Pharmacists Working in PBMs/Managed Care are Scumbags #RuiningTheProfession

[TruthRx]

Why would a pharmacist waste so many years going through school to work in this area that is so clearly ruining the profession is beyond me.

Seem like retail/hospital rejects!

Don't believe me?

http://www.ncpanet.org/pdf/leg/nov11/pbm_revenue_streams_lack_transparency.pdf

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[moolman]

FYI, I work in managed care. I can relate to what your saying and why you believe it. There's more to managed care than just PBMs.

The opposite is true, hospital and retail pharmacist would give their left testicle or arm to work in managed care.

It's like saying why should any pharmacist work for a big retail chain or big hospital chain. The chains are killing independents just as much as a PBM.

There are no easy answers, my advice, have you ever considered switching careers?

 

[MountainPharmD]

Why would a pharmacist waste so many years going through school to work in this area that is so clearly ruining the profession is beyond me.

Seem like retail/hospital rejects!

Don't believe me?

http://www.ncpanet.org/pdf/leg/nov11/pbm_revenue_streams_lack_transparency.pdf

You obviously have zero understanding of what is going on in the pharmacy profession. What did you do...wake up this morning and decide to Google pharmacy, read a few articles and now you are an expert?

If you knew anything you would know the corporate retail chains have ruined the profession and have turned it into the joke it is today.

Keep Googling pharmacy....heck after reading a few more articles you can be an expert on the entire healthcare field!

 

[npage148]

Aside from being a middle man, what does a PBM actually do? It seems like they are just in the business of ineptly pushing papers between pharmacies and insurance companies

 

[SHC1984]

Why would a pharmacist waste so many years going through school to work in this area that is so clearly ruining the profession is beyond me.

Seem like retail/hospital rejects!

Don't believe me?

http://www.ncpanet.org/pdf/leg/nov11/pbm_revenue_streams_lack_transparency.pdf

You sound jealous that you did NOT get a PBM position so now you are hating it.

Everyone would kill for a PBM position over retail or hospital...but the chances of landing one is very slim b/c it's such a good position.

Don't be a hater.

 

[MountainPharmD]

You sound jealous that you did NOT get a PBM position so now you are hating it.

Everyone would kill for a PBM position over retail or hospital...but the chances of landing one is very slim b/c it's such a good position.

Don't be a hater.

Not everyone gets to be cool!

 

[MountainPharmD]

Aside from being a middle man, what does a PBM actually do? It seems like they are just in the business of ineptly pushing papers between pharmacies and insurance companies

We could argue that all day long. Supposedly they save companies money by managing their prescription benefit.

We do not ineptly push paper....we are 99% paperless so we ineptly transfer electronic documents. Get it straight!

 

[gotdrugs]

 

[sisson329]

Wow I'm a bit shocked to see this many people not understand what PBMs really do. I figured it was something most pharmacists pieced together over time in dealing with billing or just keeping up with current events. If you're trying to beat up on the poster for acting as if he's understands it all then feel free, but that articles actually does a damn good job at summarzing a good portion of what's going on with PBMs and the rest of pharmacy. Also why they're pushing so hard for transparency...try looking up and completely understanding the pricing aspects and the chain of payment, it will help you understand what that article is really saying.

Would also like to note that yes, of course not all PBMs are evil entities or something, and we also have to remember that this is America, capitalism is supposed to be a part of it, and it has it's downfalls.

 

[WVUPharm2007]

Added to the list of things that annoy me:

People that use the "#" key anywhere other than Twitter or when referencing a telephone pad in some way.

 

[hereticmnk]

Ok but there are some valid points to be made about PBM's. Transparency, ******ed pricing models and actual cost saving are some of my problems with PBM's. But I do not think PBM's are ruining the profession. They just have some problems that need to be addressed.

 

[WVUPharm2007]

Ok but there are some valid points to be made about PBM's. Transparency, ******ed pricing models and actual cost saving are some of my problems with PBM's. But I do not think PBM's are ruining the profession. They just have some problems that need to be addressed.

They've already ruined the profession. It's just that we are so used to them, that we just accept their useless asses without question. They've turned us into their unpaid insurance agents. Who's the person that deals with the maintenance of their god damned formularies? Us. What is the most annoying part of the job? Dealing with those *******s. Who comes an steals from us when they come audit us and find out that we forget to put a semicolon on a label? Those *******s.

Really, I wish we could just do away with them and have a single payer, national formulary. Imagine the red tape that could be avoided if everyone had the same basic protocol. Physicians would know what would need an authorization before the even write the script. They'd have everything right there in front of them rather than the dart-throwing madness involved in trying to figure out WTF your insurance will pay for we have right now. Imagine the cost savings when pharmacists no longer have to waste their time with the tens of thousands of individual little plans out there...and drug companies actually had to compete for spots on the national formulary...it would be awesome.

They do nothing - NOTHING - but add unneeded confusion and cost to our healthcare system.

 

[PharmGeek]

If you knew anything you would know the corporate retail chains have ruined the profession and have turned it into the joke it is today.

This is absolutely right. Retails ruined pharmacy a long time ago

 

[hereticmnk]

They've already ruined the profession. It's just that we are so used to them, that we just accept their useless asses without question. They've turned us into their unpaid insurance agents. Who's the person that deals with the maintenance of their god damned formularies? Us. What is the most annoying part of the job? Dealing with those *******s. Who comes an steals from us when they come audit us and find out that we forget to put a semicolon on a label? Those *******s.

Really, I wish we could just do away with them and have a single payer, national formulary. Imagine the red tape that could be avoided if everyone had the same basic protocol. Physicians would know what would need an authorization before the even write the script. They'd have everything right there in front of them rather than the dart-throwing madness involved in trying to figure out WTF your insurance will pay for we have right now. Imagine the cost savings when pharmacists no longer have to waste their time with the tens of thousands of individual little plans out there...and drug companies actually had to compete for spots on the national formulary...it would be awesome.

They do nothing - NOTHING - but add unneeded confusion and cost to our healthcare system.

Wow, tell me how you really feel
Ok but tbh a similar case can be made about retail chains. Some people would say its evolution while others would say it destroyed the previous model. I agree that PBM's were created for something else and ended up doing something else instead.

Now I agree with you that a single payer would be the best way to deliver health care services in this country, but I like single payer because of different reasons (access). Now, single payer does not mean there would be no red tape.. case and point- Medicare plans. I have some reservations with the drug companies not making a huge profit because it is that profit that drives innovation.

Managed care should be on the decline with the passing of ACA. ACO's might be the new "thing". Managed care was a great idea at the time of its conception but fee-for-service has to go and it seems like its on the way out in favor of concierge medicine.

 

[WVUPharm2007]

Wow, tell me how you really feel
Ok but tbh a similar case can be made about retail chains.

No, it can't. Drug stores, even the dreaded CVS and Wags, at least fulfill a purpose of some sort. Even if it is less than optimal, at least they serve a purpose as a cog in the machine. PBMs literally have no purpose other than a mechanism by which they create extensive red tape and procedure for the express purpose of maximal profit while providing negligible cost savings. True, a government payer would have similar types of red tape, but it would be streamlined red tape. Red tape a person could be reasonably expected to navigate. True, people will still need a prior auth to get access to certain drugs...but that prior auth would follow the same protocol for EVERYONE. You could actually - and this idea actually gives me a raging hard on - have a decent idea of what drugs are covered right off the bat for everyone. And physicians would, too. Imagine the gain of manpower that could be achieved. Those 60 tech hours seem 25% more useful instantly...and that's because they aren't spending 30 minutes on the phone with a PBM every damned night.

Minimal red tape. It would be beautiful. Right now there are countless individual strands of red tape, intertwined into endless knots until the process that is "primary payment mechanism for modern pharmacy practice" becomes a cluster**** of epic proportions. That's what we have now. The Great PBM Cluster****.

 

[moolman]

Wow, tell me how you really feel
Ok but tbh a similar case can be made about retail chains. Some people would say its evolution while others would say it destroyed the previous model. I agree that PBM's were created for something else and ended up doing something else instead.

Now I agree with you that a single payer would be the best way to deliver health care services in this country, but I like single payer because of different reasons (access). Now, single payer does not mean there would be no red tape.. case and point- Medicare plans. I have some reservations with the drug companies not making a huge profit because it is that profit that drives innovation.

Managed care should be on the decline with the passing of ACA. ACO's might be the new "thing". Managed care was a great idea at the time of its conception but fee-for-service has to go and it seems like its on the way out in favor of concierge medicine.

FYI, in CA, the health plans here already run like a ACO system so when the ACA passed everyone was like, ok, nothing is changing. The east coast people not used to it were the ones freaking out when we met them at AMCP.

Managed care is on the rise because of the ACA, maybe not in the same way but it will adapt like everything.

No offense but it's just frustrating because managed care is so big and varied and trying to explain it on an Internet message board is tough. There's so many assumptions about it or people think they know what's its about that it's pretty humorous. It's kinda like how a lot of you see undergrads talk about pharmacy careers and they talk as if they really know what's really going on. I know I sound like an ass but all my post have been honest and I try to be informative.

 

[moolman]

And I do agree than PBMs are a problem, when I heard about the Medco, ESI merger. I pooped my pants.

 

[Unchained]

I want the job at the PBM where you hit a big red deny button when a claim comes thru and then high five other members of the team.

 

[moolman]

I want the job at the PBM where you hit a big red deny button when a claim comes thru and then high five other members of the team.

For drug claims it's pretty black and white when something is approved or denied. I think there's more controversy for medical claims. On the drug side, there's a PA criteria and clinical judgement of the pharmacist and we're on the side of the patient, we did take a oath too remember.. Haha... All of its regulated up the wahzoo, there's a bunch of laws and grievances that can be filed, the majority of things are approved.

Our red button broke last month so we just approve everything right now and we usually do belly bumps not high fives.

 

[hereticmnk]

No, it can't. Drug stores, even the dreaded CVS and Wags, at least fulfill a purpose of some sort. Even if it is less than optimal, at least they serve a purpose as a cog in the machine. PBMs literally have no purpose other than a mechanism by which they create extensive red tape and procedure for the express purpose of maximal profit while providing negligible cost savings. True, a government payer would have similar types of red tape, but it would be streamlined red tape. Red tape a person could be reasonably expected to navigate. True, people will still need a prior auth to get access to certain drugs...but that prior auth would follow the same protocol for EVERYONE. You could actually - and this idea actually gives me a raging hard on - have a decent idea of what drugs are covered right off the bat for everyone. And physicians would, too. Imagine the gain of manpower that could be achieved. Those 60 tech hours seem 25% more useful instantly...and that's because they aren't spending 30 minutes on the phone with a PBM every damned night.

Minimal red tape. It would be beautiful. Right now there are countless individual strands of red tape, intertwined into endless knots until the process that is "primary payment mechanism for modern pharmacy practice" becomes a cluster**** of epic proportions. That's what we have now. The Great PBM Cluster****.

I agree but you there is a place for PBM's. Prescription benefits are niche in nature and most insurance companies do not wish to deal with the BS and carve out their business to PBMs. They will keep on existing.

I have worked in retail for some time and I agree they can be a pain a royal pain the butt.

 

[hereticmnk]

FYI, in CA, the health plans here already run like a ACO system so when the ACA passed everyone was like, ok, nothing is changing. The east coast people not used to it were the ones freaking out when we met them at AMCP.

Managed care is on the rise because of the ACA, maybe not in the same way but it will adapt like everything.

No offense but it's just frustrating because managed care is so big and varied and trying to explain it on an Internet message board is tough. There's so many assumptions about it or people think they know what's its about that it's pretty humorous. It's kinda like how a lot of you see undergrads talk about pharmacy careers and they talk as if they really know what's really going on. I know I sound like an ass but all my post have been honest and I try to be informative.

Please correct me if I an wrong. I am interested in managed care so an honest discussion is always welcome.

Is managed care discarding ffs model anytime soon? I will be much more familiar with managed care in the coming months (for reasons I can't disclose) . It is hard to find sources on the impact of ACA on MCO's. I assumed they would be on the decline with the seismic shift in healthcare delivery systems outlined by ACA. ACO's are supposed to be the "new" things.

And I do agree than PBMs are a problem, when I heard about the Medco, ESI merger. I pooped my pants.

You can blame the McCarran–Ferguson Act for that.

 

[All4MyDaughter]

Now I agree with you that a single payer would be the best way to deliver health care services in this country, but I like single payer because of different reasons (access). Now, single payer does not mean there would be no red tape.. case and point- Medicare plans. I have some reservations with the drug companies not making a huge profit because it is that profit that drives innovation.

Managed care should be on the decline with the passing of ACA. ACO's might be the new "thing". Managed care was a great idea at the time of its conception but fee-for-service has to go and it seems like its on the way out in favor of concierge medicine.

Medicare part D plans are NOT a single payer system.

Also, ACA isn't going to hurt managed care organizations. Who do you think is going to benefit from requiring people to buy insurance?

 

[Doctor M]

There is NO need for PBMS. I could just as well offer the same pricing to employers that PBMs offer the employers. PBMs are unnecessary, thieves and a waste of space. I guarantee you, get rid of PBMs, watch drug prices fall. There is no system far more corrupt than a PBM that says they only pay for clean claims and penalize you for technical errors. And about CVS, all they did was exploit the business. No one stopped them, and now they are just kicking ass. PBMs are not necessary. Period

 

[Doctor M]

You obviously have zero understanding of what is going on in the pharmacy profession. What did you do...wake up this morning and decide to Google pharmacy, read a few articles and now you are an expert?

If you knew anything you would know the corporate retail chains have ruined the profession and have turned it into the joke it is today.

Keep Googling pharmacy....heck after reading a few more articles you can be an expert on the entire healthcare field!

I now truly believe today, that the chains did what they did because the PBMs caused it. I use to believe that the chains were all evil. But knowing what i know today from my experience in the last 3 years, the PBMs are the root of all evil.

 

[npage148]

I agree but you there is a place for PBM's. Prescription benefits are niche in nature and most insurance companies do not wish to deal with the BS and carve out their business to PBMs. They will keep on existing.

I have worked in retail for some time and I agree they can be a pain a royal pain the butt.

So any insurance company can manage all aspects except rx coverage because it's too complex?

That's quite the joke

 

[MountainPharmD]

There is NO need for PBMS. I could just as well offer the same pricing to employers that PBMs offer the employers. PBMs are unnecessary, thieves and a waste of space. I guarantee you, get rid of PBMs, watch drug prices fall. There is no system far more corrupt than a PBM that says they only pay for clean claims and penalize you for technical errors. And about CVS, all they did was exploit the business. No one stopped them, and now they are just kicking ass. PBMs are not necessary. Period

Wal-Mart is or has tried that. They did something very similar with the company Catapillar. I am not sure how it turned out.

 

[MountainPharmD]

I now truly believe today, that the chains did what they did because the PBMs caused it. I use to believe that the chains were all evil. But knowing what i know today from my experience in the last 3 years, the PBMs are the root of all evil.

The big chains could have stopped them before they became so big and powerful. Instead Walgreens and CVS kept siging those ****ty contracts year after year hoping they could make up the loss on volume. When Walgreens finally got tired of it and took a stand it was to late.

We, as pharmacists, screwed up and gave the profession away to the big corporate chains. All for big signing bonuses and fat paychecks. Now the corporate chains have given the profession away and it is controlled by the PBM's.

 

[MountainPharmD]

So any insurance company can manage all aspects except rx coverage because it's too complex?

That's quite the joke

That is what they claim.

PBM's got their start back in the 70's by claiming they could increase efficiency in claims management and reimbursment. Prescriptions were starting to become a hugh expense for insurance companies. PBM's got in at the right time and became an ingrained part of how pharmacy business is done. It's just snow balled from there to the point we are at now. The big insurance companies do not have the capabilities to do what the PBM's do because the PBM's have been doing it for so long.

The tide is changing a bit. United Health Care and Blue Cross Blue Shield have started doing the own pharmacy benefit management in house. Cut out the middle man and retain all the profits!

 

[Doctor M]

Wal-Mart is or has tried that. They did something very similar with the company Catapillar. I am not sure how it turned out.

From what I hear, it has turned out pretty good.

 

[BMBiology]

If PBMs do not offer any value, then why are they still here? The free market would have gotten rid of them by now. Because they can do things cheaper and more efficient. They cut cost. Insurance companies love them. They are not going anywhere.

 

[Doctor M]

The big chains could have stopped them before they became so big and powerful. Instead Walgreens and CVS kept siging those ****ty contracts year after year hoping they could make up the loss on volume. When Walgreens finally got tired of it and took a stand it was to late.

We, as pharmacists, screwed up and gave the profession away to the big corporate chains. All for big signing bonuses and fat paychecks. Now the corporate chains have given the profession away and it is controlled by the PBM's.

hindsight is 20/20. Walgreens does put there foot down, but then they go crawling back (express scripts). Although I will say that they def dont take crappy reimbursements from Molina and Amerigroup.

 

[Doctor M]

If PBMs do not offer any value, then why are they still here? The free market would have gotten rid of them by now. Because they can do things cheaper and more efficient. They cut cost. Insurance companies love them. They are not going anywhere.

They are still here cause they have strong lobbying power. They can also sell themselves pretty darn good; there is no transparency in their business; and employers dont know any better.

 

[All4MyDaughter]

If PBMs do not offer any value, then why are they still here? The free market would have gotten rid of them by now. Because they can do things cheaper and more efficient. They cut cost. Insurance companies love them. They are not going anywhere.

LOL at this. Our free market removes all inefficiencies. Yeah. Pass the Koolaid.

They are still here cause they have strong lobbying power. They can also sell themselves pretty darn good; there is no transparency in their business; and employers dont know any better.

Pretty much!

 

[Its Z]

We have no one else to blame but ourselves for the downfall of pharmacy.

It's because we lack the integrity to uphold and do what's right for the profession instead sold our souls for shortsighted quick gains.

It's like the land owners selling their trees that deplete the rain forest. Who cares about the world as long as I eat today.

 

[BMBiology]

LOL at this. Our free market removes all inefficiencies. Yeah. Pass the Koolaid.

Another reason why PBMs have thrived is because people underestimate them and don't have a clear understanding of what they do. You may disagree with how they do their business but you don't make billions a year without offering value to the employers.

 

[Doctor M]

You sound jealous that you did NOT get a PBM position so now you are hating it.

Everyone would kill for a PBM position over retail or hospital...but the chances of landing one is very slim b/c it's such a good position.

Don't be a hater.

I would rather eat sh-t than work for any PBM. What is so good about it? I compare the business of PBMs to the the business of the banks that stole so much during the collapse of our housing market a few years back. Greed Greed greed. It is a joke what they do. They are there to make sure they are profitable and the pharmacies only bill the likes of furosemide potassium and lisinopril. Forget about the specialty drugs and compounds. They will find something technical to rescind payment. Thieves thieves thieves. Again, i would rather screw a goat than work or be near any position that steals from hard working people.

 

[BMBiology]

there is no transparency in their business; and employers dont know any better.

Fair enough. You own a pharmacy. Lets have transparency in your business and the deals you made. Why would any business let their competitors know about their affairs?

 

[All4MyDaughter]

Another reason why PBMs have thrived is because people underestimate them and don't have a clear understanding of what they do. You may disagree with how they do their business but you don't make billions a year without offering value to the employers.

You must work for a PBM.

I'll leave it to this badass post from the great Doctor M:

I would rather eat sh-t than work for any PBM. What is so good about it? I compare the business of PBMs to the the business of the banks that stole so much during the collapse of our housing market a few years back. Greed Greed greed. It is a joke what they do. They are there to make sure they are profitable and the pharmacies only bill the likes of furosemide potassium and lisinopril. Forget about the specialty drugs and compounds. They will find something technical to rescind payment. Thieves thieves thieves. Again, i would rather screw a goat than work or be near any position that steals from hard working people.

 

[All4MyDaughter]

Fair enough. You own a pharmacy. Lets have transparency in your business and the deals you made.

LMAO. There is a hell of a lot more transparency in most small business than with PBMs. For starters, let's talk about PBM MAC pricing. "We won't tell you what it is in advance, nor how we calculate it, but you must accept it, no matter what." Transparency my ass.

 

[Doctor M]

Another reason why PBMs have thrived is because people underestimate them and don't have a clear understanding of what they do. You may disagree with how they do their business but you don't make billions a year without offering value to the employers.

You make billions from stealing other peoples money. Their business is dirty. How can you say spread pricing is legit. You MAC me on a drug but still charge the employer almost AWP?? and then come and audit me and penalize me for technicalities? Fraud Waste and abuse my ass. More like when and where can we make more money?

 

[BMBiology]

LMAO. There is a hell of a lot more transparency in most small business than with PBMs. For starters, let's talk about PBM MAC pricing. "We won't tell you what it is in advance, nor how we calculate it, but you must accept it, no matter what." Transparency my ass.

Like in any business, if you don't like their offer then take your business somewhere else.

Are you going to tell your cash patients how much you purchased the drug for and how much you are profiting from them?

 

[Doctor M]

Fair enough. You own a pharmacy. Lets have transparency in your business and the deals you made. Why would any business let their competitors know about their affairs?

Darling, my books are open to every PBM out there, the IRS and every freaking federal entity out there. We dont make deals and we dont make billions.

 

[BMBiology]

Darling, my books are open to every PBM out there, the IRS and every freaking federal entity out there. We dont make deals and we dont make billions.

Really? Is it opened to your competitors down the street from your pharmacy as well?

 

[Doctor M]

Like in any business, if you don't like their offer then take your business somewhere else.

Are you going to tell your cash patients how much you purchased the drug for and how much you are profiting from them?

What do PBMs purchase? I bought the drug i dispensed to the patient. And then they come back and take is all back...

 

[Doctor M]

Really? Is it opened to your competitors down the street from your pharmacy as well?

You are comparing apples to oranges. A PBM makes deals with the federal govt, manufactures, and employers. If you are going to profit from federal dollars, you need to be transparent. Again, i dont make deals with anyone.

 

[BMBiology]

You are comparing apples to oranges. A PBM makes deals with the federal govt, manufactures, and employers. If you are going to profit from federal dollars, you need to be transparent. Again, i dont make deals with anyone.

Wait a minute, you don't take Medicaid or Medicare?

 

[All4MyDaughter]

You make billions from stealing other peoples money. Their business is dirty. How can you say spread pricing is legit. You MAC me on a drug but still charge the employer almost AWP?? and then come and audit me and penalize me for technicalities? Fraud Waste and abuse my ass. More like when and where can we make more money?

Another brilliant post. Dr. M!

Like in any business, if you don't like their offer then take your business somewhere else.

Are you going to tell your cash patients how much you purchased the drug for and how much you are profiting from them?

That's the thing. You don't get their offer in advance and you can't refuse a claim where reimbursement is less than cost. Don't like what they want to pay on a claim? Too bad, you have to fill it anyway or you're violating your contract.

Sure, pharmacy owners could just refuse to sign PBM contracts, but how practical is that? And all of this PBM pricing BS is designed to force retail pharmacies out of business so people will have to use the PBM's mail order pharmacy. Sure, that's ethical.

We are getting screwed right now on generic Lortab 10s. Our normal kind isn't available and the other generic brands raised their prices. But the lovely PBMs haven't updated their pricing, no... of course not. So we're losing money on nearly every script.

 

[Doctor M]

Really? Is it opened to your competitors down the street from your pharmacy as well?

We can argue this all day, and the truth is, the legislation is coming to make PBMs more transparent. Their business practice is dirty. If we could tell them to eff off, we all would. But obviously we have let them grow so powerful, we must pick up the pieces.

 

[Doctor M]

Wait a minute, you don't take Medicaid or Medicare?

Hahaha, again, you are comparing 2 different things. Like I said, my books are open to them. have been audited numerous times, including purchasing and what i paid for it, Again Darling, the pharmacy business has been so exploited, your argument is weak and baseless. Our business is and every pharmacy business is transparent, otherwise how would a PBM know to pay me 5 dollars above my cost? You cant compare my pharmacy to the pharmacy down the street. We are talking about the transparency of PBMs.

And taking Medicare or Medicaid is NOT a deal. My books and purchasing is open to them. Rebates are reported, so again, we are widely transparent.

 

[Doctor M]

Another brilliant post. Dr. M!



That's the thing. You don't get their offer in advance and you can't refuse a claim where reimbursement is less than cost. Don't like what they want to pay on a claim? Too bad, you have to fill it anyway or you're violating your contract.

Sure, pharmacy owners could just refuse to sign PBM contracts, but how practical is that? And all of this PBM pricing BS is designed to force retail pharmacies out of business so people will have to use the PBM's mail order pharmacy. Sure, that's ethical.

We are getting screwed right now on generic Lortab 10s. Our normal kind isn't available and the other generic brands raised their prices. But the lovely PBMs haven't updated their pricing, no... of course not. So we're losing money on nearly every script.

This is a perfect example of another BS ploy. And contacting the PBM is useless.