Pharmacoeconomics (4) from Loren Pierce on Vimeo.
I have a specific example of how these PBM’s … in our case … Silver Scripts/Caremark which is part of CVS Health. Barb has a prescription that she has taken for 10+ yrs
This particular medication has always required a PA (Prior Authorization) from Silver Scripts, and they wanted a $600+ copay meaning that it was a Tier 4 medication. Which means that the total price of the 90 day prescription was in the $1500+ arena.
I asked the independent pharmacy that we patronize what their “cash price” was and it was $325.00. I started making some phone calls and found that a BIG BOX store would fill the prescription for CASH for $88.00
And the third time that I got it filled at the same BIG BOX store .. the CASH PRICE was $44.00.
It use to be that the pt was suppose to be charged the PBM contracted price in this particular case .. the copay would be abt 40% of a total price of abt $1500.00 ($600.00) OR the pharmacy’s CASH PRICE and in the first case would be $325.00. Maybe they have changed the contracts so that they can EXTRACT extra money out of pts.. especially those on Medicare Part D… most who are trying to make ends meet on their social security check.
In reality on this particular medications, CVS/Caremark/Silver Scripts was actually charging me – the pt – more than the cost of the medication – they actually had a POSITIVE CASH FLOW when we had that particular Rx filled, and we no longer had to screw around with a PRIOR AUTHORIZATION BS… every year.. when Barb had taken this chronic medication for over a DECADE.
To me, the “savings” from the Medicare Part D program is more “smoke and mirrors” than any real savings to Medicare pts.
Filed under: General Problems
Glad you properly define this all for us Pharmacist Steve, Thank you.
CVS pharmacy is run by a bunch of crooks. I stopped using them a long time ago. They kept telling me that my pain meds were on back order over and over again but they had no intention of filling the script
Even though I had been with them and used the same medication go over 15years. I complained to the manager than to the Corporate office and they just didn’t care. Find another pharmacy, they believe
If you take opioids you are an addict.
That’s really really bad Steve. If I could move these thieves would be wondering not if but how long they would be in prison.