Pharmacist here. It’s not our fault as much as you think. Basically, the insurance companies invented something called “Pharmacy Benefits Managers” who basically act as a middleman between you and your doctor on what you can get, and how much they will reimburse the pharmacy if you do.
If your doctor says you need atorvastatin, but your PBM says they only want to pay for simvastatin, you can either get your doctor to pay for simvastatin, or pay for atorvastatin yourself with a discount card. The cost for a generic med like that is probably about your copay anyways, so no big loss to you to skip the headache.
Surprisingly, they invented fees for pharmacies! If you choose the route to get your doctor to change you to simvastatin, we get the privilege of managing that for you, and once we finally reach your doctor and make the change, they will give us maybe $10 to fill it for you! Plus you have a $10 copay, so there is some money… But of course we have to source the med. It probably costs us like $12 for this example, maybe less maybe more, depending on the manufacturer. So if we do all of this then it seems like we made $8, but SURPRISE, your PBM charged us a fee for utilizing them. It might be $6. It might be more if we don’t meet certain criteria, like percentage of diabetic patients on statins.
So okay we have our nice $2 to pay for shipping your med to the oharmacy, renting our location, and filling it (I think it’s less than half that on average, I just don’t know the actual figures) with our staff. It should come as no surprise that we have very limited options on manufacturers now.
You might say “well at least the PBM fought to make my meds cheaper in the end” but no! They now get to say to your insurance company “okay we managed getting your patient another month of lower cholesterol, please pay us $100 for our efforts”. So, indirectly, you paid an extra $100 on this whole thing through your insurance premiums. Not sure on if this part is true I just heard it as a rumor.
But wait there’s more! The insurance company actually owns the PBM all along! They paid themselves to offer themselves this service for you!
So anyways I’m getting out of retail pharmacy. Thanks for coming to my ted talk.
Pharmacist here. It’s not our fault as much as you think. Basically, the insurance companies invented something called “Pharmacy Benefits Managers” who basically act as a middleman between you and your doctor on what you can get, and how much they will reimburse the pharmacy if you do.
If your doctor says you need atorvastatin, but your PBM says they only want to pay for simvastatin, you can either get your doctor to pay for simvastatin, or pay for atorvastatin yourself with a discount card. The cost for a generic med like that is probably about your copay anyways, so no big loss to you to skip the headache.
Surprisingly, they invented fees for pharmacies! If you choose the route to get your doctor to change you to simvastatin, we get the privilege of managing that for you, and once we finally reach your doctor and make the change, they will give us maybe $10 to fill it for you! Plus you have a $10 copay, so there is some money… But of course we have to source the med. It probably costs us like $12 for this example, maybe less maybe more, depending on the manufacturer. So if we do all of this then it seems like we made $8, but SURPRISE, your PBM charged us a fee for utilizing them. It might be $6. It might be more if we don’t meet certain criteria, like percentage of diabetic patients on statins.
So okay we have our nice $2 to pay for shipping your med to the oharmacy, renting our location, and filling it (I think it’s less than half that on average, I just don’t know the actual figures) with our staff. It should come as no surprise that we have very limited options on manufacturers now.
You might say “well at least the PBM fought to make my meds cheaper in the end” but no! They now get to say to your insurance company “okay we managed getting your patient another month of lower cholesterol, please pay us $100 for our efforts”. So, indirectly, you paid an extra $100 on this whole thing through your insurance premiums. Not sure on if this part is true I just heard it as a rumor.
But wait there’s more! The insurance company actually owns the PBM all along! They paid themselves to offer themselves this service for you!
So anyways I’m getting out of retail pharmacy. Thanks for coming to my ted talk.