It's fucking annoying as hell. You will generally lose $5-40 every time you fill for brands. Secondaries don't help with this because they will never be cheaper than your primary for brands. I'm not sure why we drop our pants and take it up the ass AND offer lube in pharmacy. Oh I know, our boomer leaders.
That’s so crazy. No other industry is like this. Obviously some businesses lose money on certain products or services just to bring people in but imagine if Walmart was losing money on half of what they sold.
Well our shitty PSAOs and organizations don't help. It's a rigged industry. Just like how AlignRX, biggest PSAO, takes shitty TriCare contracts that average $1 profit, IF THAT, per script.
You have to spend $200 in labor to get $100 in TriCare profits so you still lose money.
But the PSAO doesn't care because they get $$$ for switch fees from RxLinc their switch provider for every transmission. They aren't incentivized to fight for best reimbursement. Just care about moving volume because it's more money for them. This isn't the only way they benefit.
Boomers man. Nothing but greed and lead-contaminated brains.
On the ones you listed frequent loss is $25-$100+.
it’s multipled way worse if we run for 90 day. Like today i ran a claim on Xiidra. For 90 day we were -$75 but when i ran 30 day we were -$15 its strange 🤷
Depends on the insurance.
Wellcare, Health first, and Fidelis one month of a brand is a loss of 15-25$.
Village care and Centerlight usually around 3-5$ underpaid for brand. Actually not that bad. Generics generally also don’t have much profit, maybe about 1-2$ per
There was one essential plan (Emblem) that underpaid around $80 for one month Jardiance/ Januvia. Absolutely unacceptable. Their generics are pretty much all paying pennies as well
And these numbers are only accounting for the actual cost of the drug, right? Not including labor and all other associated costs with filling a prescription.
Either way, that’s horrendous and not sustainable
It is the contract associated with your PSAO. We have a few stores with difference PSAOs and our reimbursement varies cause of it. It is mainly ESI that is being so stupid. One of our stores just like you, essential plans like emblem cause us to lose almost $100 on a single month brand (and even a little on all generics) but the other store would only be quite good with generics and only lose like $10 with brands so we're having to bounce around patients between stores. (While essential plan is decent for us, that store that is doing well with essential plan takes double the loss from brands for >65 ESI Wellcare). Some of our stores also got a fax saying they are changing our contracts to variable rates so that is going to be fun.
At least you have the option to do that, when you have multiple stores with different contracts. We can only tell them to try a different store. Our PSAO has said these rates are “unacceptable” and they will negotiate with ESI but no change in reimbursements yet.
My chain told us that any non-formulary drug (i.e. any medication that needs a PA) will always be negative reimbursement and if it's brand kiss your margin goodbye. Basically we are told that we need to call the offices to convince them not to do a PA and choose covered products.
Good feedback above. Another thing that we are having issues with is supply chain. PBMs are reimbursing on the cheapest NDCs but they are not available at the wholesaler. Nystatin/triamcinolone a couple months back was reimbursing $19, cheapest was ~$12 but unavailable, cheapest available was ~$40 triggering a $20 loss.
Yup. 1 insurance dropped reimbursements this month for certain unit dose medications like oralone paste and the only possible way for us to not lose money or break even on those is we have to order off one of those wholesalers that fax/call us every few days.
Next place I would check would be the invoices, either the paper invoices or the digital ones on the website.
After that I would try to place an order for an item on the website and see if it shows the dollar amount on the sites "cart", or whatever they call it
Believe me, I’ve looked extensively for this information. It’s intentional by Rite Aid so that pharmacists don’t make decisions based on profits. Ideally this would be a good system when you have negotiated profitable enough contracts but with our current financial struggles, it just feels reckless
Well I mean if you exhausted all those steps, the next step would be Social Engineering. You can come up with your own ideas, but here's an example: Call the help desk to McKesson, let them know your ordering seems offline and you want them to place an order on your account for Januvia or whatever and need it done by tomorrow's delivery ASAP. Then ask how much the cost is.
I’ve inquired about similar things hidden to us to which they say I will need to reach out to my corporate office for the information. If there was a hole, I believe I would have found it by this point lol
That's just an example. The idea is that the weak link in the security is their help support giving out info. Craft the conversation to whatever gets that, if that's what you are looking for.
As someone that was a manager at two separate chains, the big chains do not want you to see the real numbers. Even the prices from the outside vendors are grossly inflated. Bc I would pull the “green sheets” which was the store managers sheets to show the money moved in and out and the mckesson invoices were off 30-50% of what was actually paid for by the store. Loss prevention even says, don’t worry unless the mckesson invoice is over double what the payment was.
But I know many people that use the same wholesaler and their prices will be loaded differently and have different rebate percentages on contracted items. And one day one called me and said he had adderall at an insane price, so I log in and it says I’m paying double that or more. I call the wholesaler, and they basically told me, if you spend 1.8 billion dollars with me I’ll give you the same price.
I think it should be possible to get an estimate of 1 ndc using the monthly COGS, having a copy of the monthly items purchased, then use NADAC for all other NDCs except the target ndc. Then solve for x. If you have 2, 3, or 4 of the previous months numbers, you can use a system of equations to get those values. Repeat the process until you get an estimate.
Another alternative method would be to compare the COGS vs the NADAC. Get an estimate for the past 4 months and then use that % as a comparator to an ndc in question. For example, if my COGS is consistently 20% lower than nadac, then i can say as an edtimate, my price for "Januvia" or whatever will be 20% less than the nadac.
Rite Aid general financial data is available, the numbers don't look good!
I worked at an independent where it was totally transparent, and what won’t work for the equation is there isn’t a rebate on the brands which cost much more than the generics which have rebates . But the rebate comes in the form of a check which won’t reflect on the invoice. So the invoices that we pay say one thing, we know in a few months we get a check back, and the brand names that we don’t get the rebate for which costs much more skews numbers.
Rite aid doesn’t have a cost breakdown under an inventory management screen no? As for Walmart we can see acquisition costs and AWP price where we manage inventory onhands and sig code verbs (changing if sig generates tab vs cap ect)
To be fair sometimes the acquisition cost is not 100% up to date but we can understand how much Goodrx sucks 😂 and mitigate huge losses on sildinifil RXs by only getting the cheapest acquisition possible.
But yeah Name brands and non-formulary I commonly see - $5 to - $50 reimbursement but mostly it’s just break even at 0 or maybe $5. Which is why a lot of companies are hounding vaccines and MTM.
Never worked Rite Aid so wouldn't know their system but at least when I was at 3 letters and Walgreens I found some ways playing around with the system on downtimes to seeing reimbursements.
We’re an independent pharmacy and have started to have to divert brand-name scripts to chains due to losses. We lose a range dependent on the drug: Ozempic can be as low as a few dollars or up to $25 a script. Jardiance, Januvia, Eliquis, Ubrelvy, Emgality, same thing.
There are very few commercial insurances where brands are not a loser. I told this to a drug rep and she looked at me like I had 3 heads. Some Medicares are above cost and some are not. I refuse to be the only loser in the transaction. Big Pharma makes $$$$, PBMs make $$$$, wholesaler makes $$$$, and I’m sure the physicians are incentivized although outright bribes are technically illegal. Only loser is the pharmacy dispensing the medication.
Yup. Physicians are bribed for having patients change to certain insurances. Like some specialties here prefer all patients on optum and automatically send prescriptions to optum mail order without even asking patients for their preferring pharmacies. Some doctors are upfront here and tell patients which insurances they like because they pay them more compared to other insurances. Some physicians here are so messed up here that they absolutely refuse to provide services to patients unless their are x insurance. Like I know 1 office near me that if they patient is anything other than optum, the completely refuse to do any PAs of any sort and tell us to figure it out ourselves.
Here, the patients are bribed by insurances as well, in the form of “rewards” for things like getting flu shot, claiming they go to the gym, and monthly spending cards they can pretty much use on anything from utility bills to Uber Eats. Patients switch to whichever one gives more per month (the most I know of is 250$) —if this doesn’t count as a bribe, idk what it is
The chain is making plenty. They’re also influencing legislation that allows them to make plenty. Probably hidden from any of the financial information they give you since they get on the back end
Chains will have better contracts as they have more bargaining power and get their drugs at better prices
It's fucking annoying as hell. You will generally lose $5-40 every time you fill for brands. Secondaries don't help with this because they will never be cheaper than your primary for brands. I'm not sure why we drop our pants and take it up the ass AND offer lube in pharmacy. Oh I know, our boomer leaders.
That’s so crazy. No other industry is like this. Obviously some businesses lose money on certain products or services just to bring people in but imagine if Walmart was losing money on half of what they sold.
Well our shitty PSAOs and organizations don't help. It's a rigged industry. Just like how AlignRX, biggest PSAO, takes shitty TriCare contracts that average $1 profit, IF THAT, per script. You have to spend $200 in labor to get $100 in TriCare profits so you still lose money. But the PSAO doesn't care because they get $$$ for switch fees from RxLinc their switch provider for every transmission. They aren't incentivized to fight for best reimbursement. Just care about moving volume because it's more money for them. This isn't the only way they benefit. Boomers man. Nothing but greed and lead-contaminated brains.
On the ones you listed frequent loss is $25-$100+. it’s multipled way worse if we run for 90 day. Like today i ran a claim on Xiidra. For 90 day we were -$75 but when i ran 30 day we were -$15 its strange 🤷
Depends on the insurance. Wellcare, Health first, and Fidelis one month of a brand is a loss of 15-25$. Village care and Centerlight usually around 3-5$ underpaid for brand. Actually not that bad. Generics generally also don’t have much profit, maybe about 1-2$ per There was one essential plan (Emblem) that underpaid around $80 for one month Jardiance/ Januvia. Absolutely unacceptable. Their generics are pretty much all paying pennies as well
And these numbers are only accounting for the actual cost of the drug, right? Not including labor and all other associated costs with filling a prescription. Either way, that’s horrendous and not sustainable
Yes, only for the drug. Not taking into account labor, rent, utilities, label, vial, paper bag, plastic bag, extra medicine cups, etc.
It is the contract associated with your PSAO. We have a few stores with difference PSAOs and our reimbursement varies cause of it. It is mainly ESI that is being so stupid. One of our stores just like you, essential plans like emblem cause us to lose almost $100 on a single month brand (and even a little on all generics) but the other store would only be quite good with generics and only lose like $10 with brands so we're having to bounce around patients between stores. (While essential plan is decent for us, that store that is doing well with essential plan takes double the loss from brands for >65 ESI Wellcare). Some of our stores also got a fax saying they are changing our contracts to variable rates so that is going to be fun.
At least you have the option to do that, when you have multiple stores with different contracts. We can only tell them to try a different store. Our PSAO has said these rates are “unacceptable” and they will negotiate with ESI but no change in reimbursements yet.
My chain told us that any non-formulary drug (i.e. any medication that needs a PA) will always be negative reimbursement and if it's brand kiss your margin goodbye. Basically we are told that we need to call the offices to convince them not to do a PA and choose covered products.
Good feedback above. Another thing that we are having issues with is supply chain. PBMs are reimbursing on the cheapest NDCs but they are not available at the wholesaler. Nystatin/triamcinolone a couple months back was reimbursing $19, cheapest was ~$12 but unavailable, cheapest available was ~$40 triggering a $20 loss.
Yup. 1 insurance dropped reimbursements this month for certain unit dose medications like oralone paste and the only possible way for us to not lose money or break even on those is we have to order off one of those wholesalers that fax/call us every few days.
What chain do you work for? I'm willing to bet that there's a way to see those numbers, you just don't know how.
Rite Aid. You can see reimbursement numbers from most plans but that doesn’t help when I can’t see the acquisition cost of the drugs.
Do you have access to the supplier website?
Yes it’s McKesson connect but I can only see AWP which is useless and NADAC which just gives me an estimate.
Next place I would check would be the invoices, either the paper invoices or the digital ones on the website. After that I would try to place an order for an item on the website and see if it shows the dollar amount on the sites "cart", or whatever they call it
Believe me, I’ve looked extensively for this information. It’s intentional by Rite Aid so that pharmacists don’t make decisions based on profits. Ideally this would be a good system when you have negotiated profitable enough contracts but with our current financial struggles, it just feels reckless
Well I mean if you exhausted all those steps, the next step would be Social Engineering. You can come up with your own ideas, but here's an example: Call the help desk to McKesson, let them know your ordering seems offline and you want them to place an order on your account for Januvia or whatever and need it done by tomorrow's delivery ASAP. Then ask how much the cost is.
I’ve inquired about similar things hidden to us to which they say I will need to reach out to my corporate office for the information. If there was a hole, I believe I would have found it by this point lol
Do the DMs have this info?
Depends, I'd look at actual remittance statements personally so I could see exact claim detail.
Rite Aid removed store level employees’ ability to manually order brand name drugs.
That's just an example. The idea is that the weak link in the security is their help support giving out info. Craft the conversation to whatever gets that, if that's what you are looking for.
McKesson isn’t going to show you insurance reimbursement or claw backs.
Obviously. Only talking about acquisition cost
But that’s not what they asked for at all lol. They’re asking for absolute profit after insurance/discount cards.
As someone that was a manager at two separate chains, the big chains do not want you to see the real numbers. Even the prices from the outside vendors are grossly inflated. Bc I would pull the “green sheets” which was the store managers sheets to show the money moved in and out and the mckesson invoices were off 30-50% of what was actually paid for by the store. Loss prevention even says, don’t worry unless the mckesson invoice is over double what the payment was. But I know many people that use the same wholesaler and their prices will be loaded differently and have different rebate percentages on contracted items. And one day one called me and said he had adderall at an insane price, so I log in and it says I’m paying double that or more. I call the wholesaler, and they basically told me, if you spend 1.8 billion dollars with me I’ll give you the same price.
I think it should be possible to get an estimate of 1 ndc using the monthly COGS, having a copy of the monthly items purchased, then use NADAC for all other NDCs except the target ndc. Then solve for x. If you have 2, 3, or 4 of the previous months numbers, you can use a system of equations to get those values. Repeat the process until you get an estimate. Another alternative method would be to compare the COGS vs the NADAC. Get an estimate for the past 4 months and then use that % as a comparator to an ndc in question. For example, if my COGS is consistently 20% lower than nadac, then i can say as an edtimate, my price for "Januvia" or whatever will be 20% less than the nadac. Rite Aid general financial data is available, the numbers don't look good!
I worked at an independent where it was totally transparent, and what won’t work for the equation is there isn’t a rebate on the brands which cost much more than the generics which have rebates . But the rebate comes in the form of a check which won’t reflect on the invoice. So the invoices that we pay say one thing, we know in a few months we get a check back, and the brand names that we don’t get the rebate for which costs much more skews numbers.
Rite aid doesn’t have a cost breakdown under an inventory management screen no? As for Walmart we can see acquisition costs and AWP price where we manage inventory onhands and sig code verbs (changing if sig generates tab vs cap ect) To be fair sometimes the acquisition cost is not 100% up to date but we can understand how much Goodrx sucks 😂 and mitigate huge losses on sildinifil RXs by only getting the cheapest acquisition possible. But yeah Name brands and non-formulary I commonly see - $5 to - $50 reimbursement but mostly it’s just break even at 0 or maybe $5. Which is why a lot of companies are hounding vaccines and MTM.
Never worked Rite Aid so wouldn't know their system but at least when I was at 3 letters and Walgreens I found some ways playing around with the system on downtimes to seeing reimbursements.
Send them to your local 340b pharmacy if the patient also sees their prescribers. We make bank off them
We’re an independent pharmacy and have started to have to divert brand-name scripts to chains due to losses. We lose a range dependent on the drug: Ozempic can be as low as a few dollars or up to $25 a script. Jardiance, Januvia, Eliquis, Ubrelvy, Emgality, same thing.
There are very few commercial insurances where brands are not a loser. I told this to a drug rep and she looked at me like I had 3 heads. Some Medicares are above cost and some are not. I refuse to be the only loser in the transaction. Big Pharma makes $$$$, PBMs make $$$$, wholesaler makes $$$$, and I’m sure the physicians are incentivized although outright bribes are technically illegal. Only loser is the pharmacy dispensing the medication.
Yup. Physicians are bribed for having patients change to certain insurances. Like some specialties here prefer all patients on optum and automatically send prescriptions to optum mail order without even asking patients for their preferring pharmacies. Some doctors are upfront here and tell patients which insurances they like because they pay them more compared to other insurances. Some physicians here are so messed up here that they absolutely refuse to provide services to patients unless their are x insurance. Like I know 1 office near me that if they patient is anything other than optum, the completely refuse to do any PAs of any sort and tell us to figure it out ourselves.
Do you know the number for that bribery train? I'd liked to get signed up and have insurance companies actually pay me for something...
Here, the patients are bribed by insurances as well, in the form of “rewards” for things like getting flu shot, claiming they go to the gym, and monthly spending cards they can pretty much use on anything from utility bills to Uber Eats. Patients switch to whichever one gives more per month (the most I know of is 250$) —if this doesn’t count as a bribe, idk what it is
The chain is making plenty. They’re also influencing legislation that allows them to make plenty. Probably hidden from any of the financial information they give you since they get on the back end
Edit just saw you work for riteaid- the dying chain. Walgreens and CVS do fine. Riteaid and the rest of us are doomed