Pharmacy School

[Dethfang]

Originally Posted by MrSpitz

There's conflict of interests on every side though. Community pharmacists simply represent their retail company, which has its own preferential relationships with manufacturers and if you have noticed the number of pharmaceutical reps. visiting the community pharmacy and pushing their drugs has sky rocketed as well. That's not really limited to doctors.

The role of the pharmacist is to bring costs down, but when you have so many different pharmacies with such high salaries AND so many different locations to ship and stock drugs to you end up injecting more cost into the system which simply is made up by the retail store having a higher mark up on the drug which gets passed to the insurance reimbursement which gets passed to premiums or copays. There is a huge need for maintenance and making sure complications do not arise, but retail pharmacies are more of assembly lines then counseling stations and the current outlook doesn't see that changing.

Community pharmacists don't prescribe the medications. The conflict of interest comes in telling someone they need X when you happen to sell X. There are virtually zero drug reps coming into Walgreens. The pharmacists simply do not have the ability to sell whatever hot blockbuster drug the reps are out pushing because of the checks and balances within the system. Doctor's on the other hand are basically catered every meal by drug reps who bring them lunch and give them information about new drugs while they eat it.

The higher pharmacist salary does not actually get passed to your prescription copays or premiums, your copay is decided solely by your insurance company. At Walgreens it works like this: the insurance company says we will reimburse you $X for tier 1 and the copay is $Y, $X for tier 2 and the copay is $Y, and $X for generics and the copay is $Y. The breakdown is usually something like $30 / $22 / $10 and this is usually done in one month supplies. Tier 1 is usually newer drugs that don't have generics, tier 2 is name brand, and generics are of course the generic. On some drugs, we actually lose money filling them with certain insurances because the prices are negotiated as a group instead of individually.

Walgreens then chooses whether or not to do business with said insurance company. Of course the insurance company wants / needs to do business with Walgreens / CVS / etc to remain a desirable business. Insurance reimbursements, especially medicare part D have been lower and lower over the past few years which is actually starting to cause a pinch in the pharmacy market forcing retail establishments to go for quantity of prescriptions.

Retail pharmacies provide as much prescription counseling as YOU need. Most patients don't have questions regarding their medication, I have worked entire shifts in / around the pharmacy and out of 200-250 patients only about 10-15 generally have questions. We are required by law to offer them consultation regarding their medications.

[Designz]

Originally Posted by Dethfang

Retail pharmacies provide as much prescription counseling as YOU need. Most patients don't have questions regarding their medication, I have worked entire shifts in / around the pharmacy and out of 200-250 patients only about 10-15 generally have questions. We are required by law to offer them consultation regarding their medications.

Yes, if you ask a patient if they "understand", they'll say yes even if they don't, lol, or if you ask them if they have any questions, they'll say no for the sake of time.

[MrSpitz]

It does get passed on, because Tier 1 / Tier 2 and different pricing strategies take into account the cost of medication at the counter. Insurers constantly review their reimbursement expenditures and what they reimburse you as Walgreens, not the particular maker of the drug.

Insurance companies classify brand and generic but they don't look at wholesale prices of reimbursement, they look at how much it costs them year by year. This is set by the activity of the middle men, the retail chains. This absolutely is accounted for by the patients paying into said insurance plan and is absolutely marked up by the retail chain to cover their added costs and make profit. This does not mean the insurance companies are not bastards in their own right and play with drug tiering and generic copays for their own benefit, nor does it mean pharmaceutical companies are accurately first pricing their products.


The drug reps come into pharmacies to see if they can setup deals to put advertisements, such as 'sponsoring' a blood pressure testing day to bring added business to that specific pharmcy for being able to put up a nice big cardboard ad at the counter. That is not uncommon at all. And when they are there they frequently speak with the pharmacists about the drugs so that they can reccomend them to patients as alternatives, which then prompts the patient to talk to the physician.


Again, I'm not internet free theorying this shit. I may be an asshole but I don't make shit up.

[Designz]

Originally Posted by MrSpitz

It does get passed on, because Tier 1 / Tier 2 and different pricing strategies take into account the cost of medication at the counter. Insurers constantly review their reimbursement expenditures and what they reimburse you as Walgreens, not the particular maker of the drug.

Insurance companies classify brand and generic but they don't look at wholesale prices of reimbursement, they look at how much it costs them year by year. This is set by the activity of the middle men, the retail chains. This absolutely is accounted for by the patients paying into said insurance plan and is absolutely marked up by the retail chain to cover their added costs and make profit. This does not mean the insurance companies are not bastards in their own right and play with drug tiering and generic copays for their own benefit, nor does it mean pharmaceutical companies are accurately first pricing their products.


The drug reps come into pharmacies to see if they can setup deals to put advertisements, such as 'sponsoring' a blood pressure testing day to bring added business to that specific pharmcy for being able to put up a nice big cardboard ad at the counter. That is not uncommon at all. And when they are there they frequently speak with the pharmacists about the drugs so that they can reccomend them to patients as alternatives, which then prompts the patient to talk to the physician.


Again, I'm not internet free theorying this shit. I may be an asshole but I don't make shit up.

You probably got more drug reps because your pharmacy was close to the hospital, so the reps can do a two birds with one stone kind of thing

[MrSpitz]

No, we were close to an emergency facility. Its like a psuedo-emergency room only facility providing immediate care for a rural population.

Ie. When my mom went there with chest pains (which turned out to be acid reflux) they had the equipment to stabilize her if needed, but once that happened she was ambulanced to a real hospital for tests. For critical cases they have a helicopter.

But if you are way out in the sticks and just needed stitches or something they got that business. There's actually a lot of these now, 'urgent care' setups that provide limited emergency treatment but are not hospitals and don't have as stable a staff or ties to any larger health care organization.


There were a lot of pharmacy reps. because we did a lot of business and the pharmacy manager (which at Rite Aid is a pharmacist, at walgreens and CVS I believe the pharmacy manager is also the store manager and not a pharmacist) was very receptive to having the reps sponsor free days for diabetes education or like I said high blood pressure in exchange for advertising space at the counter due to increasing competition from a new CVS, a new Walgreens, and get this, a new Rite Aid just down the street. He wanted to keep his numbers to corporate up and those specialized days bring in a lot of people.

[Dethfang]

Originally Posted by MrSpitz

Insurance companies classify brand and generic but they don't look at wholesale prices of reimbursement, they look at how much it costs them year by year. This is set by the activity of the middle men, the retail chains. This absolutely is accounted for by the patients paying into said insurance plan and is absolutely marked up by the retail chain to cover their added costs and make profit.

Every so often the insurance companies and the retailers settle on terms for reimbursement. Walgreens can't just say "we want an extra $5 a script" and force the insurance companies to pass that markup along to the customers. For the most part, reimbursements are down and continue to trend that way. The insurance companies are raising their rates at a higher percentage than they are raising reimbursements.

Also, most chain pharmacies don't allow displays or special events sponsored by random drug companies. The only real "swag" I have seen at Walgreens is the occasional pen or notepad with a drug's logo on it and 95% of those come directly from pharmacists that work locally at Lilly.

[MrSpitz]

Deth I get ya, but thankyou for agreeing. The insurance companies agree with the retail chains on pricing, with the retail chains price reflecting their added costs and motives for profit. That is the crux of what I was saying and it is fairly simple to see where everything falls after that. Retail stores obviously do not determine the absolute market, but buddy don't say this stuff after replying above about inusrance companies setting tiers and prices as if it was in a vacuum from the retail chains activities. That is an outright lie actually.


Reimbursements are not down, I don't know what you are talking about.

Edit: Thanks for the discussion, sorry to hijack the thread. I'm not going to argue with people who have a vested interest in this.

[aychamo_aycono]

insurance companies sure set the price for doctors services! Fucking hate them!