02/21/2025
FOURTEEN CENTS. Today I filled a prescription for a patient and was reimbursed a grand total of fourteen cents. The label cost 6 cents. The bottle cost 55 cents. Not to mention the cost of the medication itself. And it goes in a bag. Those arenโt free. Thereโs also the cost of my techโs time to read it, type it, and count it. Oh and Iโm supposed to counsel the patient on 27 aspects of the drug and how to use itโฆ.with the degree I paid $100,000 for. I pay a cashier to provide exceptional customer service. And all of that is worth a grand total of FOURTEEN CENTS.
Iโm not searching for sympathy. Iโm sharing for understanding. There is very important pharmacy legislation coming up. The โPBMโsโ exist to keep ME from defrauding the system. But no one keeps them from defrauding meโฆand youโฆand your insurance company. Iโve seen several things floating around about how insurance companies wonโt pay for things anymore. But what people donโt realize is this is really the work of the PBM. They make deals at your expense, and at my expense, to put money in their pocket. All in the name of keeping small pharmacies from โgetting richโ. Trust me, nobody is getting rich filling prescriptions for fourteen cents.
They require many patients to use mail order pharmacies THAT THEY OWN. And they reimburse those mail order pharmacies WAY MORE than local pharmacies. Why? So they can take money from one of their pockets and funnel it straight to another.
I had another patient (actually more than one) needing a drug that is available in generic form. The PBM only allows use of the brand name drug. The patientโs insurance company will have to pay an extra $100 for use of the brand name drug. Iโm reimbursed $45 LESS than the cost of the drug (not even counting the cost of all those other factors mentioned above). And the PBM pockets the rest, when it could have been filled MUCH cheaper.
Commercials and ads are beginning to surface to explain how the PBMs work. Except they tell you how they were meant to work. They claim all pharmacists are rich and lie about these situations. They claim we overbill everything. When the truth is it literally does not matter what we bill. They pay whatever they want either way! If you have a local (especially independent) pharmacist, talk to them. They will all tell you the same things Iโm saying here. They/we arenโt lying to you. We are up against multi-million dollar organizations who are taking money from pharmacies and patients alike, and driving up the cost of healthcare exponentially. When you see these ads, do not be deceived. When people tell you we are trying to pass a prescription drug tax, do not be deceived. We do not want your costs to increase. We simply want the money your insurance company pays on your behalf to come to the people filling your prescription (without someone else taking a huge cut first and leaving us holding the bag). Your insurance company is already paying it. It just isnโt getting to where it needs to go! We are trying to stop these companies from taking our money, your money, and putting it in their pockets. If something isnโt done soon, there will be no small town pharmacies. PLEASE do not be deceived.
The more you knowโฆ๐
THANK YOU to our patients who stick with us!
This was reposted from another pharmacy owner but this is the state of our industry.
