Current Events > Refusing prescriptions because we lose too much money filling them

(+) Yeah! (+)

It really sucks, man. PBMs would gladly squeeze independent pharmacies out of the industry entirely if they got their way. Sometimes I worry if I'll have a job in 10-20 years.

There is no such thing as choice in American healthcare. You get whatever insurance your job provides, go to the doctors your insurance company covers, take the medications your insurance says you're allowed to take, and fill those prescriptions where they say you can.

Join the military for socialized Healthcare? Unless it's ptsd. Then you need to not say a word. Did I get it right?

You don't get to refuse a prescription just because you lose money on it. If you are contracted with the PBM and in network, you fill the claim.

How about we all just not sign up for health insurance this year? F them. They are already taking too much. Just middle men. Why!?

People I work with always talk about "stop being sheep" because they're conservative, but they don't see they are just spouting BS spread by lobbiests to make them think it is better here. Thank God I've traveled outside the country to know it is BS. Even before that I knew it was.

The health care in other countries just for dumb stuff was way better.

Wait, a pharmacy can refuse to fill a prescription just to save money?

Dat_Cracka_Jax posted...

You don't get to refuse a prescription just because you lose money on it. If you are contracted with the PBM and in network, you fill the claim.

StealThisSheen posted...

Wait, a pharmacy can refuse to fill a prescription just to save money?

We don't have an obligation to go out of business by filling prescriptions that lose tons of money. We're not some multibillion dollar chain. We see the profit (positive or negative) of every fill in real time. We shop for the best deals on drug purchases every day and constantly modify inventory points to minimize the amount of drugs sitting idle on our shelves. We don't have the power to negotiate individually with PBMs. In fact, the coalition we are part of has completely cut off from one of the major PBMs because independent pharmacies aren't going to keep the lights on by hemorrhaging money. When patients ask their insurance company why independents are no longer in network, that company basically tells them that those pharmacies were given an offer and refused to cooperate.

Also, I have literally heard about PBMs suggesting pharmacies blame backorders if they can't afford to fill a drug at loss.

Well, I'd never want to go to your pharmacy, then.

hockeybub89 posted...

We don't have an obligation to go out of business by filling prescriptions that lose tons of money. We're not some multibillion dollar chain. We see the profit (positive or negative) of every fill in real time. We shop for the best deals on drug purchases every day and constantly modify inventory points to minimize the amount of drugs sitting idle on our shelves. We don't have the power to negotiate individually with PBMs. In fact, the coalition we are part of has completely cut off from one of the major PBMs because independent pharmacies aren't going to keep the lights on by hemorrhaging money. When patients ask their insurance company why independents are no longer in network, that company basically tells them that those pharmacies were given an offer and refused to cooperate.

Also, I have literally heard about PBMs suggesting pharmacies blame backorders if they can't afford to fill a drug at loss.

You actually do if you are contracted to do so. I know that there are prescriptions that the pharmacy does make money on and ones that they lose money on. You don't get to cherry pick the ones you like to fill. I hope the member complains and the pharmacy gets slapped legally.

Dat_Cracka_Jax posted...

You actually do if you are contracted to do so. I know that there are prescriptions that the pharmacy does make money on and ones that they lose money on. You don't get to cherry pick the ones you like to fill. I hope the member complains and the pharmacy gets slapped legally.

Whatever you say, bro. Not our fault the federal government is too deep in the pockets of insurance companies and Big Pharma to stop them from fucking up healthcare more and more. We're not sacrificing the many to help the few.

Major chains, that don't need the money, get multiple times more reimbursement per fill. And like I said, pharmacies aren't ordered to sell at a massive loss. They are told to lie and say the drugs are not available. I'm gonna challenge your notion that independent pharmacies are legally required to lose money until they die. We can manage a certain amount of loss and offset it, but not hundreds of dollars per fill. That's not tenable

StealThisSheen posted...

Well, I'd never want to go to your pharmacy, then.

Not our fault the powers-that-be want to give the big guys three course meals, while forcing the little guys to fight over table scraps and shaming them for thinking they are owed more. And companies like CVS and Walgreens will still run their companies as lean as possible (by cutting corners and payroll) to maximize even more profits. They're trying to strong arm everyone else out of business to force patients to use their bullshit pharmacies, where you can get your prescriptions filled by a skeleton crew that's stressed out of its mind and is forced to upsell you on nonsense.

We're as much victims of the system as the patient.

Sorry to hear that, TC. Ive been feeling the pinch as of late with my prescriptions costing a lot more than usual and my insurance doesnt want to pay as much for the co-pay, but at least Ive still been able to get my medications filled even if Im paying an arm and a leg for them at times.

I cant imagine what Id do if I couldnt get them filled since I need them to keep the more troublesome aspects of my high functioning autism in check so Im able to function normally.

Hopefully things will get better for all our sakes since this is worrisome to say the least.

Agent_Stroud posted...

Sorry to hear that, TC. Ive been feeling the pinch as of late with my prescriptions costing a lot more than usual and my insurance doesnt want to pay as much for the co-pay, but at least Ive still been able to get my medications filled even if Im paying an arm and a leg for them at times.

I cant imagine what Id do if I couldnt get them filled since I need them to keep the more troublesome aspects of my high functioning autism in check so Im able to function normally.

Hopefully things will get better for all our sakes since this is worrisome to say the least.

Most people have high-deductible plans, so the patient is on the hook, and then the pharmacy could also get such little reimbursement that they lose money. Healthcare exists in America in 2023 to benefit neither the patient nor the healthcare providers. It's just a business flowing obscene amounts of money to drug companies and insurances.

I'm very sorry to hear you're feeling the crunch.

hockeybub89 posted...

Whatever you say, bro. Not our fault the federal government is too deep in the pockets of insurance companies and Big Pharma to stop them from fucking up healthcare more and more. We're not sacrificing the many to help the few.

Major chains, that don't need the money, get multiple times more reimbursement per fill. And like I said, pharmacies aren't ordered to sell at a massive loss. They are told to lie and say the drugs are not available. I'm gonna challenge your notion that independent pharmacies are legally required to lose money until they die. We can manage a certain amount of loss and offset it, but not hundreds of dollars per fill. That's not tenable

None of this addresses the fact that you are in breach of contact for cherry picking claims to fill and telling patients to go fuck themselves when you're not happy at the contracted rate for a specific fill.

Do you have this issue more with brand or generic drugs?

Barring a super bad thing happening, it's cheaper for me to not even have insurance

Almost as if healthcare being a commodity is stupid and someone should do something about it...

Dat_Cracka_Jax posted...

Do you have this issue more with brand or generic drugs?

Sometimes brands. Certain generic C2s seem to be the bulk of the problem. The weird artificial scarcity is definitely a factor in that. It's like "aw shucks only the manufacturers that sell it at 3 times the price of their competitors are available!"

[LFAQs-redacted-quote]

If the pharmacy contacts a network with a PBM, then they fill the prescriptions for the members in that network and are reimbursed at the rate the pharmacy has contacted with the PBM.
What did I miss?

Dat_Cracka_Jax posted...

If the pharmacy contacts a network with a PBM, then they fill the prescriptions for the members in that network and are reimbursed at the rate the pharmacy has contacted with the PBM.
What did I miss?

And if the reimbursement rate is "lol get all the way fucked" then pharmacies can absolutely not fill the prescription. Again, it is suggested that they lie and say the drug is not available in those situations.

hockeybub89 posted...

And if the reimbursement rate is "lol get all the way fucked" then pharmacies can absolutely not fill the prescription. Again, it is suggested that they lie and say the drug is not available in those situations.

Lying about the reason implies that you are doing something wrong.

hockeybub89 posted...

And if the reimbursement rate is "lol get all the way fucked" then pharmacies can absolutely not fill the prescription. Again, it is suggested that they lie and say the drug is not available in those situations.

I hate to agree with the other guy, but if you have to lie about it, then... Doesn't that mean you CAN'T actually (legally?) do that, and you're just... Doing it anyway and lying about it?

Like, I get the system sucks, and you basically have to do this to survive, as a business. I just think "We're not going to sacrifice for the patient" is probably the wrong rhetoric to sell it with.

That's capitalism baby

What other business would it be okay to sell products at a loss? You could argue game consoles, but they have software to make up the difference. A restaurant wont stay in business if they sell food at a loss. Groceries wont stay in business if they sell stock at a loss.

Why does the public magically switch thing and think its okay for a pharmacy to sell prescriptions at a loss? If a pharmacy fills a prescription and theyre being told theyre going to lose $500+ on it, why should they just accept that loss? The pharmacy wouldnt be there if they were forced to and then all youre left with is CVS and Walgreens.

BroodRyu posted...

What other business would it be okay to sell products at a loss? You could argue game consoles, but they have software to make up the difference. A restaurant wont stay in business if they sell food at a loss. Groceries wont stay in business if they sell stock at a loss.

Why does the public magically switch thing and think its okay for a pharmacy to sell prescriptions at a loss? If a pharmacy fills a prescription and theyre being told theyre going to lose $500+ on it, why should they just accept that loss? The pharmacy wouldnt be there if they were forced to and then all youre left with is CVS and Walgreens.

A pharmacy isn't like other businesses, because again, healthcare heing a commodity is stupid

I think I came off aggressive, and I shouldn't have.

I get WHY it happens. I think I just reacted because the rhetoric TC used around it sounded kinda heartless. He likely didn't intend it to be, so I retract my... Aggressiveness.

IceCreamOnStero posted...

A pharmacy isn't like other businesses, because again, healthcare heing a commodity is stupid

And I agree. But until we do single payor healthcare no business that isnt CVS or Walgreens wants to lose hundreds on prescriptions.

IceCreamOnStero posted...

A pharmacy isn't like other businesses, because again, healthcare heing a commodity is stupid

Ok, but independent pharmacies still need to have money to pay their employees and provide the services that make them preferable to patients over the big chains. All selling drugs at a loss in this environment would do is force them to all shut their doors within a few years, and then they can't help anyone. The big greedy corporations would just win by default after every other pharmacy kills itself. Even a non-profit would have operating costs. Pharmacies aren't run by volunteers. It's a career.

Dat_Cracka_Jax posted...

Lying about the reason implies that you are doing something wrong.

Well yes we are doing something wrong. I just told you the entire situation is wrong. Healthcare in America is wrong at a molecular level. Though our pharmacy doesn't personally push the lie. We will either blame it on insurance, which isn't inaccurate, or just straight up tell the truth.