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Sunday, July 31, 2022

Retail Pharmacies For The Win On Immunizations


Introduction

Who remembers what vaccines you are due for without seeing your doctor?  Well given how often people forgot about their second Covid-19 vaccine, I cannot imagine not many people do. I could not tell you the last shot a received that was not a Covid-19 or flu shot.  Even then you go in for a checkup, but vaccines still can be missed.  I remember I received my first HPV shot as a teen and went around 10 years before completing the series.  For those of you who do not know, Gardasil 9 which protects against HPV is given at months 0, 2, and 6.  Which means this was missed on numerous occasions.  The point I am making is most vaccines are administered in a clinic or hospital while  a significantly less are administered at pharmacies.  I honestly lost count at the number of people who I gave Covid-19 shots to who never knew we were capable of administering vaccines.  I always jokingly said I would see them in the fall for their flu shot.


Pre Covid-19 Vaccines

According to many studies before Covid-19 vaccines became available about 2/3rd of flu shots were administered at a hospital or clinic while only 1/3rd of flu shots were administered in a pharmacy.  I always thought this was wrong.  I remember as an intern and pharmacist I have always administered what I would consider a large amount of flu shots.  In reality it only ended up to be about ~400 a season, but some days when you do 20 plus, it can feel like a lot more.  Looking at the data more in-depth, the pharmacy only administered about 1,200 flu shots total.  This number seemed like a lot but at the same time when this number is put into perspective we were only hitting about a 1/4th of the population in the area.  We also had to work hard to even touch these numbers by completing offsite clinics with local businesses and the elderly homes nearby.  When we were signing up to be a provider to administer Covid-19 vaccines the owner and I agreed if we could double our flu shots we would be ecstatic.  We did not stop there however.  We had to provide an estimate on the number of vaccines we would be administering.  In doing so, we went big and set a goal I did not think we would hit of 5,000 vaccines total. 


Post Covid-19 Vaccines

Covid-19 Vaccines provided a whole new class of difficulties.  First of all, we had to fight an arm and a leg just to get vaccines at our pharmacy.  We partnered with both our state and a Federal Pharmacy Partner (FPP) and had to receive vaccines from the state at the very start of this.  For some reasons my state was allocating vaccines based on geographic area and favoring hospitals and clinic.  This did not include the federal government also favoring CVS and Walgreens to vaccinate all Long Term Care (LTC) facilities which makes my blood boil.  In a work place were CVS and Walgreens already abuse their pharmacist, I do not know why they were allowed to do it.  Especially, since the closet CVS/Walgreens pharmacy happens to be almost 50 minutes away and in the first few months they wasted well over 100,000 doses due to poor planning.


The Start of Something Big

When we were receiving vaccines from the state, it was a slow start.  We were only able to receive 100 dose a week if we were lucky.  This all changed once our pharmacy was able to order vaccine from our Federal Pharmacy Partner.  Starting in March of 2020 we were able to administer 100 vaccines per day 5 days a week!  It was a lot of work setting this up, but the pay off was rewarding.  We also receive tons of compliments from our community stating how easy and organized we were.  Although I managed our vaccine process, I am not an organized person.  I have to give thanks to my staff for that.  We were able to keep administering around 100 doses per day well into summer before things slowly tapered off.  I was not keeping track at the number of doses at this time but I would estimate we did well over 5,000 shots during that time frame.  Lets put this in perspective, we went from doing around 1,200 flu shots a season to doing over 5,000 Covid-19 shots in about the same time!  That is an insane increase in vaccines administered at our pharmacy.  It was a start of a shift from hospitals and clinics to pharmacies administering a majority of vaccines.


  Time For Boosters

As we slowed down on the number of shots we were giving, we had to adapt.  We found what worked for our pharmacy and made it as easy as we could for our community.  But we were not prepared for what would happened when the CDC and FDA approved the 1st booster dose in October 2020.  There were a lot of elderly patients who were ready to get the booster and they came to us.  Why? Well this is because the local hospitals and clinics had a waiting list 3 weeks to a month out.  Our pharmacy was the place most people came to as our wait time was less than a week.  Once again we were able to administer around 3,000 booster shots before the end of the year.  


A Time For A Change

By the end of 2020 we were able to administer just over 10,000 Covid-19 vaccines!  This is twice the amount of our insane goal of 5,000 and almost 10x our total number of flu shots.  Covid-19 vaccines saw a shift were 2/3rds of all shots were given at a pharmacy compared to 1/3rd from hospital and clinics.  You could say this is due to the differences between both business models.  To be fair, hospitals were more focused on treating Covid-19 patients compared to pharmacies.  This shift is a win for independent retail pharmacies and our time to take advantage and look at other vaccine opportunities.  The Covid-19 pandemic has many children miss important vaccines which could have easily been avoided.  Now it is our turn to focus on other ways we can vaccinate our communities. 


Thursday, July 28, 2022

Pharmacy Benefit Mangers (PBMs)


Pharmacy Benefit Managers, Who Are They and What Do They Do?

When you walk into the pharmacy to pick up a medication and present your insurance card, how does the pharmacy bill for the medications?  Not only that, but how many times have you went to the pharmacy, presented an insurance card, to only have them say they need a different card.  The way to bill for prescriptions is not as straightforward as going to the doctor.  Health insurance has a medical side to bill for all procedures done at a clinic and then a pharmacy benefit manager (PBM) which is used to bill medications.  For the medical side, it is simple.  You present your card, and you have a set copay for each visit.  For medication the pharmacy benefit manger is the one who controls the pricing of your medications.  This allows for a ton a variation in price depending on the cost of the drug, brand or generic and much more.

3 Main PBM

There are 3 main pharmacy benefit managers who controls about 90% of the market.  They are Express Scripts, CVS Caremark (part of CVS), and OptumRx (owned by UnitedHealth Group).   PBM’s are commonly called the middleman.  There only service is to work in conjunction with manufacturers, wholesalers, pharmacies, and health insurance providers.  Their role is to hand the negotiation and payments within the supply chain.  PBM’s negotiate contracts with drug manufacturers on behalf of insurers and are paid a rebate by that drug manufacturer.  Another organization called Pharmacy Services Administrative Organizations (PSAOs) negotiated reimbursements with PBM on behalf of the pharmacy.  PBM’s then pay the pharmacy on behalf of the health insurance provider what each drug dispensed to patients.  PSAOs work directly with pharmacies vs PBM’s who I stated work for the health insurance provider.

How Do PBM’s Make a Profit

PBM’s make money primarily through administration fees charged for their services.  In laymen terms, they tell the health insurance to pay $20 for a medication but have the pharmacy charge the patient $25.  The PBM would take the difference of $5.  To put it in perspective, PBMs make a set amount of money.  Depending on the cost of the medication, this could be a significant amount.  Not to get too off topic, but I cannot tell you how many times I have checked prescriptions where our pharmacy is losing money.  The drug literally cost more money than what we are getting paid.  I do not know about you, but I do not know what business is able to operate when they sell a product at a loss.

 

PBMs have been a burden for all pharmacies, especially independent pharmacies.  A few years ago, Walgreens stopped accepting express scripts as a PBM due to their negative reimbursement.  The question comes when this will stop?  When will more transparency be available?  These questions may never be answered.  In my opinion, the main reason has to do with the business model of PBMs and the lack of information provided.  We currently have politicians who have no idea how PBMs work or can warp their heads around the idea of losing money on something out of your control.  My only hope is we see transparency.  Require the PBMs to report their reimbursement and we as independent owners and staff members need to step up to help find a solution.

Tuesday, July 26, 2022

My First Blog Post -- Introduction


This is my first blog post ever, so I wanted to provide an introduction about myself.  I currently work as a pharmacist at an independent pharmacy.  My role is clinical pharmacy lead which I investigate ways where our pharmacy can provide clinical services.  If anyone has experience with this, you would know this is a frustrating battle since this is not a common practice.  In a typical retail pharmacy, your job is to check prescriptions for patients hence the term, “vending machine pharmacist”.  This is a lot of what you will see at large chains like Walmart, CVS, Walgreens and more.  I am here to change stigma of retail pharmacy by developing a sustainable program.

 

To be honest with myself I absolutely hate writing and it is not one of my strong skills.  That begs the question, why would I take the challenge of writing? Well, I found myself frustrated.  Frustrated with healthcare, frustrated with patients thinking it’s our fault their copay is so high, and frustrated with companies making tons of money off retail pharmacies.  I am using this as an avenue to vent my frustration and open the door to the problems we face. 

 

Let take a deeper dive into myself.  I graduated pharmacy school in 2019 right before the Covid-19 drama we are currently facing.  My passion has always been being a hospital pharmacist.  I enjoy the rush of rounding on patients and providing detail care to each of these patients.  For me, it is like a puzzle.  I must figure out the problem of each patient and provide an individual care plan for each patient.  Yes, the doctor is the one who assesses the patient, but it is my job to make sure the doctor treats the patient with the most appropriate medication.  So why did I choose retail.  For one, most hospital jobs require or look for someone who has completed a residency.  Second, I enjoy a challenge of maybe one day owning and operating my own pharmacy and if I can become successful in creating clinical services then I would be doing the same thing as working in a hospital.

 

I hope to bring you along in my journey to education you about what retail pharmacy is.  As I said it is more than just being a “vending machine pharmacist”.  I will also provide insight to how we operate as a business.  We must watch so many things as you will learn most of our income is out of our control.  So, sit back and enjoy my rant.  Please feel free to commit.  I look forward to hear your thoughts.