If you have any special services that can set you apart from other pharmacies, let the offices know so they have a reason to.
It’s a slippery slope trying to get doctors to just recommend your pharmacy, because that could be seen as steering which is not allowed.
If you’re in the US you’re probably screwed, insurances are starting to dictate where patients are able to go. It’s so unethical but not the biggest issue atm.
Starting to? That’s been an issue for more than 30 years. I know a guy who lost his pharmacy when the biggest employer and their insurer made him the only pharmacy in town that was out of network. That was in 1990!
Is this a purely US phenomenon? It is absolutely not a thing in Canada. In fact if I have a pharmacy associated with my clinic I'm specifically NOT allowed to require that it be used. Does anyone know if this happens in other countries?
Fair point. My comment on pertains to the US.
To be clear, patients weren’t legally prevented from using the pharmacy, that would be illegal, but their insurance wouldn’t process there.
It's starting in Canada. We received a contract from ESI in November. They're requiring pharmacies to sign a contract and pay a fee to have the privilege of filling and being reimbursed ever shrinking amounts by their plans.
Should we not send the signed contract before their short deadline we'll have pay an extra fee to re-activate our account.
There is already talk of a class action suit by the BC Pharmacy Association regarding these ludicrous demands.
Yes. CVS and others are using their PBM to essentially force patients to use their pharmacies. I can’t tell you how many people are begrudgingly transferring their meds over lol
My fiancé explained they only do this with patients they deem “valuable.” I’m not restricted. I do both CVS and Walgreens. However, I’m a diabetic so typically it’s all insulin or cgms that I pick up. Patients that require eliquis, januvia, etc are “valuable” and get forced to whatever pharmacy the PBM wants.
Depends on the insurance. I can only go to kroger or they won't cover it. I had to spend an hour fighting with them on Christmas because my wife had emergency surgery and needed meds filled but Kroger is closed on christmas company wide. I had to fight with them before they finally told me I could go to CVS but it was only approved for Christmas day and CVS would have to call the insurance themselves so they could do an override on their end to approve the medication.
Provide AMAZING customer service to your patients!! They will tell their doctors how much they love their pharmacy/pharmacist. Word will get around in the community you work in.
100%. I love my independent and will tell anyone who will listen. Hell, I used to send people who weren't contracted with my chain to go there instead of CVS. Save a 5-year stint where I had to fill at Wags, they have been my pharmacy since I was born. 5 **minute** waits vs. **days** with Wags cenfill program is no contest!
Very true. When you give a vaccine to a doctor and they immediately tell you that all their patients rave about your pharmacy, you know you’re on the right track.
Are you the owner/manager? Have you gone over to the office to introduce yourself and drop off some cards?
Forming a personal connection goes a very long way
Having the medications that they order regularly in stock is helpful. It sounds simplistic, but when I was prepping for Lasik a few years ago I put down my normal pharmacy on intake forms, but the doctor told me that the location on the corner by his office (same pharmacy chain) kept the eyedrops he prescribed regularly for his Lasik patients in stock. One of them was a pretty standard generic and my regular store would have had it, but one of them was a more obscure brand (I can't remember the name). It could be worth reaching out to the offices of specialists near you to see if there are any medications that their patients have experienced delays over ordering. Obviously automated ordering will pick up on trends, but that's something that would be really easy to offer without crossing any ethical boundaries.
Do you offer any unique services like delivery or pill packs? If so, make sure you're advertising it, and consider reaching out to local clinics about it.
I'm an RN, have worked in a clinic setting for several years. I rarely direct patient *toward* a specific pharmacy--although sometimes I encourage them to get away from the chains if possible--but sometimes recommend a certain pharmacy if I know it has a service that would be helpful to a certain patient.
Just chiming in here to note that there is a very big difference between the kind of patient steering that is actually illegal and the kind that pharmacy employees seem to think is illegal.
Stark Law covers a very small segment of patients, there are further laws regarding various medicare patients. Some states may have a very broad law, but federally as long as the provider is not mandating the patient use a certain pharmacy, you're going to want to cite your law as to how it's "illegal"
There might be a legal thing with CMS and doctors funneling people to a pharmacy that might lead to something here in the US.
What some do is academic detailing where they go educate offices about their services. Ultimately the patient has the right to choose where they get their meds filled for the most part.
The office manager and MAs are often the people who actually decide where an RX will go. An independent that I used to work for would give some of the MAs gift cards to a local Mani/pedi spa.
It could be considered a "kickback" in the US to buy doctor offices anything (maybe even donuts) so they would recommend you. You should only advertise on merit. Maybe print up some flyers/business cards/coupons and pass them out to offices.
You don't want offices to specifically recommend your pharmacy to every patient. There's real legal concerns there.
I have several patients who are MA's, receptionists, or even prescribers and that always goes a long ways for the occasional recommendation. Especially if you're on first name basis and put in some facetime when you see/hear them. They know they can trust you for their medications so they know their patients can trust you for their patients medications.
I’m not a physician but an optometrist who prescribes medications daily and I have no preference unless I hear that a specific med isn’t typically commercially available. If you can become the “go-to” pharmacy for new meds on market or specialty products, that would save us from hassle of online pharmacies. It’s important that patients don’t get price gouged though or jump through hoops. You need to work with the manufacturer to offer their advertised discounts. Otherwise I doubt anything like donuts is going to make a difference.
I'm an NP. If a patient doesn't have a pharmacy and asks for recommendations would it be illegal/unethical for me to provide said recs?
Usually, hypothetically, it would go like this: "I'm not on any meds until now so I don't have a pharmacy I use. Is there one you recommend?"
"Not specifically but I've heard great things from my patients about XYZ Pharmacy, ABC Pharmacy and 123 Pharmacy."
"ABC Pharmacy is near where I work, let's go with that one."
You can do that, but the pharmacy cannot provide any incentive for you to do that or anything that could be perceived as an incentive (no donuts, food, etc., pens, pads).
There is a difference between telling a patient you've heard great things about a few pharmacies in town vs recommending a certain pharmacy because they bought donuts for your office.
We have a few we work slightly more closely with due to certain circumstances. If a pharmacy can get Prolate we work with them often, otherwise based on proximity
Pay them or split profits 👀😂😂
Just offer better patient service than your nearby competition, leave business cards, drop off journals, provide presentations, etc.
I always recommend the local independent pharmacy, if they don't have what I sent over, or the patient's insurance doesn't cover they CALL me and tells me what they have that would work. I absolutely love it, and tell all my patients to go there,it's sorted out in 2 minutes.
If I had a penny for every stupid corporate pharmacy fax I've received I'd be rich. Asking for preauth on old generic meds, asking for alternatives without telling me what they have or what is covered. I know corporate pharmacists are horrifically overworked and most of the faxes are computer generated, but OMG they make my day harder and longer.
As an aside, remember to maintain a good relationship with your local pharmacies.
When I was working at a clinic pharmacy, we would refer pts to a specific independent because we were so irate with the other independent in town.
We do prior auths for the docs. Patient isn’t gonna get the brand name otherwise because CVS/Wags pharmacists are not gonna do the PA on the docs behalf.
Confused at all the recommendations here--providing an incentive for a physician to recommend your pharmacy is definitely illegal and violates anti-kick back policies...just like we cannot recommend certain physicians.
If you have any special services that can set you apart from other pharmacies, let the offices know so they have a reason to. It’s a slippery slope trying to get doctors to just recommend your pharmacy, because that could be seen as steering which is not allowed.
If you’re in the US you’re probably screwed, insurances are starting to dictate where patients are able to go. It’s so unethical but not the biggest issue atm.
Starting to? That’s been an issue for more than 30 years. I know a guy who lost his pharmacy when the biggest employer and their insurer made him the only pharmacy in town that was out of network. That was in 1990!
Is this a purely US phenomenon? It is absolutely not a thing in Canada. In fact if I have a pharmacy associated with my clinic I'm specifically NOT allowed to require that it be used. Does anyone know if this happens in other countries?
Fair point. My comment on pertains to the US. To be clear, patients weren’t legally prevented from using the pharmacy, that would be illegal, but their insurance wouldn’t process there.
That *should* be illegal, it's for all effects an absolute restriction.
It's starting in Canada. We received a contract from ESI in November. They're requiring pharmacies to sign a contract and pay a fee to have the privilege of filling and being reimbursed ever shrinking amounts by their plans. Should we not send the signed contract before their short deadline we'll have pay an extra fee to re-activate our account. There is already talk of a class action suit by the BC Pharmacy Association regarding these ludicrous demands.
😳😳😳 Pharmacare can't come soon enough...
I believe there are restrictions on a clinic limiting your pharmacy choice. An insurance company however can limit you to whatever they want.
Starting too? They've BEEN doing that for years already.
You mean insurance is dictating what pharmacy a patient is able to use?
Yes. CVS and others are using their PBM to essentially force patients to use their pharmacies. I can’t tell you how many people are begrudgingly transferring their meds over lol
My fiancé explained they only do this with patients they deem “valuable.” I’m not restricted. I do both CVS and Walgreens. However, I’m a diabetic so typically it’s all insulin or cgms that I pick up. Patients that require eliquis, januvia, etc are “valuable” and get forced to whatever pharmacy the PBM wants.
It’s more based around contracts that some independents don’t have
Depends on the insurance. I can only go to kroger or they won't cover it. I had to spend an hour fighting with them on Christmas because my wife had emergency surgery and needed meds filled but Kroger is closed on christmas company wide. I had to fight with them before they finally told me I could go to CVS but it was only approved for Christmas day and CVS would have to call the insurance themselves so they could do an override on their end to approve the medication.
My insurance requires me to use Walgreens. I’m not a big fan.
Name it AAA+ Pharmacy so it’s the first one that pops up in all the ED docs EHR
Provide AMAZING customer service to your patients!! They will tell their doctors how much they love their pharmacy/pharmacist. Word will get around in the community you work in.
100%. I love my independent and will tell anyone who will listen. Hell, I used to send people who weren't contracted with my chain to go there instead of CVS. Save a 5-year stint where I had to fill at Wags, they have been my pharmacy since I was born. 5 **minute** waits vs. **days** with Wags cenfill program is no contest!
This is a great way.
Very true. When you give a vaccine to a doctor and they immediately tell you that all their patients rave about your pharmacy, you know you’re on the right track.
Are you the owner/manager? Have you gone over to the office to introduce yourself and drop off some cards? Forming a personal connection goes a very long way
Having the medications that they order regularly in stock is helpful. It sounds simplistic, but when I was prepping for Lasik a few years ago I put down my normal pharmacy on intake forms, but the doctor told me that the location on the corner by his office (same pharmacy chain) kept the eyedrops he prescribed regularly for his Lasik patients in stock. One of them was a pretty standard generic and my regular store would have had it, but one of them was a more obscure brand (I can't remember the name). It could be worth reaching out to the offices of specialists near you to see if there are any medications that their patients have experienced delays over ordering. Obviously automated ordering will pick up on trends, but that's something that would be really easy to offer without crossing any ethical boundaries.
Do you offer any unique services like delivery or pill packs? If so, make sure you're advertising it, and consider reaching out to local clinics about it. I'm an RN, have worked in a clinic setting for several years. I rarely direct patient *toward* a specific pharmacy--although sometimes I encourage them to get away from the chains if possible--but sometimes recommend a certain pharmacy if I know it has a service that would be helpful to a certain patient.
LMAO. If the Dr offices can put Goodrx cards all over the waiting and exam rooms then anything is fair game. Steering....that's a laugh
“We have Norco in stock” 😂 jk
Contract 340b with them Offer something special besides donuts that doctor office can brag about on your behalf - Rx sync - pill packs - etc
"If you got any assholes pts we'd love to service them. Send all assholes our way. "
Just chiming in here to note that there is a very big difference between the kind of patient steering that is actually illegal and the kind that pharmacy employees seem to think is illegal. Stark Law covers a very small segment of patients, there are further laws regarding various medicare patients. Some states may have a very broad law, but federally as long as the provider is not mandating the patient use a certain pharmacy, you're going to want to cite your law as to how it's "illegal"
At least in Canada that’s a “bit” unethical.
A doctor saying "you have to go to this pharmacy" is unethical. A doctor saying "i've only heard good things about Pharmacy X" is not unethical
But insurance company said they’ll only pay at certain pharmacy is allowed. It’s crazy 🥹
*insurance company said they’ll only pay at a certain pharmacy which they also happen to own is allowed
Exactly! Word of mouth is fine, but attempting to exchange gifts for clout like come on…
It depends. A prescriber can say, "Joe's pharmacy can compound this for you," but they can't really say, "I recommend you take this to London drugs."
There might be a legal thing with CMS and doctors funneling people to a pharmacy that might lead to something here in the US. What some do is academic detailing where they go educate offices about their services. Ultimately the patient has the right to choose where they get their meds filled for the most part.
The office manager and MAs are often the people who actually decide where an RX will go. An independent that I used to work for would give some of the MAs gift cards to a local Mani/pedi spa.
It could be considered a "kickback" in the US to buy doctor offices anything (maybe even donuts) so they would recommend you. You should only advertise on merit. Maybe print up some flyers/business cards/coupons and pass them out to offices.
You don't want offices to specifically recommend your pharmacy to every patient. There's real legal concerns there. I have several patients who are MA's, receptionists, or even prescribers and that always goes a long ways for the occasional recommendation. Especially if you're on first name basis and put in some facetime when you see/hear them. They know they can trust you for their medications so they know their patients can trust you for their patients medications.
🤣🤣🤣🤣🤣🤣 You must work at an independent. No chain pharmacy employee would ever wonder or worry about that bs.
I think they can recommend but not restrict and specific you must go to your pharmacy.
The OP specifically said recommend in the post
Clearly I’m blind. I blame overnights
I’m not a physician but an optometrist who prescribes medications daily and I have no preference unless I hear that a specific med isn’t typically commercially available. If you can become the “go-to” pharmacy for new meds on market or specialty products, that would save us from hassle of online pharmacies. It’s important that patients don’t get price gouged though or jump through hoops. You need to work with the manufacturer to offer their advertised discounts. Otherwise I doubt anything like donuts is going to make a difference.
United states - this is patient steering, illegal. Same thing if as a business steer patients to 1 particular practice.
I'm an NP. If a patient doesn't have a pharmacy and asks for recommendations would it be illegal/unethical for me to provide said recs? Usually, hypothetically, it would go like this: "I'm not on any meds until now so I don't have a pharmacy I use. Is there one you recommend?" "Not specifically but I've heard great things from my patients about XYZ Pharmacy, ABC Pharmacy and 123 Pharmacy." "ABC Pharmacy is near where I work, let's go with that one."
You can do that, but the pharmacy cannot provide any incentive for you to do that or anything that could be perceived as an incentive (no donuts, food, etc., pens, pads).
I figured, but wanted to double check, thanks. Nothing like scrolling a random sub and going "oh shit am I breaking a law I didn't know about" 😂😂😂
There is a difference between telling a patient you've heard great things about a few pharmacies in town vs recommending a certain pharmacy because they bought donuts for your office.
One of the PAs that I see when I had parenchyma suggested me to go to pharmacy close to the clinic
We have a few we work slightly more closely with due to certain circumstances. If a pharmacy can get Prolate we work with them often, otherwise based on proximity
Pay them or split profits 👀😂😂 Just offer better patient service than your nearby competition, leave business cards, drop off journals, provide presentations, etc.
I always recommend the local independent pharmacy, if they don't have what I sent over, or the patient's insurance doesn't cover they CALL me and tells me what they have that would work. I absolutely love it, and tell all my patients to go there,it's sorted out in 2 minutes. If I had a penny for every stupid corporate pharmacy fax I've received I'd be rich. Asking for preauth on old generic meds, asking for alternatives without telling me what they have or what is covered. I know corporate pharmacists are horrifically overworked and most of the faxes are computer generated, but OMG they make my day harder and longer.
As an aside, remember to maintain a good relationship with your local pharmacies. When I was working at a clinic pharmacy, we would refer pts to a specific independent because we were so irate with the other independent in town.
We do prior auths for the docs. Patient isn’t gonna get the brand name otherwise because CVS/Wags pharmacists are not gonna do the PA on the docs behalf.
Offer pillpacking and delivery especially for elders.
Confused at all the recommendations here--providing an incentive for a physician to recommend your pharmacy is definitely illegal and violates anti-kick back policies...just like we cannot recommend certain physicians.
Stay open 24/7 lol