Why are we (Pharmacy) not part of the free market place? A every increasing part of the Rxs we fill are paid for by a PBM.. some stores in the mid-high 90% range.
As a consumer.. how many things do we get as a one item price.. that encompasses a number or subset of services.. Even insurance companies when you pay a singular monthly premiums.. there is “your policy” and it is a contract outlining what is paid for and how much they will pay and how much you will pay.
It doesn’t seem to matter whether it is a new car, phone bill, funeral bill, utility bill.. all the services ( some optional) are itemized. Below is from my most recent electric bill.. 12 item lines of separate charges.
Connection Charge $ 9.40
Energy Charge
300 kW h @ $ 0.09294500
599 kW h @ $ 0.05417800
Rider 60 – Fuel Adjustment 899 kW h @ $ 0.01393000
Rider 61 – Coal Gasification Adj 899 kW h @ $ 0.00454900
Rider 62 – Pollution Cntl Adj 899 kW h @ $ 0.00363000
Rider 63 – Emission Allowance 899 kW h @ $ 0.00010800
Rider 66-A – Energy Eff Adj 899 kW h @ $ 0.00239100
Rider 66 – DSM Ongoing 899 kWh 0.00000000
Rider 67 – Cinergy Merger Credit 899 kW h @ $ 0.00058900cr
Rider 68 – Midwest Ind Sys Oper Adj 899 kW h @ $ 0.00153300
Rider 70 – Reliability Adjustment 899 kW h @ $ 0.00039800
Rider 71 – Clean Coal Adjustment 899 kW h @ $ 0.00443600
Why couldn’t the pharmacy industry allow the pt to decide what services they want and what they are willing to pay for.
The PBM industry would still pay us the cost of the medication.. less whatever portion that the patient owes.. no dispensing fee….BUT…
We would be allowed to add on a service charge for handling the Rx… the individual store could itemized the charge or not… if itemized… could make some of the services that the patient does not want to pay for.. could be subtracted…
If a pharmacy wanted to be “no frills” and short hours… they could charge a smaller surcharge.. the number of variables are nearly endless.
A Pharmacy could contract with a patient to pay a single annual fee for all Rxs filled..
There could be a delivery charge… a surcharge for providing Rx services outside of a normal business hours ( 9-6 M-F).. maybe even a higher charge after midnight.
As long as the Pharmacy is straight forward with its charges… there would be no “hidden charges”
At face value.. the PBM.. would not lose the first penny… they could still demand their rebates/kickbacks from the Pharmas.. they can still do their surcharge/up charge to whoever is paying them for the product and their services… There would be no need for restrictive networks.. everyone would get paid the same for the medication they dispense and the pt would pay for the cost of the pharmacy/Pharmacist services.
We can establish the idea with the general public that it costs to fill their Rxs and the Pharmacist’s time is worth some money.. If someone elects to have the Rxs filled at a “no frills pharmacy” and wants a RPH at a different pharmacy to answer their questions… they can be told about the fee involved for consultation/MTM… BY APPT !
If they want us to recommend a OTC product ( diagnose)… there is a charge… per the schedule… unless the patient has paid for a full service annual contract.
The patient has the right to chose the pharmacy they wish to patronize… let the “market place” decide who survives or fails. What a American concept !
Filed under: General Problems
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