A.J. & Bronco Do Not a Profession Make

Jp Enlarged

I suppose you could not find two more diametrically opposed spots on the pharmacy profession’s wheel of fortune than these two represent.  A.J. is a salaried employee pharmacist who works for a mail order (PBM) outfit and Bronco owns his own drug store.  Each spot has to be covered and, I suppose, that both of them are getting what they want from pharmacy.

So why are they after each other’s throats?  How can this end well?  Is this just a testosterone surge?  It is not the least bit helpful for practitioners who have put themselves out in front to be acting so badly.  Can this possibly just be an example of how low pharmacy has gotten?   There is plenty of room for both of them.   A.J. belittles Bronco and his West Texas practice.  Bronco slams A.J. for being a traitor.   

I do not see RIGHT and WRONG here.  When you get right to the bottom of the funnel, they do the same thing.  They provide prescription drugs for a fair price in a manner that is safe.  Everything else they do is gravy.  They have enormous energy and have invested time, experience and talent in making the other guy wrong and making themselves right.  Isn’t that the essential game we learned as a child?  Make wrong, Be right.  And even if we realize that we are wrong, we will still fight like hell to convince everybody that we are right.

I believe that A.J. and Bronco could make a difference if they identified what is really wrong and addressed that.  Together, as a team.

 

 

63 Comments

63 Comments

  1. Whistleblower  •  Oct 24, 2013 @12:04 pm

    Well said JP….now is not the time for a pissing match…working together is the only way we can take our profession back!!!!

    Joe Zorek

  2. bcmigal  •  Oct 24, 2013 @2:35 pm

    Seriously, AJ an Bronco, you two need to get over yourselves.

  3. bcmigal  •  Oct 24, 2013 @2:35 pm

    Seriously, AJ and Bronco, you two need to get over yourselves.

  4. broncofan7  •  Oct 24, 2013 @7:50 pm

    If you are not able to see the blatant hypocrisy of an EMPLOYEE OF A PBM coming to a blog whose main underlying theme is as a venue to post stories about the declining working conditions of Community Pharmacy today, and who ALSO takes every opportunity to belittle Community Pharmacy (“compounding is a scam”, “counting by 5′s”,”bypassing DUR screens as fast as you can” etc.)then I don’t know what to tell you all.

    Again, an employee of a PBM coming onto a blog whose primary focus is on Community Pharmacy and who proceeds to complain about the state of Community Pharmacy is tantamount to a shift manager at a coal plant in China posting on a blog whose main purpose is about preserving the Planet’s environment and that said employee then posts continually about how bad about air pollution is…….I can’t explain it to JP and others any clearer than that. BF7

  5. Pharmaciststeve  •  Oct 24, 2013 @9:14 pm

    BF7… if AJ used the same demeanor .. if he worked in retail.. it is understandable why he is working in a large windowless bldg… sitting at a desk..

    something like telling someone that they have a face that belongs on the radio :-)

  6. Broncofan7  •  Oct 24, 2013 @10:39 pm

    And to be clear, AJ doesn’t work in mail order, He’s in a PRIOR AUTHORIZATION call center leading a team of pharmacy technicians and processing telephone calls from physicians offices all across the country. His personal pharmacist license has zero professional liability. If one has no professional liability can that even really be considered practicing pharmacy?

  7. Broncofan7  •  Oct 24, 2013 @10:43 pm

    Steve, you may be onto something!

  8. YoungGun  •  Oct 24, 2013 @11:16 pm

    AJ struck a chord with me too Bronco. While I’m sure he is great at maximizing PBM profits by encouraging MDs to switch to meds that offer maximum rebates, I fail to see how this is practicing pharmacy. See how I just completely oversimplified your job AJ and implied that you’re a sell-out without even knowing you. That’s how I felt when you said all we do is count by fives, and work the register and check like monkeys could do. I’m sorry you had a negative experience at a retail pharmacy but some of us actually practice the right way. Just today I had to respond to a diabetic patient with hypoglycemia. She was shaking, sweating, and confused. She wanted to leave but I made her sit down, took her sugars (meter read “low” which means less than 50mg/dL on that meter and proceeded to give her glucose tabs and exerted a calming influence on her until her sugars rose to normal levels. Then we talked about recognizing the signs/Sx of hypo and hyperglycemia while her husband came to drive her home. It’s little things like these that make all the B.S. worth it. She later called to give a heartfelt thanks and told me she was underuninsured and could not afford ER treatment. That’s what our job is in my mind, to save the system money. She will be taking a reduced dose of her Sulfonylurea now that she has had multiple bouts of hypoglycemia. I’m sure we all have stories just like this one.

  9. Broncofan7  •  Oct 25, 2013 @8:25 am

    Great job younggun! About 7 months ago I had a female senior citizen bring in her blood pressure machine and tell me she didn’t think it was working because the readings were always high and different. I opened up our health mart brand blood pressure machine took it twice with her and both readings were in the 160/100 range; I then proceeded to take my own blood pressure with that same machine , it checked out perfectly and I then referred this senior citizen to the ER where some hours later she presented with 3 Rxs. Unbeknownst to me , her daughter was also a patient at our pharmacy ( she had a different/married last name) and her daughter repeatedly thanked me for taking 10 minutes and sitting down with her mother and then instructing her to go to the ER. And I can’t tell you how many thank you’d I’ve gotten for referring patients to purple pill.com etc for coupons that save patients money on their BRAND name medications. On top of all of that, at my store where we do roughly 200rxs a day we make at least 7-8 phone calls per day verifying drug dose, directions etc… Ensuring that the right patient, gets the right medication, with the right dose, etc,etc…. Community pharmacy when not overwhelmed by the metrics of corporate bean counters can be a professionally rewarding and respected career.

    Bronc, privately, as a career pharmacist, it looks like you actually practice pharmacy. Your example is something that I have been harping on for many years. THE RPh IS THE POINT GUARD FOR TRIAGE. If any of you cannot see this, or if you are so trapped behind the Prescription Mill that you are clueless, then you are not practicing pharmacy. Good job, Bronc. I know that you get a lot of satisfaction. On top of that, you get invited to weddings and you stop in at funerals to show your respect. That is top quality, platinum grade pharmacist behavior. Jay Pee

  10. broncofan  •  Oct 25, 2013 @9:28 am

    Our first step in getting our profession back to a respectable work environment is to get the PBM’s current business model EXPOSED. They are the ones creating artificial pricing pressures at our professions expense and I’d venture to say that these pricing pressures are the main reason why some of these corporate chain stores are so stringent on staying on point with their metrics……Here’s a good article:

    http://www.workforce.com/articles/19960-the-pill-game

    “The fundamental elements for a competitive market are transparency, choice and a lack of conflicts of interest. The PBM industry fails on all three dimensions. There are relatively few choices, and there isn’t transparency. It’s the one profoundly unregulated area in the health care market.”

  11. broncofan7  •  Oct 25, 2013 @9:30 am

    Our first step in getting our profession back to a respectable work environment is to get the PBM’s current business model EXPOSED. They are the ones creating artificial pricing pressures at our professions expense and I’d venture to say that these pricing pressures are the main reason why some of these corporate chain stores are so stringent on staying on point with their metrics……

  12. broncofan7  •  Oct 25, 2013 @9:31 am

    Here’s a few articles detailing it:

    “The fundamental elements for a competitive market are transparency, choice and a lack of conflicts of interest. The PBM industry fails on all three dimensions. There are relatively few choices, and there isn’t transparency. It’s the one profoundly unregulated area in the health care market.”

    http://www.workforce.com/articles/19960-the-pill-game

  13. broncofan7  •  Oct 25, 2013 @9:32 am

    “An audit released today by the City of Houston Controller’s Office Audit Division concludes that the City and plan participants lost millions of dollars in its self-insured prescription medication program. The audit focused just on the first year of the self-insured plan which began May 1, 2011. The City’s third-party plan administrator is the Connecticut General Life Insurance Company (CIGNA); the three year administrative services agreement (ASA) with CIGNA totals $84 million.”

    http://www.yourhoustonnews.com/deer_park/news/controller-says-pharmacy-benefits-not-in-best-interests-of-city/article_a1e4bc82-d4ab-5bb6-bdd0-931438a29029.html

  14. pharmaciststeve  •  Oct 25, 2013 @12:26 pm

    BF7.. how do you think that they generate 106 BILLION in gross revenue and 1.81 BILLION in net profits and a market value of 50 BILLION..??

    They basically have a “three way” .. that take some from the pharmacies.. some from the Pharmas and some from the schmucks that signed up for their service !

  15. AJ  •  Oct 25, 2013 @11:45 pm

    As long as Broncofan7 and his clueless posse are here I will always know were to go for a good laugh! The three stooges of pharmacy performing daily at JP’s blog garden!
    .
    .
    Just so everyone is clear…in the picture above I’m the one with the beard and cool skull necklace.
    .
    PBM’s have been around since the 80′s and all of a sudden they are the sole cause of the destruction of pharmacy? You fools don’t have a clue! How long do you think things would last without someone managing the cost of an employers prescription drug program? You would see every major employer drop prescription drug coverage like a hot potato!
    .
    For all you fools screaming for fairness and transparency. How about you lead the way and set the example. Go ahead and make your entire pharmacy business “transparent”. Give a printout to each of your customers showing them exactly what you paid for the drug and your profit margin. Broncofan7 said “The fundamental elements for a competitive market are transparency, choice and a lack of conflicts of interest.” If that’s the case retail pharmacy sure fails on the transparency part. Since there is no transparency how do do I know if there are any conflicts of interest? How do I know you not getting rebates from your wholesaler for stocking certain drugs?
    .
    Do you guys go back and read your posts? How can you not see how ridiculous you sound?

  16. Broncofan7  •  Oct 26, 2013 @11:13 am

    I’m not educating you for FREE anymore AJ….

  17. Pharmaciststeve  •  Oct 26, 2013 @1:28 pm

    AJ … the “drug cards” started in 1969 with the UAW contract between the BIG THREE, John Deere & International Harvester..

    Pharmacy had survived for how many millenniums before the PBM’s came on to the scene ?

    And after all that time.. the average Rx price was up to the $4-5$ range… with virtually no generics and wholesale prices nearly static… Pharmacists have always been a bunch of greedy bastards..

    I can remember working for one place whose minimum Rx price was a whole $1.25 and another whose minimum price was cost + $1.00.

    Wholesalers worked on a 18% margin.. Pharmacies in the 40% range. Today those numbers are 5%-6% and low 20% range… and average Rx price $50 range with 80%+ generics.

    Major changes between then and now.. Medicaid & PBM’s.. Congress implementing MAC’s, Medicaid mandatory rebates and mandatory generics.

    What many people don’t know.. is that there is a company – can’t remember its name right now – that negotiates with the pharmas discounts for the PBM’s So we have a FOURTH PARTY in the Rx distribution channel.

    We now have double the number of middlemen between the pharmas and the patients.. each extracting their own overhead and infrastructure and desire to make a profit..

    I have yet to have anyone show me how more middlemen in a distribution channel can reduce the price to the end consumer !

  18. AJ  •  Oct 26, 2013 @2:29 pm

    Utilization management Pharmaciststeve. If doctor’s practiced evidenced based medicine instead of emotional based medicine there would be no need for utilization management. If the latest innovations from big pharma were something other than me too drugs that offer no advantage over current therapy yet cost 300 times more there would be no need for utilization management. It doesn’t matter who does it…a stand alone PBM or a big medical insurance company. If it wasn’t done the system would have collapsed years ago.
    .
    Providing a prescription drug benefit is a huge expense for major employers. These employers voluntarily utilize PBM’s to help lower the cost. If these employers didn’t do something to lower the cost they would be unable to provide the benefit.
    .
    You guys just don’t get how everything really fits together. You have such a narrow little focus you miss the big picture.

  19. Peter D  •  Oct 26, 2013 @3:26 pm

    I agree that transparency is needed at both the PBM and the community pharmacy level. In Ontario, it’s simple. A patient can just look up the listed price for any provincially covered molecule on a website. They can see what Ezetrol is reimbursed at, generic panto, etc. The provincial formulary covers about 90% of the molecules that are available, so transparency is pretty high. Also, in Ontario, we are required to list the dispensing fee on the Rx receipt AND post our usual and customary fee on a big yellow sign in the pharmacy.

    Patient’s still get confused between the dispensing fee and the co-pay, but at least they have some information. Adopting this approach to drug pricing would greatly improve perception of the pharmacy and move the dialogue into more of a professional direction (what service are you providing) and away from a commoditity/retail direction.

    But, the same can be said for PBMs. Disclosing what they reimburse to pharmacies and what they charge their clients would be very helpful to employers so they can see where value exists and doesn’t exist. The same can be said for our own provincial government. They expect pharmacies to be completely transparent, yet they get HUGE rebates from brand name drug companies and listing fees from generic companies. Once something is on the provincial formulary, private plans feel forced to include it on their formulary too.

    What’s good for the goose is good for the gander.

  20. Broncofan7  •  Oct 26, 2013 @4:50 pm

    Your treachery to your profession is surpassed only by your naivety AJ….

  21. Broncofan7  •  Oct 26, 2013 @4:52 pm

    You are a fully indoctrinated employee in lockstep with your employer’s completely false sales narrative.

  22. broncofan7  •  Oct 26, 2013 @5:15 pm

    PBM speak: “utilization management” TRANSLATION: Prescribing Physicians need to use the drugs produced by manufacturers who have agreed to give the PBM a kickback rebate.

    An Example you say?
    Dexilant rejects for PA while Nexium does not EVEN for patients who have paid claims in their claims HX for Plavix(clopidogrel).

    IF physician’s are guilty of practicing “Emotional based medicine”, the PBM’s are guilty of practicing medicine WITHOUT A LICENSE.

    Health and Pharmacy benefits are typically marketed TOGETHER and it’s VERY,VERY RARE that insurance agents even have the option of selling simply a MEDICAL PLAN on the private purchase consumer market. How do I know? Because I am SELF INSURED and obviously can expense my family’s medications through my store.

    The reason that drug prices have spiraled out of control is because our government has not imposed price ceilings on manufacturers as they do in Canada and many other industrialized nations. Our system allows manufacturers to increase and set drug prices as they choose and it fosters the relationship between the FOR PROFIT PBM and the manufacturer. The reason why Brand Retin-A has an AQ cost here in America of $150 and it can be SOLD as Brand in Canada for a mere $45 is because they have government/provincial imposed price ceilings in place…..and the profession of Pharmacy in Canada is THRIVING and drug spend per person is obviously less than in America.

    As Steve already pointed out, middlemen require a PROFIT to stay viable, and that profit is an added and unneeded expense to our ever ballooning Health care costs here in the USA.I could sell every RX in my Pharmacy for AQ + $20 and make a great living and keep health care costs down IF and ONLY IF the US government were to step up and place caps on the manufacturers.

    AJ believes that his employer is the one helping to keep those manufacturer prices down and the fact that he noted high drug spend in the USA in an earlier post is a testament to how he’s speaking out of both sides of his mouth. They in fact are in NO POSITION to help keep prices down, but they do try to limit access to certain manufacturers medications by virtue of backroom rebate and kick back agreements. But as drug spend continues to grow and be higher than in many parts of the world, it’s obvious that the PBM model is a failure in that regard.

  23. AJ  •  Oct 26, 2013 @6:03 pm

    Broncofan7…take a breath…go back and re-read what I posted. I did not type or suggest 90% of the crap you just spewed onto this blog. I make no higher calling claims about PBM’s. I make no claims that PBM’s lower costs for anyone except the employers who provide prescription drug insurance. PBM’s are FOR PROFIT just like you and your little pharmacy. Oh, wait…you must be in this for the good of man kind right? Since FOR PROFIT as you typed is soooo bad you must give every cent you make to charity right?
    .
    You’re a damn fool and don’t have even a pedestrian understanding of how the system works. For someone who owns his own business your lack of knowledge over even the simplest of concepts is frightening.
    .
    You got one thing right…the middle man requires a profit to stay in business. In the overall scheme of drug distribution retail pharmacy is a middle man no different than your wholesaler or the insurance company.
    .
    I challenge you bronconut7 to produce your P&L statement from last year and shows us how YOUR little pharmacy was able to keep health care costs down. Please prove to us with real objective hard data how your FOR PROFIT retail pharmacy is not an added and unneeded expense to the healthcare system. You’ve repeatedly made all these sensational and grandiose statements on the value of the FOR PROFIT retail pharmacy. Please share with us all the hard data you’ve used to come to that conclusion. I don’t want any theoretical numbers or guesses. I want absolutely irrefutable hard data that proves your little FOR PROFIT retail pharmacy saved the healthcare system and your patients more than than your gross margin and operating costs.

  24. broncofan7  •  Oct 26, 2013 @6:36 pm

    You truly aren’t worth my time but here goes nothing:

    YOUR EMPLOYERS CORPORATE MOTTO:

    http://info.cvscaremark.com/our-company/our-culture/our-purpose

    NEXT, YOUR DISIGENUOUS STATEMENT”
    ” I make no higher calling claims about PBM’s. I make no claims that PBM’s lower costs for anyone except the employers who provide prescription drug insurance.”

    http://www.yourhoustonnews.com/deer_park/news/controller-says-pharmacy-benefits-not-in-best-interests-of-city/article_a1e4bc82-d4ab-5bb6-bdd0-931438a29029.html

    ““Another area of concern for us was the preferred drug rebates paid to the PBM-CIGNA. In the contract, CIGNA is permitted to choose the preferred drug based on the rebate, not on the efficacy-effectiveness-of the drug nor the cost/benefit ratio of the medication. Clearly, the City should have significant input into the formulary offered to its employees and their dependents, and it appears we did not have that input, “ says Green. “Again, staff professionals with expertise in this area are essential, says Green”

  25. broncofan7  •  Oct 26, 2013 @6:40 pm

    Your idiocy knows no bounds….

    AJ: “I make no higher calling claims about PBM’s. I make no claims that PBM’s lower costs for anyone except the employers who provide prescription drug insurance”

    Now go read your company’s MOTTO:

    http://info.cvscaremark.com/our-company/our-culture/our-purpose

    “Staying healthy isn’t easy these days. Health care costs keep rising. People are overwhelmed and confused by all the changes. They’re looking for help. They’re looking for solutions that make a difference. At CVS Caremark, we know that to make a difference, you have to do things differently. So we’re reinventing pharmacy to help people on their path to better health. We’re reinventing pharmacy to provide caring expert guidance, new cost-effective solutions, and even more convenient access to care. You might not expect this from a pharmacy or a PBM, but you can expect it from a pharmacy innovation company. That’s CVS Caremark. Helping people on their path to better health. It’s our purpose, our promise, our passion … every day”

  26. broncofan7  •  Oct 26, 2013 @6:42 pm

    but, but, but….” I make no claims that PBM’s lower costs for anyone except the employers who provide prescription drug insurance”…….

    NOT SO FAST GENIUS.

    http://www.yourhoustonnews.com/deer_park/news/controller-says-pharmacy-benefits-not-in-best-interests-of-city/article_a1e4bc82-d4ab-5bb6-bdd0-931438a29029.html

  27. broncofan7  •  Oct 26, 2013 @6:47 pm

    but, but, but….” I make no claims that PBM’s lower costs for anyone except the employers who provide prescription drug insurance”…….

    http://www.benefitspro.com/2013/10/17/exposing-pbms-spread-pricing-game?ref=hp

    “Groups advocating for increased transparency in the world of pharmacy benefits managers often cite “spread pricing” as one way PBMs drive up the cost of prescription drugs for employers and consumers. While the practice is often hard to expose, the upcoming issue of Fortune Magazine includes an in-depth piece, called “Painful prescription,” which does just that.

    Reporter Katherine Eban uses the story of Meridian Health Systems — a former customer of the nation’s largest PBM, Express Scripts — to show the sometimes drastic difference in what PBMs charge patients to fill prescriptions and what they in turn pay pharmacies to dispense those prescriptions. This difference often leads to greater profits for the PBM and increased costs for the employer.

    Robert Schenk, who oversees Meridian’s spending on employee medications, dug through the employer’s bills to discover just how rampant the practice was. One such example he found were charges for generic amoxicillin — Meridian was billed $92.53 when an employee filled the prescription, but Express Scripts paid only $26.91 to the pharmacy to fill the same prescription.

    That amounts to a “spread” of $65.62 for only one prescription. In another instance, Meridian was billed $26.87 for a prescription of the antibiotic azithromycin. Express Scripts paid the pharmacy $5.19 to dispense the prescription, creating a spread of $21.68″

  28. broncofan7  •  Oct 26, 2013 @6:52 pm

    but, but, but….YOU HAVE ABSOLUTLEY NO CLUE WHAT YOU ARE WRITING ABOUT. HELL YOU DON’T EVEN UNDERSTAND THE VERY ESSENCE OF YOUR EMPLOYER’S EXISTENCE…… I JUST PUT YOUR NOSE BACK INTO THE CARPET ONE MORE TIME FOR MAKING YET ANOTHER STINKING PILE OF AN UNINFORMED SH*TTY POSTS.

    Just go collect your check all at the peril of the profession that you pretend to be a part of you naïve FRAUD. BF7

  29. broncofan7  •  Oct 26, 2013 @7:01 pm

    “You got one thing right…the middle man requires a profit to stay in business. In the overall scheme of drug distribution, retail pharmacy is a middle man no different than your wholesaler or the insurance company.” -AJ

    Say,what????????

    Community pharmacy IS THE SERVCIE PROVIDER, not a middle man, dolt.

  30. AJ  •  Oct 26, 2013 @8:38 pm

    No…Community Pharmacy is the last step of the prescription drug distribution cycle. Since retail pharmacy is IN THE MIDDLE between the drug manufacturer and the patient you are the quintessential middleman you idiot!
    .
    What justification do you have for your markup? Explain why you think it’s perfectly acceptable to charge a markup and make a profit all for distributing a product.
    .
    Service?!??! Service?!?!?! What service? Distributing a product is not a service.

  31. AJ  •  Oct 26, 2013 @8:54 pm

    Here you go link man…look at this…I guess the two articles I found mean all community pharmacists are crooks and steal money from the government. This your classic trick. Post a couple articles and then make broad sweeping generalizations across an entire industry. How does it feel jack ass?
    .
    Pharmacare LLC and Caremerica LLC pharmacies in Connecticut alleged pharmacy fraud scheme federal prosecutors say bilked the government out of at least $2.6 million in Medicaid and Medicare reimbursements.

    Read more: http://www.baltimoresun.com/news/maryland/harford/fallston-joppa/ph-ag-pharmacy-fraud-0731-20130730,0,2072494.story#ixzz2isXHYR8m

    Clover Pharmacy owner in Tampa Florida stole $5 million from Medicare/Medicaid

    http://tbo.com/health/medical-news/pharmacist-stole-more-than–million-from-medicaremedicaid-b82488728z1

  32. Broncofan7  •  Oct 26, 2013 @9:08 pm

    Your post speaks for itself. I’ve got nothing to add to further illuminate your delusion….

  33. AJ  •  Oct 26, 2013 @9:08 pm

    Here’s some more links for the links man. Don’t think your little world isn’t going to get rocked too!
    .
    States Seek to Boost Price Transparency at Retail Pharmacy Level
    .
    http://www.hschange.com/CONTENT/966/#ib1
    .
    Transparency is Here! CMS Exposes Pharmacy Prescription Profit Margins
    .
    http://www.drugchannels.net/2012/10/transparency-is-here-cms-exposes.html
    .
    Center for Medicare and Medicaid Services (CMS) released its first batch of detailed data on pharmacy acquisition costs and pharmacy revenues (by payer type). These data allow anyone to compute average per-prescription pharmacy profit margins for more than 3,000 drugs at the 11-digit National Drug Code (NDC) level.
    .
    Uh oh! Looks like you may have some splaning to do!
    .
    Here’s my favorite broncotransparencyfan7.
    .
    Pharmacies, drugstores object to Medicaid price transparency effort
    .
    The pharmacy and drugstore lobbies are strongly objecting to a new effort by the federal government to gather more data on drug prices in the Medicaid program.
    .
    Read more: http://thehill.com/blogs/healthwatch/medicaid/113811-pharmacies-drugstores-object-to-medicaid-price-transparency-effort#ixzz2iscDCY4Q
    .
    Whoa! I thought transparency was the gold standard broncofan7?

  34. Pharmaciststeve  •  Oct 27, 2013 @1:06 am

    BF7.. notice that AJ did not deny a fourth party .. negotiating discounts from the Pharmas for the third parties.

    If you take the average RX price when the “drug cards ” started and applied the CPI.. the average price today would be 25-35 range.. instead of the 50-60 today

    How much could the healthcare system saved if the PBM’s had not gotten into the process of saving the healthcare system money…

    If you take AJ’s concept that the insurance company is a middleman as well .. then we have THREE additional middlemen than we had back at the end of the 60′s.. Since pts paid cash for their Rxs and they submitted claims to their insurance company.. Of course, we all know that insurance companies consume abt 20% of the premiums that they receive to support their infrastructure.

    Here is a recent quote from Motley Fool about Express Script

    http://www.fool.com/investing/general/2013/10/23/express-scripts-moves-to-exclude-drugs-from-nation.aspx

    Express Scripts managed to process a staggering 1.3 billion claims in 2012. During the first half of the current year, the company managed to handle 759.4 million claims, meaning its well on its way to surpassing last year’s claim numbers. The enormous claims volume processed by Express Scripts places it in a unique position to leverage its asset-light capital structure, and, therefore, maximize its returns. Express Scripts as a result boasts some of the lowest sales, administrative, and general costs, as well as the highest profit per claim in the industry.

    Meaning that their NET PROFIT is abt $1.00/Rx processed.

    Abt the same as the community pharmacy’s net profit/Rx.. that has to provide a product and a service and the product normally is from a broke bottle… and is HEAVY capital structure.

  35. broncofan7  •  Oct 27, 2013 @9:44 am

    but, but, but …..” I make no claims that PBM’s lower costs for anyone except the employers who provide prescription drug insurance”……

    http://www.drugchannels.net/2013/10/express-scripts-and-inevitability-of.html

    “Express Scripts is following CVS Caremark’s example, so manufacturers should be unsurprised by another inevitable consequence of the generic wave. Brand-name drugs in highly genericized therapeutic classes face enormous pressure for price and rebate concessions. Tier 3 formulary position no longer guarantees cost-effective patient access. And scariest of all: your pricing actions and marketing tactics increase the risk of formulary exclusion.”

  36. broncofan7  •  Oct 27, 2013 @9:48 am

    Not covering a medication at all (FORMULARY EXCLUSION) is another way that the PBMs “SAVE THE EMPLOYERS MONEY..”

  37. broncofan7  •  Oct 27, 2013 @10:04 am

    AJ, apparently you are a socialist at your core as you advocate HEALTH CARE PROVIDERS rendering services AT THEIR COST.

    Do patient’s pay the physician’s AT COST for having an ultrasound performed? how about a surgery?

    So now why would you think that Pharmacy’s should be reimbursed at their AQ cost for medications? The average cost to dispense in the USA runs around $11–so why are dispense fees from insurance companies typically 1/10th of that?

    ANSWER: BECAUSE YOU WORK FOR A PBM WHO IS PAID BY THE EMPLOYER AND INCENTIVIZED TO KEEP AS MUCH OF THAT EMPLOYER’S MONEY DESPITE THE FACT THAT SERVICE IS ACTUALLY BEING PROVIDED BY THE PHARMACY IN THE DISPENSING OF THE MEDICATION.

    You are one fully indoctrinated, Kool-Aid drinking fool who’s reflecting his EMPLOYER’s bias with every post…

  38. broncofan7  •  Oct 27, 2013 @10:12 am

    AJ, go read the comment section in the drug channels article you posted, it sets the author who is a PBM/ PHARMA corporate shill straight…………

    http://www.drugchannels.net/2012/10/transparency-is-here-cms-exposes.html

  39. broncofan7  •  Oct 27, 2013 @11:18 am

    Hey look AJ,

    http://www.careerbuilder.com/JobSeeker/Jobs/JobDetails.aspx?APath=2.31.0.0.0&job_did=J3J8H36N4SGMVKFX5QL&sc_cmp1=js_jrp_jobclick&IPath=ILKGV0C

    Ironically your employer is looking to hire YOUR replacement and guess what? A head hunter contacted ME OF ALL PEOPLE because of ” my stellar resume that meets up perfectly with the needs of Caremark”…I guess my 6 years of working at 2 PBMS, including 4 as a lead in a PA department is something they are craving right now.

    And guess how much they are offering?
    $50/hr…..YES,FIFTY DOLLARS AN HOUR to start. I asked the head hunter if he realized that this is 2013 and not 2003 and he said that is Caremark’s contracted rate. Even if it was $55-58/hr I obviously wouldn’t be interested as I have learned the error of my earlier ways.

    AJ, you and I graduated within a year of each other and despite me showing you REPEATEDLY on this blog the error of your ways, you still are partaking in the undermining of your licensed profession while earning a wage that is a decade behind current Pharmacist wages…now it all is beginning to make sense, you’re just a S-L-OW learner…..

  40. AJ  •  Oct 27, 2013 @11:29 am

    All right JP…I’m going to let you have your blog back. As you can see I like to argue. I’ve been busting broncofan7′s balls for my own entertainment purposes. In all the madness though there have been bits and pieces of good information.
    .
    JP writes “I believe that A.J. and Bronco could make a difference if they identified what is really wrong and addressed that. Together, as a team.”
    .
    I agree. However, identifying what’s wrong is just a start. Coming up with a solution is the real trick. I propose that every regular reader of this blog should shift gears and start thinking about solutions. Arguing about what’s wrong solves nothing. The world of healthcare is changing. It will change with us or without us.
    .
    I wrote a paper in pharmacy school about my vision of the future of pharmacy. I will see if I can find it and e-mail it to JP to see if he thinks its worthy enough to post and get the conversation started.

  41. AJ  •  Oct 27, 2013 @12:06 pm

    Broncofan7 my employer is absolutely looking to hire my replacement! Sadly they’re not looking for a pharmacist to fill it. I’m amazed a head hunter called you. They’re doing everything they can to eliminate pharmacist positions. If management gets their way there won’t be an employee in the building who has a license or any healthcare experience and that includes pharmacy technicians. They’re trying to turn every single position into a $7 to $8 an hour high school diploma only deal.
    .
    Make no mistake broncofan7. I work were I do for one reason only…my family. I work Monday thru Friday 8-4 with no nights, weekends or holidays. I don’t miss a single one of my kids activities. For the first time in my career I was able to take vacation over the Christmas holiday last year and I’m doing it again this year.
    .
    Yes, the pay is well below market. Yes, the place is run by a bunch of idiots. No, I don’t care because I work there for my family. I was a pharmacy manager for a major retail grocery chain and took a $34,350 a year pay cut when I took this job. My only regret is I didn’t do it sooner!

  42. broncofan7  •  Oct 27, 2013 @12:19 pm

    “I wrote a paper in pharmacy school about my vision of the future of pharmacy. I will see if I can find it and e-mail it to JP to see if he thinks its worthy enough to post and get the conversation started”-AJ

    Yet another example of you combining your absolute naivety with sprinkling of arrogance. Why would you think that your impression of Pharmacy while ATTENDING COLLEGE AND HAVING NOT YET BEEN AN ACTIVE PHARMACIST WITHIN THE PROFESSION would be any kind of starting point for a discussion on what’s wrong with the current state of Pharmacy and how some wet behind the ears student vision for the profession would be any kind of Panacea??

    Even as an EMPLOYEE Pharmacist, you may have an acute awareness of what’s wrong with the PRACTICE side of our profession, but one still wouldn’t have an understanding of the underlying financial structure that supports the practice of Pharmacy.

    That is why I consistently advocate for Pharmacists to become owners. There are over 23,000 independents nationwide and the more of us who become aware of the underlying business fundamentals that support our profession, the more politically active those Pharmacists will become and our profession will be better for it because there is strength in numbers.

    AJ, I reached out to you personally as we then proceeded to delete and/or block the email address that I had been corresponding with you after 3 to 4 emails. Our emails were not contentious and I was expressing to you some business plans to lay the groundwork for an INDY where we reside. AJ has no interest in taking ownership of his profession; for those who may be reading this blog, a great place to start is to locate a few independents in your area, speak to the owner, go and work a few shifts in the independent and then go to an NCPA ownership workshop. The average gross margin per RX is $12.50 per nationwide stats; those owners who I know personally are typically in the $15-16 range….that means 100 rxs per day and you’d be at $1500 GROSS MARGIN (that’s cost above DRUG AQ cost) daily. Pay yourself $500/day, your 2 techs combine for $170 a day and all of your other overhead would amount to roughly $30 a day and you’d have $800 GROSS PROFIT left over daily to use as the owner for growing the business or to simply save and pad your personal wealth.

    I don’t consider myself more intelligent than the average Pharmacist, but what I do have is an intellectual curiosity that was stoked when I was working on weekends for various independents throughout the state of Texas when I was employed by 2 PBMs from 2004-2010. It was that experience coupled with taking a calculated risk (if my business fails I go back to what I was doing in 2010; making $120K a year working for someone else)that has led me to be both more professionally satisfied AND at the same time more financially stable and personally wealthy. With more and more Pharmacists graduating and salary pressures and employment opportunities shrinking nationwide, ownership can be a great opportunity and I truly hope that somewhere there are others reading this blog and feel compelled to look into Pharmacy ownership. I can be reached @ broncofan7@ymail.com

  43. AJ  •  Oct 27, 2013 @2:13 pm

    Broncofan7…said “Yet another example of you combining your absolute naivety with sprinkling of arrogance. Why would you think that your impression of Pharmacy while ATTENDING COLLEGE AND HAVING NOT YET BEEN AN ACTIVE PHARMACIST WITHIN THE PROFESSION would be any kind of starting point for a discussion on what’s wrong with the current state of Pharmacy and how some wet behind the ears student vision for the profession would be any kind of Panacea??”
    .
    Oh Broncofan…because it almost exactly predicts what is happening now with the ACA (ObamaCare). It’s an excellent starting point for people like you who aren’t forward out of the box type of thinkers. I like to reference it because 10 years ago it was obvious to me the current healthcare system was inefficient and unsustainable. It came from my experience working for the VA, a 600 bed hospital and Walgreens. See small minded short sighted people like you are the problem. You are solely worried about making money. You are no different than the big corporations like Walgreens and CVS. You’re just smaller. Read all your posts again…all you do is cry like a little girl because the big bad PBM is not paying you enough money to distribute a product.
    .
    Seriously you need to take a deep breath and think about the big picture for a minute. Your idea is to turn the clock back 40 years and fraction the profession into thousands of independent profit motivated pharmacies. How does that reduce costs, increase efficiency and improve patient outcomes? Please take a break from your senseless ramblings and posting of random links and make a point.
    .
    EXPLAIN TO ME HOW INCREASING THE NUMBER OF INDEPENDENT FOR PROFIT PHARMACIES WILL REDUCE COSTS, INCREASE EFFICIENCY AND IMPROVE PATIENTS OUTCOMES. Use verifiable statistics and data to backup your answer.

  44. AJ  •  Oct 27, 2013 @2:31 pm

    Yep…this says it all!
    .
    Bronco said “The average gross margin per RX is $12.50 per nationwide stats; those owners who I know personally are typically in the $15-16 range….that means 100 rxs per day and you’d be at $1500 GROSS MARGIN (that’s cost above DRUG AQ cost) daily. Pay yourself $500/day, your 2 techs combine for $170 a day and all of your other overhead would amount to roughly $30 a day and you’d have $800 GROSS PROFIT left over daily to use as the owner for growing the business or to simply save and pad your personal wealth.”
    .
    Keep your eye on the MONEY and building your personal wealth running an unsustainable, inefficient and costly to the system business. As the entire healthcare model changes you will be left in the dust crying like a little girl blaming everyone but your small minded self.

  45. AJ  •  Oct 27, 2013 @3:21 pm

    Broncofan here’s one more for you..
    .
    http://www.beckershospitalreview.com/hospital-physician-relationships/walgreens-strategy-behind-aco-participation.html
    .
    Go ahead and post some more non-sense…call me naive, stupid and uniformed.
    .
    For the last three years if you haven’t been working on how to transform your business into the ACO model you’re in big trouble.

  46. broncofan7  •  Oct 27, 2013 @4:29 pm

    This profession, as with any other profession, was built and sustained on the basis of profitability. The profitability that Pharmacies EARN based upon the delivery of Pharmaceuticals to patients is minimal compared with your average retail store selling a product that doesn’t require any special education or license.

    YOUR employer on the other hand is a MIDDLEMAN whose premise was derived on the basis of saving the healthcare system money and making it more convenient for employers and their employees but who’s existence does in practice, the EXACT OPPOSITE by limiting access to the Pharmacy provider of a patient’s choice in some instances and charging employers X number of dollars MORE than the agreed upon transaction fee for managing an employers Pharmacy benefit.

    Again, I am DONE educating you for FREE. You’ve got my email….IF you want to learn how to regain any semblance of professional integrity while working as a steward of your profession at the same time, write me. What you’re doing right now is serving your own personal interests and it is completely antagonistic to our profession as a whole. The nerve of someone like you to be commenting about what’s wrong with Community Pharmacy on a blog that is primarily focused on bringing together Community Pharmacists is mind numbing…couple that fact with your cheap shots at community Pharmacy and you’re one step above roadkill…….

  47. AJ  •  Oct 27, 2013 @5:53 pm

    The “free” education you have provided broncofan7 is worth exactly what it cost…nothing.
    .
    You have failed to answer a single question I’ve asked you. You have failed to produce any data to support your claims.
    .
    The only counter you have offered is to claim anything I say should be discounted because I work for PBM. The only response you have is to redirect each of my posts and questions with an attack on the PBM industry. Mind you PBMs were never part of the original discussion. Nor was the current profitability of independant retail pharmacy.
    .

  48. Broncofan7  •  Oct 27, 2013 @5:54 pm

    And thank you for your Faux Concern related to ACOs and my businesses future viability…..but your concern is unwarranted.

  49. AJ  •  Oct 27, 2013 @6:11 pm

    Oh really? As of a post you made on October 11th you didn’t have a damn clue about ACO’s. You are three years behind the power curve on this slick. Your welcome for the FREE education you have received from myself and others on here. Are you finally starting to get it? It’s not something else to focus on. It’s a fundamental change to the entire healthcare system. You don’t need to get a hospital administrator’s attention. They are well aware of the Obamacare changes and the ACO model of payment put forth by CMS.

    October 11th Broncofan7 said…
    .
    “Very helpful information about the WAGS hospital programs. As an independent it’s something else to focus on to help build a loyal patient base and since many of us already offer free home delivery ( and free mailing in some instances) it would fit in easily with our current model. Getting the attention if a hospital administrator will be the most difficult step.”

  50. broncofan7  •  Oct 27, 2013 @6:19 pm

    Your “points” are as effective as your alma mater’s defense was against Baylor yesterday…..I was only UNAWARE of the fact that Walgreens had a physical presences in some hospitals..

    “Has anyone researched Wag’s WellTransitions program? I came across an article which states the AHA has endorsed this program. If I understand correctly, a Wag pharmacist visits patients in the hospital (prior to discharge) and discusses medication adherence. Thoughts?
    http://news.walgreens.com/article_display.cfm?article_id=5799

  51. broncofan7  •  Oct 27, 2013 @6:33 pm

    and full disclosure…I ALREADY DO HAVE A PHYSICAL PRESENCE IN 1 HOSPITAL.

  52. broncofan7  •  Oct 27, 2013 @6:34 pm

    and FULL DISCLOSURE…I ALREADY HAVE A PHYSICAL PRESENCE IN ONE HOSPITAL.

  53. broncofan7  •  Oct 27, 2013 @6:35 pm

    FULL DISCLOSURE: I already DO have a physical presence in ONE hospital…….

  54. AJ  •  Oct 27, 2013 @6:44 pm

    I know you you do. I checked you out on the State Board website. That’s what I don’t get. Why are you wasting your time defending independent retail pharmacy? There is nothing independent about an ACO. By definition it’s an organization. The days of the independent practitioner are over.
    .
    You are right there with all the pieces in place to take advantage of the biggest change our healthcare system has ever experienced.

  55. AJ  •  Oct 27, 2013 @7:04 pm

    Here is the final piece of the puzzle.

    http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/user-defined-tags/pharmacist/pharmacists-offer-mtm-services-suppor

    It’s all right here in this article.

    “With their unique roles, pharmacists are moving away from being only drug dispensers to becoming consultants and medication managers in the coordinated care environment of ACO’s”
    .
    This my friends is the future of our profession. All we need are forward thinking individuals to take it and run. What we don’t need are pharmacists stuck in the past who are stuck on reimbursement for distributing a product. That model is inefficient and expensive and does not fit into the new model of healthcare that is focused on patient outcomes.

  56. broncofan7  •  Oct 27, 2013 @7:09 pm

    Because my clinic Pharmacies are an EXTENSION of my stand alone Independent Pharmacy. Without my stand alone Pharmacy, my clinic Pharmacies are not even in existence.

  57. broncofan7  •  Oct 27, 2013 @7:41 pm

    And Mr. Plagakis,
    How can I make a $$$ contribution towards your server/blog fee? BF7…

  58. pharmacyslave2000  •  Oct 28, 2013 @11:25 am

    This is all very entertaining but it’s becoming cumbersome and childish. I understand both AJ’s and BF7′s points-of-view but I don’t think it is necessary for someone to have to validate how they choose to practice pharmacy to anyone else. BF7, you obviously have carved out a nice, profitable little niche for yourself in your area. You seem to be an astute businessman and you should be congratulated for what you’ve accomplished. AJ, you’ve chosen a different path, one that suits your expectations and fits your lifestyle. Neither of you are wrong, you’re doing what you need to do. I’m about the same age as both of you (37 yo). I’ve worked in a few different types of pharmacy and none really seemed to be to my liking. I look at this job as just that, A JOB. A means to an end. I don’t want to be a business owner, I just want to be respected and treated appropriately by my employer. I work retail because it gives me the best quality of life, i.e. the most money in my paycheck and a suitable amount of free time. I really don’t care about all the ancillary corporate bullshit. I’ll be what they want me to be. I don’t live my life for any “profession”, for any customers or for any corporation. My loyalty lies where it should, with the people I care about the most. At the end of the day, no matter what job you have, that’s all that should be important.

  59. Broncofan7  •  Oct 28, 2013 @3:35 pm

    pharmslave : no one faults you for your position.the difference between you and AJ is that he is a willful employee of a business who’s very existence is a driving force behind the conditions in community pharmacy that many are here complaining about. And he demeans community practice while posting here.

    Every pharmacist isn’t cut out to be an owner either due to their personal choice or character traits among many factors. But the audacity of an employee to cone on this board and tell us what’s wrong with our profession is beyond pale….

  60. Broncofan7  •  Oct 29, 2013 @11:10 am

    AJ– can I request that you show me around the facility? Ha!

    Caremark has reviewed your resume and requested an interview with you for this Friday at 10AM. Are you available to attend this interview in Richardson, TX this Friday?

  61. AJ  •  Oct 30, 2013 @8:35 pm

    Sweet! Go for it!

  62. Broncofan7  •  Oct 30, 2013 @8:48 pm

    Tell your bosses I’ll take $60/hour , I’ll telecommute and I don’t answer phones….:-)

  63. AJ  •  Nov 19, 2013 @3:42 pm

    Broncofan…we need to find something else to argue about. That was fun.
    .
    Just for the record Broncofan may be a genius…even if he likes a crap ass football team.

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