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When a pharmacy loses money on a drug because the PBM’s MAC price is below the pharmacy’s best available product acquisition cost, it is generally described as “underwater.” Often today, generic drugs see abrupt and unexpected price increases. These increases are sometimes unbelievable, with a product’s acquisition cost potentially increasing by hundreds of percent overnight. When this......
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Medicare is gradually moving providers to a new, quality driven model.The current fee for service model used for so many years rewards providers for doing more: more procedures, more prescriptions, more admissions. The new quality model is designed to reward success. For example, fewer hospitalizations, fewer complications, or fewer adverse drug events. One tool being used are the Star......
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In the children’s tale “The Emperor’s New Clothes” by Hans Christian Andersen, the King is duped by a tailor promising him a suit of material so fine that it is only visible to those worthy. As the King parades around the kingdom completely naked, most everyone is afraid to tell him about his mistake. This tale, since translated into over......
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The other day, during a conversation I was involved in, an employee questioned the number of persons employees by small businesses in the United States. I recalled having heard that the number was significant and might even have been more than 50%. When I was younger, I would have had to go to an encyclopedia to......
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The Thriving Pharmacist has spent some time in the past discussing MAC prices as they are applied to PBM-pharmacy contracts. The concept of MAC price, however, is also a tool used by the PBMs in their dealings with the payor. Despite being several years old, the article referenced below address how the PBM industry manipulates MAC prices on......
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“If it’s rights for the patient, then its right for pharmacy”.  I first heard this statement, or something very similar to this from an esteemed colleague, Bob Osterhaus.  Over the years, I have cited this statement in many venues convincing pharmacists to always put the patient first and do the “right thing” to ensure that they......
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We often want to pass on things we find interesting that are not worthy of a full-length blog post. For that reason, we have added a Twitter account to the Thriving Pharmacist. Follow us at @ThrivingRPh (sorry, the full name doesn’t fit twitter’s guidelines). We will, of course, also tweet each new blog post there,......
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Recently, I  spent over one hour to resolve an issue that should not have taken nearly as long as it did, nor should have been a problem from the start.  It had to do with a patient who needed blood glucose strips filled.  This patient uses an insulin pump, so she must check her blood sugars......
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The PBM Industry The Pharmacy Benefit Manager (PBM) industry has gone from being a claims processor (simplifying paying claims for the insurance payor) to a manager of the entire pharmacy benefit for hundreds of millions of patients. Is not uncommon for a PBM to tout the savings they garner the system thru their management of......
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Stephen Eckel (Pharm.D.) describes the effects of non-adherence on this Pharmacy Times interview. It represents a lot of the same themes we have been talking about and is worth a listen. Click here to watch....
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