GoodRx

[VictorOfHungerGames]

How are yall dealing with goodrx?

i dont understand why or how goodrx even exist. So they take 90% of profit and pharmacy takes 10%... yet pharmacies are still taking them?

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[dblock05]

Its 2020 bro.

But 90% of work in corporate retail so we don't see any of the money and corporate wants us to take goodrx....so yeah thats pretty much it.

 

[MilknCheerios]

GoodRx cuts pharmacy profits, but in return, the pharmacy is supposed to get foot traffic and at least some profit as opposed to none. It allows the patient to feel that they're getting a good deal on their meds since pharmacy cash prices are ridiculously set (in the corporate retail setting) and hopefully, they'll come back. GoodRx claims that the pharmacy is contractually obligated to accept it, but I have never seen such an agreement in writing. I do believe in saving patient's money, but not if I lose money in doing so. I also only run a few cards for a patient before saying I found them the best one.

It's not a great thing for the pharmacy profession, but there are worse things.

 

[WVUPharm2007]

GoodRx isn't really a third party. They contract with real third party payers like Navitus and Optum. And those contracts the real third parties have with the pharmacy are what are contractually enforceable. So that contract you signed with Optum has the requirement that you accept GoodRx claims built in because those are really Optum claims via the GoodRx middleman. Being that each contract with each individual PBM is a mix of lower and higher reimbursements, you typically make money on each contract as a whole. But being armed with numerous third party contracts, GoodRx can cherry pick the best deals from multiple PBMs and offer rates to consumers that frequently make pharmacies lose money. That's why when you do a drug search on their site, you always get random BINs and PCNs depending on the drug you want a discount card for. Back in the day, discount cards weren't that bad. They were for one processor and one processor only. Your profit would still ebb and flow, but overall, money was still there to be made. With GoodRx, you have to match the best price for several processors and are forced to lose money all the time.

So GoodRx makes money on each claim, the PBMs are fine with this because they get a cut, and the pharmacy is there at the end holding the bag. It's actually quite a brilliant scheme. Some rando Silicon Valley dweebs that signed a few predatory contracts are stealing your profits for basically creating a simple search engine and laying in the cut.

If I were an independent pharmacy owner, I'd be on the dark web trying to contract some hacking group from like Latvia with Bitcoin to coordinate an endless DDOS attack on GoodRx and Singlecare. But, alas, I work for CVS so IDGAF.

 

[VictorOfHungerGames]

Since we are an indie, we are able to adjust cash prices so we try to match goodrx if patients present them. Thats if there is a decent profit on the drug.

my question is, is it better to keep on matching goodrx prices and attract more people vs... not? Haha i know some pharmacies dont. I would assume it is better make a small profit and retain that prescription than have the patient go elsewhere from a business perspective.

 

[WVUPharm2007]

Since we are an indie, we are able to adjust cash prices so we try to match goodrx if patients present them. Thats if there is a decent profit on the drug.

my question is, is it better to keep on matching goodrx prices and attract more people vs... not? Haha i know some pharmacies dont. I would assume it is better make a small profit and retain that prescription than have the patient go elsewhere from a business perspective.

If you do that, you are changing your usual and customary price. Which may open you up to civil liabilities.

 

[Niceguy90]

Since we are an indie, we are able to adjust cash prices so we try to match goodrx if patients present them. Thats if there is a decent profit on the drug.

my question is, is it better to keep on matching goodrx prices and attract more people vs... not? Haha i know some pharmacies dont. I would assume it is better make a small profit and retain that prescription than have the patient go elsewhere from a business perspective.

So, For a cash paying patient you adjust a lower goodrx matched price but If you are not submitting same cash claims to Medicaid or Medicare, you are also doing medicare fraud. It can be serious trouble.

 

[WVUPharm2007]

So, For a cash paying patient you adjust a lower goodrx matched price but If you are not submitting same cash claims to Medicaid or Medicare, you are also doing medicare fraud. It can be serious trouble.

And if you don't submit a higher U&C price every time to third parties, you maybe be leaving money on the table because they only pay what you charge. GoodRx has quite the racket going. The only way for customers to access cheaper than U&C pricing is via a middleman like them.

This is why we need to write reforms on how billing is done.

 

[VictorOfHungerGames]

So, For a cash paying patient you adjust a lower goodrx matched price but If you are not submitting same cash claims to Medicaid or Medicare, you are also doing medicare fraud. It can be serious trouble.

Submitting cash claims for medicare? If patient is paying cash/out of pocket, why would we bill to medicare?

 

[VictorOfHungerGames]

If you do that, you are changing your usual and customary price. Which may open you up to civil liabilities.

How so? We can charge how much ever we want. There is no set of rules on how much we can charge on cash paying prescriptions. If patient doesnt have insurance or does not want to use insurance, whos going to regulate how much we charge for a drug?

 

[Niceguy90]

Submitting cash claims for medicare? If patient is paying cash/out of pocket, why would we bill to medicare?

I mean if you switch to cash for whatever reason for Medicare patient who is paying more than a cash paying patients who mentioned goodrx. How would you justify an audit?

 

[VictorOfHungerGames]

I mean if you switch to cash for whatever reason for Medicare patient who is paying more than a cash paying patients who mentioned goodrx. How would you justify an audit?

What audit? Audit from who? Its an indie. I am the pic. Owner has given me a green light on what i do with pharmacy. We try to beat chain prices every time. If walmart goodrx price is $10, we charge $9. And explain to patient how goodrx is a fraud lol its a small town we have taken over almost every cash paying patients in town.

 

[WVUPharm2007]

How so? We can charge how much ever we want. There is no set of rules on how much we can charge on cash paying prescriptions. If patient doesnt have insurance or does not want to use insurance, whos going to regulate how much we charge for a drug?

Pharmacy Discount Programs Can Lead to a Violation of the False Claims Act

Retail pharmacies that offer a discount drug pricing program to consumers must charge Medicare the same prices for drugs that they charge consumers who

bergermontague.com

If you charge less than your U&C, any Part D plan can come back and clawback the difference between what they paid and what you charged the discount cash payer. Plus you will get fined. And, yes, private PBMs likely have the same clause in the contracts you signed with them.

 

[VictorOfHungerGames]

Pharmacy Discount Programs Can Lead to a Violation of the False Claims Act

Retail pharmacies that offer a discount drug pricing program to consumers must charge Medicare the same prices for drugs that they charge consumers who

bergermontague.com

If you charge less than your U&C, any Part D plan can come back and clawback the difference between what they paid and what you charged the discount cash payer. Plus you will get fined. And, yes, private PBMs likely have the same clause in the contracts you signed with them.

Looks like they were charging the customers different prices based on whether they were in kmarts discount program or not. Not exactly what we are doing. We are matching prices based on goodrx prices theyre presenting, not based on what insurance they have or whether they are medicare or not. Most of the patients we are matching prices for dont have insurance, so not sure how this would affect us.

 

[WVUPharm2007]

Looks like they were charging the customers different prices based on whether they were in kmarts discount program or not. Not exactly what we are doing. We are matching prices based on goodrx prices theyre presenting, not based on what insurance they have or whether they are medicare or not. Most of the patients we are matching prices for dont have insurance, so not sure how this would affect us.

Actually, what you are doing is worse than that. KMart was claiming that being in a paid discount club doesn't make them the "general public" anymore. Which the courts disagreed with. You aren't even putting that loophole up. You are just giving people discounted prices. If you do not bill GoodRx and give a person off the street a price that is cheaper than the U&C price you use to charge Medicaid, it violates the False Claims Act.

 

[VictorOfHungerGames]

Actually, what you are doing is worse than that. KMart was claiming that being in a paid discount club doesn't make them the "general public" anymore. Which the courts disagreed with. You aren't even putting that loophole up. You are just giving people discounted prices. If you do not bill GoodRx and give a person off the street a price that is cheaper than the U&C price you use to charge Medicaid, it violates the False Claims Act.

Specialty Pharmacies Face Emerging Fraud Risk in 'Usual and Customary' Pricing

Specialty pharmacies need to track drug pricing throughout the claims adjudication process to avoid potential liability.

www.pharmacytimes.com

This may be the case you’re referring to and U&C price was doctored.

“As part of a discount program, Kmart set low prices for cash customers who signed up for one of Kmart’s discount programs, and charged higher prices for the same generic drugs paid for by third-party insurers, including Medicare Part D and state Medicaid programs, and some non-program cash customers.”


Not whats happening at indies whos trying to match goodrx prices.

 

[WVUPharm2007]

It is. You might not be caught as easily and there is no published paper trail advertising the price like Kmart had...but if you read the law, the price you give cash customers becomes your new usual and customary price.

Just hope you don't have a technician that wants a whistleblower award.

 

[VictorOfHungerGames]

It is. You might not be caught as easily and there is no published paper trail advertising the price like Kmart had...but if you read the law, the price you give cash customers becomes your new usual and customary price.

Just hope you don't have a technician that wants a whistleblower award.

Lol so youre saying as long as it isnt documented... fair game? Lol gotcha

 

[BenJammin]

It's crazy how you can be required to do business with a company you've never contracted with. GoodRx is genius. They do no work at all and get paid for the hard work of CVS and Walgreens pharmacists. You fools slave away while you make some guy in California rich for every claim you transmit. The American Dream.

 

[WVUPharm2007]

Lol so youre saying as long as it isnt documented... fair game? Lol gotcha

Its a risk. Are you confident Medicare won't audit? Are you confident your techs won't be whistleblowers? Keep in mind they are awarded a portion of what Medicare recovers.

 

[WVUPharm2007]

It's crazy how you can be required to do business with a company you've never contracted with. GoodRx is genius. They do no work at all and get paid for the hard work of CVS and Walgreens pharmacists. You fools slave away while you make some guy in California rich for every claim you transmit. The American Dream.

As with all things, The Wire has a quote for that.

 

[txpharmguy]

Its a risk. Are you confident Medicare won't audit? Are you confident your techs won't be whistleblowers? Keep in mind they are awarded a portion of what Medicare recovers.

The likelihood of an audit for a $10 drug is really low.