Month: January 2018

Pharmacy in the Media

The Clawback – How Will We Claw Back?

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-clawback-drugs-20170809-story.html

The LA Times recently posted an article on a hot topic across the country that elaborates on a possible reason behind rising drug prices. The article covers a topic called clawbacks. Clawbacks occur when a PBM (pharmacy benefit manager – the middleman between pharmacies, insurers, and drug manufacturers) is able to take some of the money that is paid to a pharmacy by the insurer as their own. The PBM is able to make money off of clawbacks through negotiating prices with all parties mentioned above. They take a portion of money from the claim that the pharmacy and the patient will never see.

Now that we have introduced the topic, let’s talk about why this is a bad look for all involved in pharmacy. People don’t understand the exact operations that go on behind the counters of a busy community pharmacy. This article that the LA Times wrote, talks about the large money flow that crosses between pharmacies, insurance companies, PBMs, and drug manufacturers. Unfortunately, from the sound of it, PBMs have unfairly used their platform to negotiate private contracts that benefit them to make more money that none of the other parties see. As you can imagine, with rising drug prices and healthcare being such a popular topic in the news, it isn’t a good look for anyone involved. Prices are being inflated for someone other than the patient to gain money.

How are prices being inflated? Well, PBMs have managed to negotiate prices with insurers that are actually over the cash price of certain medications. A percentage of the difference is then sometimes rewarded to the PBM through this thing called a clawback. So, basically, the price of a medication is being inflated, in order for a PBM to profit. The middleman gaining more money. Then there are things called gag clauses in some contracts that keep pharmacies from speaking about the lower cash price. This sounds pretty bad and obviously, the public should be mad. Now, put the gag clauses to the side. This article makes pharmacists look bad by basically saying that we hold our tongues to essentially not get in trouble and lose contracts from insurance companies. I disagree. Pharmacies fill hundreds of prescriptions a day. If a technician or pharmacist had to bill insurance and then bill cash for every single prescription to see which one was cheaper, that would double up the load at one of the workflow steps. This is extremely tedious and goes against the grain of efficiency that every pharmacy strives for to survive right now. Pharmacies don’t try to harm patients by billing whatever costs the most. Most technicians and pharmacists that I know go out of their way to try to make scripts cheaper for their patients.

Parts of this article are pretty community pharmacy negative. The article makes it sound like pharmacists have their hands tied behind their back and can’t do anything to benefit the patient. The LA Times, in my opinion, needs more education on the workflow that goes on behind a pharmacy to truly understand how the idea of a clawback becomes a problem for not just the patient, but also the pharmacist and technician working to fill their prescription. Generally, the technician that gives the patient the script is the last person there to tell them the price. That means that the technician becomes the butt-end of the patient’s financial problems with their prescription. Not a good problem to have.

This article portrays a negative intention on the entire process of filling a prescription. It’s unfortunate. It paints PBMs as the culprit, but then it makes other pieces of the pharmacy puzzle out to be helpless. I chose this article because it is a hot issue and everyone could be more educated about it. It is a somewhat complicated idea. I think this could have been spun as community pharmacy positive if the LA Times decided to focus more on how pharmacists try to make things cost-effective for their patients using some type of anecdote. The main thing to take from this though, is how will we claw back and fight this practice?

 

What is Pharmacy?

Accessible. Expanding. Busy. Medication Expertise. Problem Solving.

Pharmacy is a very diverse field that is constantly trying to address new problems successfully. Healthcare is ever evolving and this causes pharmacy to evolve right along with it. Pharmacists adjust their workflow activities and the tasks they focus on in order to better address the public problems that are presented to them. Pharmacists practice over a wide range of careers from poison control, to consultants in the hospital, to the management of PBMs, to your neighborhood community pharmacist, and many more. Pharmacists are problem solvers and that is the number one job that they hold.

This unique range of skills that pharmacists hold allows them to be utilized by the public as a medication expert. Our healthcare field is constantly trying to manufacture new therapies using medications so this keeps pharmacists on a continual treadmill of education. Constantly consuming data to learn about new therapies and stay up to date on old ones.

These unique traits put the field of pharmacy at a strong vantage point to help cover the gaps that are currently in our healthcare field. Many people out there still don’t have great access to healthcare. Pharmacists are one of the most accessible professionals available to provide healthcare. They are a phone call away and most pharmacies don’t require an appointment to see their pharmacist. What other setting do you know where you can walk in and get a vaccine and a consultation without an appointment and possibly be in and out in 20 minutes?

There are many success stories in pharmacy. This link below talks about some of them at this cool and unique website. Pharmacy Home Project does a great job showing off some of the great things that can happen in patient care with a pharmacist present. One of these stories speaks about how a chronic pain patient was having quite a lot of trouble with constipation. The patient, very innervated by their problem, did not know how to handle the situation. The pharmacist happened to dig a little deeper into the situation and found out that the patient was never prescribed or educated on the fact that the pain medications the patient was taking could cause constipation. The pharmacist then stepped in and advised that the patient begin taking a laxative and stool softener combination therapy. This solved the patient’s problem and allowed them to get back to life without having to worry about this unnerving problem. The pharmacist was able to provide the patient some education, advise, and lead them back to peace of mind. They possibly even prevented a physician visit or emergency room charge.

 http://www.pharmacyhomeproject.com/success

Pharmacy is truly many different things, but these are a few things that I believe pharmacy exemplifies. Pharmacy is poised to be a huge player to cover gaps in care for our public’s healthcare problems in the coming years. Creating transparency and educational points to show what pharmacists can do for people is huge, that way we can continue to provide great care for everyone. Pharmacists. Problem-solvers. Caregivers. Medication consultants.