What we’re about to show you will likely make your blood boil. It did ours. These are pictures you must see to affirm your sneaking suspicion that yes, you are in fact getting duped by PBMs, such as CVS Caremark.
The images below were provided by a fellow pharmacy owner and were obtained during the process of filing a MAC appeal with the Medicaid HMO, Molina. Like many owners who bill to CVS Caremark, she noticed a consistent pattern of being underpaid on reimbursements. In response to the complaint, she received the following files which show the charges to Molina for the prescription, a stark contrast to what her pharmacy received.
|Prescription||Amount Submitted by Pharmacy||Molina Paid Caremark||Pharmacy Reimbursement||PBM Spread|
|Guanfacine HCL ER 2 MG tablets ER 24H||$320.00||$121.55||$7.60||$113.95|
|Neomycin-Polymixin-Hydrocor 3.5-10K-1 solution||$106.00||$50.32||$5.40||$44.92|
Images one and two show what Molina paid CVS Caremark for two prescriptions while images three and four show what the pharmacy was paid. This highlights the reality that pharmacies are regularly underpaid for prescriptions while the insurance plans are charged far more, and the PBM gets to keep a considerable spread of profits in their pocket.
We’ve also attached the documents for download here.
What This Means
There are approximately 22,000 independent pharmacies in the United States. If we looked at the Guanfacine prescription alone, the yearly payout to PBMs is $29,832,000 if the baseline assumption is that pharmacies nationwide fill this script once a month.
MAC list pricing by PBMs puts independent pharmacy owners at a considerable disadvantage. Adding insult to injury, the majority of the pharmacy owners on the PDSadvantage message board are in agreement that the appeals process is ineffective. A best-case scenario is periodic price adjustments depending on the appeal, which, in the long run, never affect changes in pricing for pharmacy owners as a whole. Overall, this process is designed to force busy owners to choose between below cost reimbursements or an endless cycle of appeals with little change in outcome. Many argue that the effort invested in submitting appeals isn’t worth it because the core of the problem isn’t addressed, and it takes up precious time that should be spent on growing the business, not in the pharmacy.
Fight Smarter, Not Harder
CVS Caremark and other Pharmacy Benefits Managment companies, such as the other 2 of the “Big 3,” OptumRx and Express Scripts, will continue to intentionally narrow the gap between reimbursement and acquisition cost while keeping the appeals process ineffective in the face of repeated price adjustments. This leaves independent pharmacies underwater. We at PDS don’t count ourselves among those who think fighting is futile. The answer is fighting smarter, not harder by making these issues and any other unfair regulations IRRELEVANT to how you operate your pharmacy business. Here and now, we can affect change that will make issues like unfair MAC pricing a blip on the radar. If we come together, our own collective and individual success will be exponentially greater than any threat the PBMs can sling. Filing appeals is a start, but alone it is not the answer. Informed pharmacy owners know that the focus should be on putting effort toward strategies that directly impact your bottom line.
Taking Matters into Our Own Hands, Together
There are over 1,800 pharmacy owners and professionals that know the value of fighting smarter with a proven plan, backed by a community that supports and stands with them. This gathering happens every February in Orlando, Florida.
Independent pharmacy owners just like you gather with the experts and titans of the industry to:
Give owners proven, sustainable strategies that will pay immediate dividends
Light the passion for pharmacy most owners lose in the landscape of this unfair game
Give you the confidence to battle MAC pricing, DIR fees, below-cost reimbursements and any other obstacle in your way – and win
Find your people. Fellow owners that are walking the same path as you. The value of this support and knowledge-sharing is priceless. If you’d like to continue to file appeals and disputes on your own, we commend you. At least you’re doing something and making your voice heard, but that is not your only recourse.
Attend the PDS Super-Conference and see for yourself why we are so confident in our ability to change your life that we have a conference guarantee. If you don’t see the value of after the first day, we’ll reimburse your travel up to $500 and give you an additional $300 — no questions asked.
Innovation is the cornerstone of development in any industry, and continuing to conduct business as you always have will not give you any competitive advantage in today’s market. In light of significant industry changes, independent pharmacy owners have realized that working to innovate, grow, and improve is not a matter of ‘if,’ but rather, ‘when.’
Pharmacy Development Services (PDS) is the only company of its kind with a dedicated research and development team whose sole objective is to develop innovative and efficient programs that give your pharmacy the competitive edge against corporate pharmacy giants.
The future of our industry lies in the hands of the innovators and problem-solvers. Are you ready to learn more about how PDS empowers you to innovate and rethink the way you look at a successful pharmacy business? Take the first step and sign up for the PDS 2017 All-Star Super-Conference in February. Don’t miss out on how we are planning to make it the best year in independent pharmacy yet.
The PDS All-Star Super-Conference is the pharmacy event of the year that is guaranteed to change the way you run your business. Join us for the next event in February! Click HERE to learn more about the PDS Super-Conference.
Data Analytics For Pharmacy owners
We have said this countless times before; pharmacy owners play an unfair game. This isn’t just a maxim we tout to tug at your emotions. The unfair game is the core of why we wake up every day to champion pharmacy ownership. If you think you’re doing okay or getting by just fine, check out some of our pharmacy owners who are nailing data analytics among other strategies and winning the game.
Our winning strategy for lasting success is and always has been, an introspective one. The chances are that any deterioration on the outside will indicate a decay within. What is the first thing you look at when you start assessing your pharmacy business opportunities? Your team, customers, pharmacy data, financial statements, even yourself, should all be audited and tested to bat.
This is why our PDS2017 Keynote speaker is so relevant to our cause.
Paul DePodesta Has Made His Name Creating Actionable Strategies
Based on Data Analytics
During the show, he will get attendees to rethink how their system works by asking what Paul calls the naive question, ”If we weren’t already doing it this way, is this the way we would start?” By applying an analytics-driven mindset to common pharmacy issues, Paul will help PDS Super-Conference attendees rethink:
- The idea that prescription volume equals pharmacy profits. Would you rather fill 100 scripts at $5 each or two scripts for $250?
- The tools of the trade. Would you rather keep guessing at who your best customers are or experience tools that will revolutionize the way you visualize your data to target your plan?
- The resolution that pharmacists must accept any customer and prescriptions that walks through the door. Wouldn’t you rather control where you get your profits instead of being at the mercy of the cash register?
For those unaware of why Paul is a results-driven analytics titan, he is the inspiration for the Moneyball Methodology used in the major motion picture “Moneyball,” starring Brad Pitt. Sound familiar?
He served as Assistant General Manager of the Oakland Athletics from 1999 to 2003. At the time of his hire, Oakland was one of the worst teams in the league, coming off of six losing seasons while posting one of the lowest payrolls in baseball. In an industry entrenched in ingrained thinking and outdated systems, the stagnant team needed the unique management and creative approach that A’s GM Billy Beane and Paul DePodesta brought to the table.
By Paul’s final four seasons in Oakland, the A’s won more regular season games than the New York Yankees, who during the same period spent $350 million more on player payroll than did the Athletics. By his unique approach and commitment to leverage data to maintain a level of unimagined success, he and Billy Beane revolutionized the way baseball teams are built. His work has been recognized by various publications, including Fortune, who named him one of the Top 10 innovators under 40.
At PDS Super-Conference, we’re not just going to make you more money. We’re going to revolutionize the way you see your pharmacy to get you fast results you have never dreamed were possible. Pharmacy data analytics is available to the independent industry and PDS is helping owners stay competitive in an increasingly challenging business landscape.
PDS Announces All-Star Lineup for 2016 Business Growth Conference in Orlando
Every year, PDS visionary, Founder, President and CEO, Dan Benamoz, personally selects the most impactful keynote speakers, topics and exhibitors to join us in Orlando for the annual PDS Super-Conference. The 2016 lineup is our best ever with business gurus and trailblazers slated to speak on topics like team leadership, pharmacogenomics, wealth management, pharmacy sales and marketing.
A special invitation from Kevin O’Leary of ABC’s Shark Tank:
Independent Pharmacy’s Premier Event
Every day is filled with difficult choices, but choosing which industry event to attend should be easy. The 12th annual Together Toward Tomorrow Independent Pharmacy Business Growth Super-Conference is right around the corner. From February 25-27, 2016, our nation’s most successful and up and coming pharmacy owners will come together to learn compelling solutions and new executable ideas that will set the stage for continuous growth in the year ahead. Today, more than ever before, we must possess the ability to foresee and welcome industry changes as they come – armed with the solutions that will help us win. With that in mind, here are ten reasons you should attend pharmacy’s main event, PDS 2016.
1. Three Eye-Opening Days
The 2016 Super-Conference is unlike any industry event you’ve ever experienced. For three days, you’ll step into a space that will give you the right tools to generate ideas and strategically plan your business operations in a way that can’t be done anywhere else. We will dare you to think bigger and better than you ever have before, to seek opportunities and challenge the status quo.
2. Ready to Implement Ideas
What small change can you make that can pay huge dividends right now? The concepts presented at this event will teach you how to operate your business from the position of clarity and control. Our speakers will share their strategic leadership, business management, finance and marketing tools to set the groundwork for your very own robust business model. They will inspire empowered financial decision-making through every stage of the business life cycle.
3. Inspirational Speakers
We’re bringing luminary speakers from pharmacy business management and beyond to inspire you, help you infuse new ideas into your business and provide insight into how you can keep your money where it belongs – in your pocket! Click here to learn more about the 2016 lineup of keynote speakers, which includes Kevin O’Leary from ABC’s Shark Tank.
4. No Clinical Programming
We know that you don’t need another course on diabetic footwear. At the PDS Conference, topics include wealth management, pharmacy leadership, employee development, customer service and culture, increasing pharmacy sales and pharmacy marketing… just to name a few. If you don’t walk away with at least five executable money-saving and money-making ideas, you weren’t listening.
5. Leading Industry Vendors
Connect with the 100+ world-class exhibitors who will deliver state-of-the-art automated pharmacy systems and services that will refine your operations and propel your business into the high-quality profit machine you have always envisioned. Each vendor is cherry-picked for quality and has the PDS stamp of approval.
6. The Best Networking in the Industry
You are the company you keep. Interact with the top 20% of pharmacy owners in the country and connect with the most progressive minds in the business. Year after year, participants have said that the value gained from lasting connections alone justifies the trip. You will learn what other pharmacy owners have been doing to become more profitable. Plus, who can resist a chance to unwind and socialize in Florida’s warm weather?
7. Access to Competitive Strategies
The pharmacy industry is ever-changing, from health care regulations to public opinion. In a world in which knowledge is power, what you don’t know CAN hurt you. The 2016 PDS Conference will unravel key data points that will show you how to drive your strategy, soothe your fears about the future, and give your pharmacy a competitive edge.
8. PDS Membership Test Drive
PDS16 is your chance to get up close and personal with current PDS Members and learn about Members-only programming. PDS Performance Specialists and Business Advisors will be giving demos, sharing tips and answering questions. The PDS team will be delighted to share the mechanics behind our unique training programs and the secret sauce that has caused our Members to earn up to 70 times return on their membership investment.
9. Online Speaker Sessions
Over the past twelve years, our keynote speakers have made dozens of groundbreaking presentations. As an added bonus with this year’s Conference registration, you will gain access to 10 brilliant speaker sessions from year’s past. In the weeks leading up to the event, you will have the opportunity to jumpstart your progress by listening to these sessions online.
10. Free Companion Pass
We encourage conference attendees to help spread the word about amazing innovations available for independent pharmacies. Each ticket includes an extra admission for anyone who is interested in gaining a better understanding of the nature, goals and challenges of our industry ($1,795 value). Bring another pharmacy owner and help us move Together Toward Tomorrow.
What changes will threaten your business this year and next? What new revenue and profit opportunities are you missing out on? There is only one way to make sure you are in the know. Register for the most crucial event you will ever attend for your business. Still on the fence? Contact us with your questions.
Never underestimate the power of networking! It may sound too good to be true, but investing the time to speak with like-minded professionals truly has the power to transform your business. That is why Make Networking a Priority is number 2 on our list of 5 New Year’s Resolutions for Pharmacy Owners in 2016.
Take PDS President and CEO, Dan Benamoz, for example. He attends industry events year-round and always comes back overflowing with new ideas from presentations attended and friendships formed. Whether it’s a profitable new business relationship or a revolutionary program for motivating staff, the benefits of networking are endless.
Why Does Networking Matter for Independents?
When you spend time with industry leaders, you have the opportunity to eliminate trial and error by hashing out your plans with those who have already implemented similar concepts successfully. Taking advantage of the opportunity to network with other pharmacy owners could save you countless dollars and hours. When done properly, you will build a supportive community of professionals who provide motivation and encouragement when you need it most.
Here are three easy tips to help you get started right away.
- Develop a Strong Introduction.
Be prepared to deliver an elevator speech that is impactful and concise. You will want to communicate who you are and why you are at the event, with enough information to keep the conversation flowing. You may also want to prepare a few questions you can use as conversation starters.
- Manage Your Expectations
When it comes to networking, a little preparation can go a long way. Before heading to the main event, take time to find out who will be in attendance and establish reasonable goals for yourself. For example, plan to meet ten new people and distribute five of your own business cards. Don’t forget that one high-quality conversation is more beneficial than twenty brief introductions.
- Practice Often
Networking is a skill that improves with experience. Even the most outgoing pharmacy owners can be slightly nervous when testing out a newly crafted elevator speech. The more you network, the easier it gets, so get started now and practice often. Attend pharmacy trainings in your area, get involved with your state association and register for the most impactful industry conferences.
The #1 Networking Opportunity for Independent Pharmacists
As an independent pharmacist, it’s easy to discount the fact that you are part of a large, impressive community, which is why networking with peers has proven to be an invaluable tool for thousands of pharmacy owners just like you. Make 2016 easier and better by spending time with other independents at the 12th annual PDS Conference. It is a ruthlessly fact-based, what’s-really-working-now event exclusively dedicated to building strength and security in your business and for us all as a collective, today and tomorrow – in a fast-changing healthcare, retail, and e-commerce environment, where the “slow” will die fast!
Business achievement often comes down to focusing on your strengths, while working to improve your weaknesses. If you happen to be more shy or introverted than the typical charismatic entrepreneur, don’t worry! Whether you enjoy it or not, networking is vital to the success of your independent pharmacy and with a little practice and preparation, you can become a networking guru. If you’re nervous about an upcoming conference, lunch meeting or party, experiment with these tips.
Manage Your Expectations
Rather than approaching your next social event with fear, manage your expectations by planning ahead. Before heading to the main event, establish reasonable goals. For example, you may determine to meet ten new people and distribute five of your own business cards. Remember that one high-quality conversation is more beneficial than twenty brief introductions.
Practice Your Introduction
Shy people have a more difficult time starting conversations with strangers, but a small amount of preparation can make a big difference. Develop a memorable introduction, also known as an elevator speech, to describe who you are and why your pharmacy is special. You may also want to prepare a few questions you can use as conversation starters. Research the event to find out who will be there and what their interests are, so you will be prepared to discuss relevant topics.
Set a Time Limit
If you are especially nervous about a particular event, plan to stay for a short time only. Instead of planning to stay for the duration, start small by committing to one hour. Showing up is the first step. You may surprise yourself by decidingto stay longer.
Networking is a skill that improves with experience. Even an extrovert can be slightly nervous when testing out a newly crafted elevator speech. The more you network, the easier it gets, so get started now and practice often.
Introverts draw energy from being alone, so taking breaks can help immensely. Next time you feel drained at an industry event, return to your hotel room, go for a walk outside or find a quiet spot in the lobby to decompress. No matter what, do not let a fear of networking hold you back. For introverts and extroverts alike, the advantages of networking far outweigh the risks.
Every year, pharmacy owners of every kind attend the industry’s main event and report that it’s the most valuable thing they do for their business all year long. Don’t miss the opportunity to network and learn from America’s best pharmacy owners at the Independent Pharmacy Together Toward Tomorrow Conference. Tickets are now available.
Today’s pharmacies are at a significant crossroads between the conventional drug-dispensing identity of the past and a pioneering clinical role with health care provider status. For the past several decades, the concept of “provider status” has been tossed around at every pharmacy school, pharmacy association meeting and pharmacy work site. Provider status is frequently discussed at networking events, so you may be asking yourself “Is it really vital to our profession’s survival?” The answer is a definitive yes.
How will your pharmacy practice evolve to meet the needs of the 21st-century health care system? Pharmacists’ services have begun to grow well beyond functions tied only to dispensing medications. Many of today’s pharmacists also provide such advanced patient-centered services as:
- Coordination of medications (also known as a med-sync program)
- Medication management
- Comprehensive medication reviews with ongoing medication monitoring
- Chronic disease management
- Disease education
- Prevention and wellness services
- Patient education
For patients to achieve the full benefit of their medications, pharmacists must be an integral part of the health care team. Why is it so important for your pharmacy to achieve provider status?
Help the Economy
Improving quality of life and overall health in a cost-effective manner are important goals for everyone. Proper use of medications is essential to meeting that goal, particularly for those with chronic conditions requiring complex medication therapies. According to a 2009 study, the treatment of chronic diseases costs the U.S. health care system $1.7 trillion annually, accounting for about 75% of healthcare expenses. Even a small improvement in chronic disease management would result in substantial savings for your patients. As millions of Baby Boomers age into retirement, the opportunities to decrease costs are even more important to the economy.
Keep Your Customers Healthy
The impact of medication misuse is staggering. Each year, there are more than 1.5 million preventable medication-related adverse events in the United States alone. Furthermore, the health care system incurs nearly $290 billion dollars annually in mostly avoidable costs to treat issues that arise from inappropriate medication use. Non-adherence alone results in $100 billion each year in excess hospitalizations. Pharmacists like you bring comprehensive knowledge on the useof medications for the treatment, management and prevention of diseases to the health care team. You care about your customers, so achieving provider status is just one more way to give them the best care possible.
Improve Customer Satisfaction
If your pharmacy reaches provider status, your patients will no longer need to make an appointment with their primary care doctor for simple tests related to chronic diseases, patient assessments, and disease management. Your patients will maintain their health, have a better understanding of their medications and save money. If you can provide these additional services, patients will be increasingly loyal to your business.
When pharmacists are involved as active members of the healthcare team, patient outcomes improve, they report higher rates of satisfaction, and overall health care costs are reduced. Recognition and coverage of pharmacist-provided patient care services should create more incentives for pharmacy owners to expand the services offered and integrate these services into evolving business models. Understanding this and staying ahead of the competition is vital to your pharmacy’s success.
Pharmacy ownership is constantly evolving and the best way to make sure you remain ahead of the curve is to attend the industry’s main event. You will network with like-minded industry professionals and learn about every significant change to pharmacy ownership at the PDS Together Toward Tomorrow conference.
One of the best ways to improve your pharmacy is to spend time learning from mentors, experts, and other independent pharmacy owners who can motivate and encourage you in a pharmacy industry event. There is great value in surrounding yourself with people who possess similar business values, goals, and interests. Connecting with people who understand your daily struggle and have the wisdom to share their experiences is easier than you think.
Many pharmacy owners express that taking the time to attend an industry event is a huge challenge. Meanwhile, the pharmacy owners who make networking and continuing education a priority, never regret their decision to do so.
Here are seven reasons why you need to attend a pharmacy industry event this year:
Never underestimate the importance of meeting and talking with your industry peers. Hearing that you are not alone and that others are experiencing the same challenges can be a huge morale booster. Meeting like-minded pharmacy owners will provide motivation and the opportunity for new partnerships and friendships.
2. Exposure to New Ideas
No matter how experienced you are, there is always something new to learn. At industry events, you are exposed to a world of new ideas, programs, and techniques that can improve your business. Spending time with the industry’s top innovators will help get your creative juices flowing and will allow you to select new concepts to implement in your pharmacy.
3. Discover New Vendors and Suppliers
In many cases, conference attendees shy away from the tradeshow floor, because they want to avoid aggressive salespeople. At a reputable conference, the vendors are selected for their high-quality products, integrity and commitment to the client’s success. In that case, pharmacy industry events are the best way to discover innovative products and services that will make your life easier and help you stay ahead of the competition.
4. Regain Your Focus
The human brain cannot function at it’s highest level in times of stress and disorganization. A conference is a great opportunity to travel away from daily distractions, clear your mind and get refreshed. You will have the ability to refocus, develop new plans and implement new ideas like never before.
5. Stay in Touch with Old Friends
Conferences are the perfect time to reconnect with old classmates, colleagues, and mentors. You will undoubtedly have new ideas, experiences and stories to share with each other as you catch up. You will certainly make new friends, but some of your most meaningful business ideas could come from a conversation with someone you have known for years.
6. Position Yourself as an Expert
Being seen and heard during pharmacy events will serve you well in the future. When you are active in the industry, you can develop a reputation as an expert among your peers. If you are actively engaged over several years, you may even be asked to speak at events or write articles for various publications. Your customers will feel great about doing business with such a celebrated pharmacy. Being quoted by the local news or a highly visited website will do wonders for your business.
7. Have Fun
Don’t forget that conferences are also very fun! Industry events add a much-needed layer of enjoyment to managing your pharmacy’s growth by mixing a social aspect into your learning experience. Many conferences include fun activities such as meet and greet parties, happy hours, golf and even tours of the city where the event is hosted. You may even consider taking an extra day at the beginning or end of the trip to explore the region on your own.
In our fast-paced, constantly busy world, we often forget about the immeasurable value of face-to-face interaction with industry peers and leaders. Do not miss the opportunity to make this your best year yet by empowering yourself with the tools and relationships needed for independent pharmacy success. The PDS Together Toward Tomorrow Conference is now open for registration!
If you are going to attend just one conference each year, make it this one. Pharmacy professionals just like you have already signed up, expecting to be empowered, educated, and encouraged. Together, we can make 2016 the best year of pharmacy and pave the way for a better future for the entire industry. Reserve your seat now.
Connecting with other pharmacy owners is the single most important marketing and business ownership tool available to any pharmacy entrepreneur. Relationships are the catalyst for success. When you build a strong network of like-minded professionals around you, you will be amazed at the progress you can make together as a group. Building strategic, impactful relationships is completely free and getting started is easier than you think.
Get Business Cards
As a savvy business owner, you know the importance of networking, but you may not realize how influential your business cards can be. The quality of your card will leave a lasting impression on those who receive it. Purchasing quality business cards should be thought of as a critical investment, not an area to save money. Hire a professional agency and find a design that completely captures what you and your pharmacy are all about.
Practice Your Elevator Speech
When you attend a networking event, be prepared to deliver an elevator speech. A clear, brief synopsis about you and your business will allow you to communicate who you are and why you are at the event. In about thirty seconds, you will convey enough information to begin a conversation with your new contact.
Go to Industry Events
industry conference is a perfect opportunity to meet independent pharmacy owners just like you. It provides a unique opportunity to discuss best practices within the industry, learn about new programs and get advice from industry leaders who understand the challenges you face on a daily basis. You will gain a variety of viewpoints from other independent pharmacy owners and you will pick up new ideas to improve your current processes.
Connecting and networking with other pharmacy owners should be fun, not scary. If you are enjoying yourself, you will naturally attract others to you and the networking will feel much more organic. Many conferences include fun, informal events like lunch socials and happy hours, which are a prime opportunity to easily build new relationships.
There is no limit to how much your pharmacy may grow through networking. As the old saying goes, “it’s not what you know, it’s who you know.” When your network is constantly expanding, so are your chances of meeting industry experts, receiving valuable advice and learning new skills. If you are ready to make new friends and learn from the pharmacy industry’s absolute top leaders, we invite you to join us at next year’s Together Toward Tomorrow Super-Conference
At the conference, we will highlight new ways to grow your business through connection and innovation. We believe that although you are independent, you are not alone. Together, we can make 2016 the best year of independent pharmacy yet and pave the way toward a better tomorrow. Join us!