Pharmacists aren't going to take it anymore
A group of pharmacists from the President's home state met with Karl Rove last week to annouce they're mad as hell. Apparently many have been losing money since the start of Medicare Part D, due in large part to lower reimbursement rates for prescriptions. The group of self-described "small business Republicans" had strong words for the Administration:
In a letter to the president, James L. Martin, executive director of the Texas Pharmacy Association, said, "It has become obvious that you and your advisers do not understand the profession of pharmacy."
Payments from Medicare are slow as well, leaving pharmacists with backlogs of due payments stretching into thousands of dollars. Pharmacists also spent countless unreimbursed hours trying to verify eligibility:
Mr. Martin, one of the pharmacists who met with Mr. Rove, said Mr. Bush's comment was particularly galling to pharmacists because they had "bailed out the Medicare prescription drug program" in its first weeks.
Pharmacists helped hundreds of thousands of people sort through scores of prescription drug plans. They filled millions of prescriptions even though they could not get the information needed to verify eligibility.
The pharmacists outlined proposals to smooth things out, all of which are quite sensible. Among the suggestions:
• Medicare drug plans should not be allowed to advertise a specific drug store on beneficiary identification cards because this confuses beneficiaries and leads them to believe they can only receive their prescriptions at one pharmacy
• Requiring Medicare to make payments every week to 10 days
• Medicare should create incentives for pharmacists to fill generic prescriptions over name brand
The last suggestion is particularly key in order to reign in costs. The price of Medicare Part D is enormous, so long as the Bush administration refuses to allow the government to negotiate prices. But there's no reason not to encourage better reimbursement rates for generics.
The group of pharmacists who visited the White House were concerned about going out of business. The rest of us should fear this as well, lest our only choice becomes Wal-Mart pharmacies that don't carry Plan B and let pharmacists refuse to fill prescriptions for the birth control pill.
That last one doesn't seem like something that would make our K Street Big Pharma overlords especially happy.
March 13, 2006 11:30 AM | Reply | Permalink
True, but the Bush Administration is learning it could lose other allys. They've go to decide how much it's worth alienating them when the huge dollar gains for pharma are long gone. More incentives for generics wouldn't damage them even a quarter as much as price negotiation.
March 13, 2006 11:56 AM | Reply | Permalink
Ever since I heard that the pharmacists won't fill a prescription if they don't agree with it --with thier limited medical education they feel they can weigh in with their OPINION, and give you your meds or not, depending on their idiot thoughts-- I don't give a rats arse about pharmacists or whether they get paid. I hope they go broke.
As soon as they recognize that I shouldn't have to explain a damn thing to them at the prescription counter, as they aren't a doctor, and their half informed opinion should be left at home-- then I will start caring whether they get paid or are treated fairly.
Their behavior is outrageous and insensitive to the people they "serve".
--Sorval
March 13, 2006 12:02 PM | Reply | Permalink
Let Bush keep pissing off the his base. That's one of the best ways for us to win in 06 and 08. Since Bush can't be re-elected anymore, he seems to have said FU to his own party and people. His arrogance will work for us in the end.
March 13, 2006 12:42 PM | Reply | Permalink
"In a letter to the president, James L. Martin, executive director of the Texas Pharmacy Association, said, "It has become obvious that you and your advisers do not understand the profession of pharmacy."
Well, duh, they are only Republicans. You can't expect them to implement a government program with competence. They haven't been able to do anything right in five years. What could possibly lead the pharmacists to think the Bush Administration would start now?
Ron Byers
March 13, 2006 12:54 PM | Reply | Permalink
I read the other day they are going to privatize Medicaid. I thought they did that when they put them in Medicare which the Bush administration has privatized.
Privatization means the average person gets less and the businesses get more profit.
I can't imagine those on Medicaid getting less, so I guess it is the taxpayer who will pay while the Bushites funnel more money to the friends of Bush in the insurance and pharmaceutical industry.
Wal-Mart has decided to fill the morning after pill.
March 14, 2006 3:29 AM | Reply | Permalink
I practiced pharmacy for 21 years. Medicare Part D has recently been added to my list of reasons why I'm glad I got out of the profession. The group that went to the WH were independent pharmacists. Independents can't carry a large balance in their accounts receivable category very long because front end sales usually aren't enough to compensate. In an independent pharmacy, it's the back end, the prescription department, that makes or breaks the store.
I'm really surprised that what the first bullet describes is actually happening because even though it's been privatized, Medicare is still a federally funded program. It shouldn't seem to be endorsing one pharmacy over another.
Using generics will help control costs, some, but it's unclear by how much. I've been out of practice long enough now that I've completely lost touch with prescribing practices. If the bulk of prescriptions being written are for drugs that are still protected by patents, there are no generics available for these.
"…Bush administration refuses to allow the government to negotiate prices." This is where the savings would come in, but since it's private businesses (pharmacies) purchasing the drugs being dispensed, some sort of charge back mechanism would have to be put into place so the pharmacies would get reimbursed for the difference between the negotiated price and what they actually paid, because what they pay their wholesaler or directly to a drug company for the medication will be higher than the negotiated price.
Anyway, Medicare Part D seems to be a poor example of privatizing a social program.
March 14, 2006 4:53 AM | Reply | Permalink
Doug Yongue, Rph 1990 UNC grad
In over 15 years of retail experience I have seen NOTHING that was put together is such an idiotic manner as this Part D plan. I seriously thought I would have to file workers comp for the neck strain of being on the phone for so long during the entire month of January. We still have patients that are Dual-eligible for Medicaid/Medicare that they either have No plan,or maybe 2 plans (not supposed to be possible).
The PBM's and the major pharmaceutical companies are the ones that are getting rich out of this, while we were due 160K after 6 weeks of filling prescriptions and had to pay our wholesaler....with what??
The VAST majority of seniors in our area are not computer literate, and do not have easy access to a computer to try to figure out what plan they need. I would venture close to 80% don't know the names of their medications, and believe me, with 5 pharmacists on our staff we do an excellent job of counseling and answering questions. God help the people going to a deep discount store.
Bottom line--you've got to push generics to lower costs, and pay us a decent margin--some of these plans we may clear $1.50 per RX, and the average cost to fill a bottle full of air is now close to $7.00!!, so guess what, the poor folks that have NO insurace coverage get to pick up the slack!
aaaarrrrrggghhhhh
March 14, 2006 5:28 AM | Reply | Permalink
The last suggestion by the pharmacists is particularly galling. Of course they want to fill prescriptions with generics - the mark up on generics averages 2000%. Generics don't lower costs for the consumer, they provide a higher profit margin for the pharmacists.
As to their other complaints, the first is unfortunate for the pharmacists, but it's hardly a front burner problem for anyone but them and there are more pressing issues than naming pharmacies on cards. The second, the demand for payment every seven to ten days, is just chutzpah. They don't pay their suppliers every ten days, they pay them every four to six weeks like every other invoice they pay, and this notion that these poor pharmacists are fending off suppliers at the back door while helping Grandma at the front is fiction. Like everyone else, they're in business to make money, now they have to work harder to make money. Such is life.
March 14, 2006 6:14 AM | Reply | Permalink
Bev,
"Generics don't lower costs for the consumer, they provide a higher profit margin for the pharmacists." -- This isn't true. Co-pays are often lower, but even when they're not, using generics saves the overall system as a whole. Your insurer saves, and as their costs go down, so will yours.
The difference between pharmacists wanting an easy payment schedule and drug suppliers being paid every four to six weeks is huge. Think of average amount of capital a drug manufacturing firm has on hand compared to a small pharmacy. It matters.
March 14, 2006 7:53 AM | Reply | Permalink
I'm afraid I disagree. As I pointed out, the profit margin for generics is an average of 2000%. Now, just to keep things simple, let's say a patient requires an anti-nausea drug which is dispensed in a thirty unit supply. The pharmacy buys the pill at 10 cents per unit from the wholesaler and charges $1.00 per pill to the consumer. That's an average of $30.00 per prescription and a 1000% markup per unit. If the consumer is paying an average of $10.00 per co-pay and the insurance is covering the rest at albeit a deep discount, how is this lowering the high cost of prescriptions for the consumer? It isn't, it's lowering the cost for the pharmacy and providing profit margins that border on predatory practice. They're not passing the savings on to the consumer, they're passing the savings to themselves with a cut to the insurance company. This notion that generics is going to save the consumer and the insurance company from ruin is a fiction. As to the insurance company's cost going down and the consumer benefiting from lower costs to the co., I haven't seen any evidence of this, and in fact, the opposite. The co-pays are higher and going higher, no matter what kind of drug is dispensed. Insurance companies like every other company are in business to make money - if they can cut costs to themselves and raise prices to the consumer, it's in their benefit to do so.
As to the pharmacies wanting payment every ten days, what company wouldn't want that? I don't know of any pharmacy that will wait ten days for the consumer to pay them. In fact, they demand payment on dispensation, the consumer isn't extended the grace period of a thirty day invoice. As far as capital, of course big companies have more capital - they also have more overhead which means a lower profit margin. So now pharmacies have greater overhead in invoice preparation to the government which is narrowing their profit margin. I pity them, but I'm not willing to allow them a taxpayer funded loan on their accounts receivable which in effect a payment from the goverment every ten days would be.
Every company in this country would like to claim special circumstances and would demand 10 day payments on invoices if they could. I just don't see where pharmacies deserve special treatment. Most companies in this country are cutting overhead and personnel to sustain or raise the profit margin. These pharmacies aren't looking out for their customers, they're looking out for themselves - which is perfectly reasonable in a capitalist society, but the crybaby protectionism they want is just that - crybaby protectionism.
March 14, 2006 10:00 AM | Reply | Permalink
Well nothing is perfect and for sure our health system is not. There are so many problems floating around it that I find it hard to believe that it actually functions. Prescription drugs are a real challenge for our administration, let's see how they can handle this.
January 30, 2008 10:06 AM | Reply | Permalink