Back in in the 80’s, when I was in High School, I had to read the 1953 Arthur Miller play, The Crucible. The play title references a definition of the word crucible that, until I read the play, was unfamiliar to me.
cru·ci·ble noun \ˈkrü-sə-bəl\ a difficult test or challenge
That definition again came to mind this month as we started to prepare for the 2017 Medicare Part D Open Enrollment, which starts next month. The reason it came to mind is this: unlike the last two years, my pharmacies will not be preferred providers in 2017 for several of the most popular prescription drug plans. This change marks a move away from a focus on access to lives. We will soon have to convince patients to continue to use our pharmacy despite their copays being higher than other preferred pharmacies starting in January.
This will be a significant challenge. Over the last 5 years, Medicare beneficiaries have become accustomed to low, almost non-existent copays for prescription drugs. The plans have essentially made prescription drugs a commodity, and in the process forced the reimbursement paid to pharmacies down to historically low levels. In the process, these plans have also completely ignored the importance of the pharmacist and their role ensuring safety and efficacy in the patient’s medication use.
The reimbursement received by pharmacies under the commodity style reimbursement these preferred plans use has been so poor that many independent pharmacies have been either sold to chain pharmacies or otherwise closed or gone out of business. Even chain pharmacies have felt the impact on their bottom lines, though their business model allows for lower profit margins in the pharmacy by controlling prices in other departments.
Previously I have written that access to lives is important, and I still believe that. Being a participant in these narrow networks has certainly not been sufficiently profitable over the last two years, but we have been able to survive. The real question for 2017 is what happens if we lose access to a large number of our patients. Sure, we will make more money on the prescriptions we do fill, but will it offset a corresponding drop in sales due to a loss of patients?
We offer our patients a lot more than drug product, and many of our customers that are aware of this fact. Others will undoubtedly discover this if they follow the discounted copay to a preferred pharmacy in 2017. Our job starts now: educate our customers on their options, making sure they understand the difference between big box chain pharmacies dispensing medications in a commodity model and an independent pharmacy providing service and care.