together. In many ways, this is the hardest part, especially if you try to make it more complicated than it needs to … Continue reading Executing a Direct Contract
PBMs came into being as a convenience service that originated when third party prescription benefits began to emerge. Pharmacies were required to send paper claims to insurance for reimbursement. This was a time-consuming process, both in the preparation of the submissions and the time to receive payment. The fledgeling PBM industry enabled pharmacies to submit … Continue reading The Art of the Direct Contract
I own and operate an independent community pharmacy. Since the middle of March, we have made numerous changes to our operating procedures to accommodate the safety of my patients and my staff. One significant change that we had to make was to close our doors to the public and instead rely on delivery and curbside … Continue reading Another Hidden Cost of Covid-19
A few days ago, Will Maddox wrote a column for D Magazine entitled Amazon Teams Up With Local Pharmacy Benefits Manager. This news article, discussing the partnership between CerPassRx (a PBM) and Amazon’s PillPak, demonstrates the huge discrepancy in how the profession of pharmacy is perceived today. Maddox’s article describes the hot-button issues of medication … Continue reading Adherence is Just Part of the Equation
