01/24/2026
Take about three minutes to look over these emails and see why is needed . When Humana / Enclara wants to contract with your pharmacy yet their payment scale starts off -1.5 percent LESS than the actual drug cost, this makes the business of pharmacy untenable.
THIS is what negotiating with a Pharmacy Benefit Manager looks like. Humana / Enclara is a specialized hospice PBM. Hospice manages end of life care for critical patients when families can no longer care for a terminal patient. This requires care and thoughtfulness to ease the burden on the family, but that is NOT what Humana does. (Humana, Inc. NYSE: HUM). How would you like to get paid -1.5% of the COST for any drug and then deliver it for FREE? If you are interested, read more!
The Pharmacy provided compounded medications for a terminal patient last year. What was expected to be one or two months turned into six months of critical care that we dispensed at no cost. NO BUSINESS that wants to stay in business can afford to do this.
We took a critical look at this scenario. 1. The medication was not available / in stock from their mail order pharmacy so they called the local pharmacy (an independent pharmacy). 2. The nurses would forget to order in advance which prompted last minute, emergency fills and free delivery to a patient in pain. When this scenario became a monthly pattern, we questioned hospice staff. They sent out a 20 page contract for The Pharmacy to fill out, which we did and received approval to contract with their network. However, nothing about our reimbursement for services was included in the contract. Negotiations continued via email with the NPS Network Contracting Manager and two of the pages are attached.
After three weeks of discussions, Humana / Enclara finally sent over what they were willing to pay an independent pharmacy provider: 1.5% LESS than either the WAC or MAC cost of a drug, whichever was LOWER. Generously, they offered a $1.00 DISPENSE FEE to cover materials, payroll, rent and additional overhead costs. ARE YOU KIDDING ME?
Our desire is to help patients and provide the best care possible. Humana / Enclara's goal is to charge patients as much as possible and offload the costs onto other entities, as MOST Pharmacy Benefit Managers do. We helped as long as we could and ultimately REFUSED their contract. In order to get paid for months of free prescriptions, we filled out extensive paperwork with all the appropriate medical records, dates of delivery and patient notes. Humana / Enclara paid a small portion and then IGNORED the properly, timely filed documentation for $3,000.00 in reimbursements.
Pharmacy Benefit Managers TAKE ADVANTAGE and expect providers to go along. Is it in the best interest of the patient to provide good healthcare in the final stages of life? Absolutely. Do they take advantage of pharmacies in order to boost their bottom line? Absolutely. Do they care? NO The payment schedule for Hospice Pharmacy Services (page 2 of email negotiations) is in the comments section. Work through that portion with any numbers you choose and you can clearly see that the pharmacy business model has become untenable. HOW can we change this and serve our patients better? WATCH this page FOR MORE information.