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    Below-cost Rxs: One state just says no


    It happens everyday at pharmacies: A patient arrives with a prescription. The drug is in stock. However, the reimbursement the patient’s insurance pays for filling the prescription is less than what it cost the pharmacy to acquire the drug.

    Usually, the pharmacy has no choice but to take the loss, as the pharmacy benefits manager (PBM) or the patient’s insurer dictates reimbursements as part of the privilege of the pharmacy being in its network. Other times, the pharmacy does not even know what it will be reimbursed until after the claim is processed.

    Editor’s Choice: PBMs, wholesalers, and contracts 101

    Gov. Phil BryantStarting in July, a new law in Mississippi will allow a pharmacy to refuse to provide drugs or services if it is not paid more than acquisition cost. Sponsored by Sam Mims (R-McComb), Mississippi Gov. Phil Bryant recently signed the bill into law.

    If a pharmacy declines to dispense a drug, the pharmacy must provide the customer with information on where their prescription can be filled.

    Supporters of the law, especially independent pharmacists, believe it will help them stay in business. But the nation’s largest pharmacy benefit manager, Express Scripts, said the law reduces patient care and access.

    “It is unfair for pharmacies to put profits ahead of people and turn away patients who need medication. The burden should not fall to the patient or payer if a pharmacy is not a good purchaser of drugs,” Brian Henry, an Express Scripts’ spokesperson, told Drug Topics.

    Mark Lowery, Editor
    Mark Lowery an Editor for Drug Topics magazine.


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    • Anonymous
      Does Express scripts accept contracts where they lose money but insure the welfare of the client? With annual revenues of 101 billion dollars and a gross profit of 8.4 billion, I don't think so
    • Anonymous
      Brian Henry, talk about the pot calling the kettle black!!! Come on, you know you PBM's care not a wit about patient access to meds. It's all about profit & your bonuses at the end of the year. Why should any business have to sell it's product at a loss. Does Express Scripts?? Outrageous. This legislation doesn't go far enough. PBMs should be required to reimburse at least what the pharmacy paid plus a small fee.
    • robertperrella
      I am outraged by brian henry's comments stating that we do a poor job of negotiating prices from our wholesalers.actually we do a fine job.the remimbursements are evil and spiteful.the game plan of the pbm's such as express scripts is to encourage patients to use mail order.over thE last 10 years 90 percent of the top 200 drugs are now generic where this already adds about 50 percent to the profits for the pbm's and their shareholders.the present day lack of reimbursements may at most add 2 percent to the pbm's bottom line.the biggest bombshell is that the average executive for the publicly traded companies on the stock exchange such as express scripts,catarmarran,and cvs/caremark are making over $40,000,000.00 dollars including stock option bonuses !!!!!!!!!!!!!the greed is destroying not only the profession of pharmacy but the greed and avarice are destroying this once proud nation called the united staTes of America.what the pbm's are doing is federal grand larceny in our profession.these executives should be arrested and automatically executed without a trial!!!! they are way beyond guilty!!!!!!all I have to say to these prima donna white collar executives is be a team player:increase our generic reimbursements by 33 percent and buy your mistresses a Toyota corolla instead of a mercedes-benz convertible.STOP BEING SELF-CENTERED !!!!!!!!!.THE BIGGER TRAGEDY IS THE 1,200% PRICE INCREASES AMONGST THE GENERIC DRUGS!!!!!!!!!!Nobody can afford these prices.i describe the generic companies behavior as DUMB CAPATLISM !!!!!!!!these executives too should be subjected to capital punishment.THE GREED MAY EVENTUALLY WIPE OUT OUR PROFESSION OF PHARMACY!!!! What is so sad about the USA is that our standards have declined in every aspect such as the savings and loan crisis,our two faced bizarre foreign policy.we are ranked 132 out of 208 nations when it comes to human rights!we have corrupt police,corrupt politicians and of course corrupt evil,self centered PBM's!!!!!SAD TO SAY IS THAT NOBODY CARES!!!!WAKE UP AMERICA BEFORE IT'S TOO LATE !!!!!!!!
    • KentPurdy
      Mr. Henry, don't talk to us about putting profits before people. With you and your PBM colleagues, profits are #1. You've been tightening the screws on pharmacies, especially independents, for a generation! And now, one state stands up to it, and you've got the gall to point fingers at the pharmacies. Deal with it, sir, and change your reimbursement to at a MINIMUM cover the acquisition cost of the medication. Then, we can talk.
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