By Joseph Harmison, P.D.
Patients often find prescription drug pricing and coverage decisions complex and secretive. That can lead to confusion, or even anger, among patients when they come to a community pharmacy to have a prescription filled.
In the letter, published in Springfield, Missouri’s News-Leader, Lynn explains how drug prices and formularies are set.
Obviously, that’s the realm of insurance companies, typically under the auspices of a pharmacy benefit manager (PBM). Lynn also makes the case for transparency requirements for PBMs.
You can read his letter below or by clicking on the following link:
I appreciate the opportunity to respond to the article “Pharmacy thwarts effort to save money.” At Family Pharmacy, our first priority is to fill prescriptions accurately. Our second is to save every customer money. We are constantly working on behalf of the customer.
It is important for all readers to realize that pharmacies have very little to say about what insurance companies charge in co-pays. Insurance pharmacy benefits managers (PBMs) control the price paid to the pharmacy and what the customer pays. The PBM controls the quantity dispensed, the quantity they will cover, when you can refill, and even how they calculate co-pays for split pills. It is not the pharmacy that wants to charge two copays nor does the pharmacy really benefit financially if the insurance company requires two co-pays. Pharmacies are reimbursed based on a cost formula. The cost did not change because the quantity did not change. The only thing that changed was the customer’s obligation at the time of purchase. In addition, the pharmacy is bound to follow certain rules and regulations set forth by the insurance companies. Pharmacies must calculate days supply based on doses per day and quantity received not just based on quantity. Insurance companies return co-payments based on days’ supply submitted. The pharmacy would be at risk for audit and the possibility of having all payment recouped if the proper days’ supply was not submitted.
The pharmacy is on the customer’s side. This is why Family Pharmacy is endorsing full transparency laws that would regulate the insurance industry. This would open the eyes and help consumers, businesses and pharmacies. It would expose the insurance companies.
I would be glad to offer my services personally to your reader. This is a major advantage of our company to have a local president-owner and management staff that will spend the time to help your readers.
Lynn A. Morris, R.Ph., M.S., is president and owner of Family Pharmacy Inc.