Walgreens | Express Scripts Debacle

Remember years ago when these same type of "third-party" reimbursement issues were in the news, except that it was the independent pharmacists mainly complaining about it?

At that time, the chains didn't make such a fuss about lower reimbursement rates because they had economies of scale and saw those lower reimbursements as a way to reduce competition from independent pharmacies. They knew that it was only a matter of time before independents couldn't afford to remain in business with someone else dictating their pricing, so they opened their doors to these third-parties.

Now it seems that strategy has paid-off for the chains, and independent pharmacists are becoming extinct. But, the PBMs and other third-parties are still dictating reimbursement rates, and guess who's next on their list. That's right, the chains. Now that chain pharmacists have opened those doors and helped remove their independent colleagues from the picture, the chains are left competing amongst themselves to see who will get paid the least.

I wonder how will all of this affect individual chain pharmacists?

Let's take a look into my crystal ball and see what's possibly in store for us in the future - Just like their independent predecessors, the chains will be forced to accept lower reimbursement rates, consolidate even more, or eventually go out of business.

As recent history has shown, more and more responsibilities will be shifted onto lower-paid pharmacy technicians. As history has also shown, BOPs and legislators will submit to their corporate masters and change the rules to allow technicians to do what were previously "pharmacist-only" duties. Technicians will come to rule the roost.

Chain pharmacists positions and hours will be cut, and they will be expected to do much more work, and for increasingly lower pay. Because there will be less reimbursable responsibilities left for pharmacists now that technicians are doing their job, pharmacists will be moved out of the pharmacy and be expected to accept roles previously attributed to nurses and doctors. Of course, this will require more education and skills on behalf of the pharmacist, who will be expected to spend the extra time and money for school in order to become certified to provide those services.

But, now that the chains have expanded into "hands-on" healthcare services by creating their own clinics, those pharmacists will be competing with those clinic nurse-practitioners for providing services which cannot be reimbursed. Who do you think is going to win that competition?

Luckily, we pharmacists stick together and belong to one powerful single association that speaks on behalf of all pharmacists, and protects us from those greedy third-party corporate executives, right? Oh yeah, wait a minute. Damn, talk about a lack of foresight and karma, huh?

So, I wonder how will those PBM/third-party middlemen might be affected by all of this?

For some reason, the phrase "laughing all the way to the bank" keeps popping into my head. It looks as though they are in the driver's seat. They can blame the chains for any increased costs, and then shift those costs onto their clients without recourse. With chain pharmacy competition out of the way, they can create and expand their own pharmacies, and fully dictate to their patients when and where they will get their prescriptions filled, and for how much. Pretty cool for them, huh?

I'm betting that some pharmacists long ago wished they never answered that doorbell.

Source: Phoenix ABC News Channel-15