The Pharmacy Chick

My friend has little money. Jim has been coming to my store for a long time, and has job that would be considered “unskilled” because he works in a retail department store. He is always pleasant and its always pained me that as an insulin dependent diabetic, he has to make some difficult choices when it comes to paying for his meds.

DM spares no economic groups, poor and rich alike get afflicted with this disease and anybody who has it (or knows somebody who does) knows that its expensive to be a diabetic, especially when insulin is involved. Newer and cooler insulin and delivery devices have come out to make it “easier” on the diabetic and everyone of them costs a lot of money.

For a while, Jim was covered under his parent’s policy. Then he grew up and lost that insurance. He had a few jobs before this one, but none of them offered insurance. He uses Lantus and Novolin/Humulin. It is hard enough to make ends meet on minimum wage. Throw in a chronic disease for which you MUST take expensive meds to survive and things become way more complicated. Jim was excited when he gave me his new insurance card for this new job he took.

I processed his Novolin/Humulin and it came back $35…not much over the retail price of it. His Lantus came back with a $50.00 copay. $85.00 per month in insulin for a kid making not much more than minimum wage? This insurance isn’t helping too much. Its not like he is doing anything fancy. He is just using bottled insulin and syringes he loads himself, not the pre-loaded pens. He got is machine for free but the strips cost him $35 copay for the box of 100. He has to pay for his syringes.

It bugs me a bit that we have a patient who isn’t making a lot of money, but his insurance isn’t helping much. I dont have a gripe when an insurance puts a tier 3 price on a pricey drug when there are a lot of less expensive alternatives to choose from. But everything that Jim has to choose from is tier 2 or 3. Where are the generics when it comes to Insulin? Will there ever be any? It seems a clever ploy to charge a lot of money in premiums and not have to help the insured much.

At what point does the copay for a drug become too high for the insured to pay? I remember many years ago a major corporation had a 50 cent (yes one-half dollar) copay on every drug prescribed. A big shake down occurred and the copays went to $5.oo, which was actually more standard at the time. It was a big union with a lot of clout. Somehow they lost somewhere. You should have heard the whining and complaining.

Fast forward to 2008. Unless you are on state aid or Medicare-D, good luck in finding plans with copays under $10. We have plans with 50 PERCENT copays on brand meds (tell that to a Temodar or Zyvox patient). Having insurance used to be the safety net. It doesn’t seem to be that way anymore. More and more things aren’t covered, and many that are have copays that make them cost prohibitive. Not EVERYTHING has a generic, and Insulin seems to be that glaring example. For some, its not fair.

Just ask Jim.

Tags: customers, insurance, prices | |

Pharmacy Chick was internet surfing the other day when she came upon a little news item that yet another major pharmacy and grocery chain was joining the ranks of the apostates and offering the $4 prescriptions on “over 300 drugs”. (bear in mind that warfarin 1,2, 2.5,3,4,5,7.5,and 10mg counts as 8 drugs). I wish I could ask WHY?

Pharmacies have never been known for their intelligent decision making. But this one takes the cake. When Walmart ( I can use their name because its widely known) came out with their $4 offering, I bravely hoped that it would be a passing fad. After all, pharmacy amounts to what? 2% of their business? Who cares if they lose money if they can get Mr Joe Six pack to fill his cart while waiting for his $4 loss leader. Target followed later with their own list. Target is a relatively new player in pharmacy. Now its Kroger. I don’t know much about these guys, they aren’t around my neck of the woods. But Pharmacy Chick is hopping on her soap box for a few observations:

95% of my business is already managed by health insurance. These are people whose prices are already fixed and the rate of reimbursement can be called sucky at best. There are a few precious plans that have a fixed generic copay, $10 for example whether its 100 metformin or 2 lorazepam, its 10 bucks. Why are we giving a PBM incentive to cut our reimbursements even more? Ya’ll think they are blind and won’t notice?

The few cash payers that I have left are snatched up by “discount cards”. What the hell is this? Since when can Quickie Lube and Tire offer a card that decides how much I can or cannot charge for my services? Why did we ever accept this from the start? When I used to work for Joe Independent, he refused the cards. “If its not insurance, I’m not takin’ it!” And he didn’t.

Generic medications were the last bastions of profitibility in the pharmacy. If we bought it for $2 and sold it for $22, we made a tidy $20 gross profit, which was still a great deal over the $99 it would have cost the patient for the brand name. I dont care what you say, there isn’t going to be great profit in some of these auxilliary services like vaccines and MTM, they are too labor intensive. It costs a lot of labor to run those services, and in no time, PBM’s will be cutting reimbursements to is for them too. Just wait, you will see. Why are we buying the rope they are hanging us with?

One of my buddies works in a pharmacy that will price match the $4 when asked. He doesn’t get asked very much cuz he works for a discounter that sells stuff pretty cheaply already. The “when asked” part bugs me. If you are gonna do the $4 deal, either do it or don’t, this sliding scale thing bothers me. That means you have to keep track of Ms C who gets her Lisinopril for $4 and Mrs D who gets hers for $12.99. In fact the whole price matching thing gets me going, but that is a blog on its own, suffice to say that Pharmacy Chick thinks that if you are gonna do this $4 nonsense, either jump in or stay out, sticking your toe in only is gonna cause trouble with customers.

Imagine this, cuz I already have: Its a big conference room, BPOP (Biggest PBM On Planet) is having a meeting with all their decision makers. They have, in front of them, the lists of all the $4 prescriptions that all these players are offering. Mr Big in his bigger suit stands up and addresses the group: “Gentlemen, we have a golden opportunity here, these jokers have cut their own throats, and we dont have to do it for them. All we have to do is rake in the profits, because effective at next renewal period, all these meds will be contracted at $3.50. If they can accept $4, they will accept $3.50″ HAHAHA, ” Lets go have lunch, and take the rest of the day off, we didnt’ have to earn it, they just gave it to us.”

Its the beginning of the death of pharmacy, and unfortunately for us, this one can only be classified as “suicide”.

Tags: competitors, national news, pharmacy life, prices, ranting | |

He came in and handed me the script. I knew what was coming. “Brand only” Okee fine, I have no issue with that. It what always happens next that drives me to distraction. Its the bitching about the price that he does. I can fill the way they want it–brand for $200+ for a 90 day supply of Norvasc or I can do $15.00 for the generic, same manufacturer.

“No, generic doesn’t work”. Then fork over the $200.00+.

You cannot have it both ways. Every time we have this conversation, its the same. They complain about how much medicine costs and every time I offer the generic. Every time they decline. This time they thought they would trump me. “Maybe we should fill our prescriptions someplace else” they said. “Ok, I’ll buy you lunch if they are any less there for the same thing”.

They are still here…and still buying brand. I am thinking they aren’t as awash in cash as they used to be because they never used to whine. Now its all they do. I can fix it. They just won’t let me.

Tags: competitors, prices, rambling | |

Today Pharmacy Chick got to have a bit of fun doing EXACTLY what the customer wanted.

We got this new customer, a transfer really, from some competitor. She had several drugs, one of which is P. She had some insurance, and when I was getting all her information, she pointed to her P bottle and said “I dont want generic for P–it doesn’t work”. I noted the last date on the bottle–November…before the generic came out…I am seriously doubting she even tried the generic yet, but I wasn’t going to argue. I learned a long time ago that arguing with customers who have their minds made up about generic medication is akin to beating my head against a wall–it feels good only when you stop.

So anyway, as I am currently aware, there are two companies who make generic P, and one of them is the Innovator themselves, infact when you open the bottle, the darn tablets still say P, which I think is the biggest corporate cop out on the planet. If you are going to put a med in one bottle and charge $400 for it and put the same med (not even changing the paint on the tab) and charge $100 less, then somebody ought to fine your butt a bazillion dollars. You’d think they would at least take the name off the stupid tablet before putting in the bottle!

We happen to have that one at the moment, tho it could change at any time due to the fact that we have a corporate buying deal–I get whatever they have on their list of approved products.

So anyway, I collect the transfers and start the filling process. In my infinite wisdom, I obtained what she paid in November..something in the $40 range, a percentage of the brand price. I filled the prescription today with a DAW-2 (remember, its EXACTLY what she wanted) and the price now is $143 ish. Now, not having ALL the history of this woman, she may have a deductible, but I wasn’t finding out, and I didn’t do a test claim of the generic either…I don’t want to know what her copay would be because 90 days from now I will likely not have the same “brand” of generic.

The thought of trying to explain to this lady that “this tablet that SAYS p is actually the generic of p” then changing it later does not appeal to me. And remember THE GENERIC DOESN’T WORK according to her. Pharmacy chick suspects she already had this filled generic at her old pharmacy and wouldn’t accept it so she transferred to me…but thats only a suspicion.

She will get exactly what she wants. I’ll let you know what she decides when she actually has to open the pocketbook. I think I better get a bottle of the other generic, cuz I’m not sure what I would say if the identical pills were in the bottle if she decided to go generic. I think it would be a good idea if the tabs looked different–call it a hunch.

Tags: customers, pharmacy life, prices, ranting | |

I could hardly believe this unfolded:

I filled a prescription for this lady for a drug and she had no insurance. It had been 34.99 cash. I learned from a pharm friend of mine about a online discount that as long as you used a certain group number, and any 9 digit ID, it would give a pretty competitive price. It seemed like a friendly gesture to see if I could save this woman a few dollars. So, in addition to choosing the larger strength and doing the 1/2 tab thing, by using this discount, it saved her about 12.00. Pretty nice huh? I was feeling pretty good about myself, put the rx on the shelf and went home for the weekend.

I came back on monday to find another $12 refund hanging on the wall for her. I asked my partner about it and he said that her response to learning that we have her this new discount was:

“WHY the HELL haven’t you been giving me this all along–what kind of customer service do I get around here–I guess you dont really want my business!”

So, as my gut starts burning earlier than normal this day (what pharmacist doesn’t have GERD?) I think to myself–what the heck just happened? If this happened to me, I’d just be bouncing down the aisle with my new cheaper rx thinking what great people they are–they gave me a discount I neither enrolled in nor deserve! How cool is this?… BUT NO! We get ripped a new lower-orifice for not giving it to her earlier.

So, heres my new credo–thanks to this lovely encounter–you get the discounts YOU enroll in, thank you very much, don’t wanna be accused of playing favorites! No, not me! Equal opportunity prices–whatever the computer spits out.

Who needs that kind of abuse–for being nice?

Tags: customers, prices | |