When Jan 1, 2023 comes around and you are on Medicare Part D or Medicare Advantage Prgm … if the PBM’s do not change the contracts that they are “offering” independent pharmacies for 2023… your independent pharmacy will either be a “cash only” pharmacy or out of business.
Since the PBM’s came around in 1969-1970, their “contract negotiations” have always been “take it or leave it”… if you don’t take/sign the contract…”we” will make your customers/pts LEAVE your pharmacy because there will be some pharmacies in your area that will sign it..
back then, other than the manual forms that had to be filled out on every Rx filled and wait for a couple of months for the PBM’s to reimburse you..their reimbursement formula was not all that bad.
Today there is about <50% of the number of independents in our country as was in business at their peak in the mid-70’s. When I opened my independent pharmacy in 1976, in a small town/county seat of 30K-35K…there was 12 other independent pharmacies. 20 yrs later, I was burnt out, a new Revco store was opening up and I took the opportunity to sell our pharmacy… leaving only ONE INDEPENDENT PHARMACY left in town. That town now has two independent pharmacies and the newer one built his business on compounding. The town is now dominated by Walgreen, CVS & Kroger.
Since 1970, the top 4-5 PBM’s are owned by INSURANCE COMPANIES and currently they handle the payment of abt 80% of all Rxs filled and now each have multiple highly automated mail order pharmacies. Walgreens has already announced plans to implement regional “central fill, high automated pharmacies”… where they indicate that they will direct all non-control Rxs refills to be filled and transported by to the Walgreen’s store of the pt’s choice. Of course, they are counting on people being “trained” to order their necessary refills a few days ahead. It looks like Walgreen expects the PBM not to budge on the reimbursement in their contracts and CVS has already announced that they are going to close about 10% of current stores. Things appear to be changing, and the pt’s individual health care needs appears to at the very best second to the needs of the insurance industry to making increased profits
Filed under: General Problems
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