I realize up front that there are going to be many offended by my post here and for that I am sorry, but it is time to say it.
Seriously, is anyone surprised by the Express Scripts/Medco merger? Big business always wins in today’s environment. I’m sure NCPA will get this decision delayed but in the end a merger like this will always go through because of the shell games played by the participants and $$$$$.
You have all been hearing this for years. Profits from filling prescriptions are gone and are NEVER coming back. If you want to continue to bank your future on profits from prescriptions it is only a matter of time. You see the results every time you fill a prescription! It is now a commodity. What is the old saying that people erroneously claim is a definition for insanity? Continuously doing the same things and expecting different results. It really is a definition of failure.
There are those in our profession who still believe that the answer is squeezing wholesalers for lower cost of goods. You are not going to see lower COG because they are not there! Their profits are gone too. They are as efficient as they can be. Why do you think they are shifting emphasis to “specialty drugs?” National wholesalers try to be our friend and I believe that they really want to be our friend, but they don’t know how. So they cover their own rears by courting the very enemies of our profession that they claim to fight against. Don’t believe me? Then answer me this; why do they even provide pricing to the PBMs? Did it ever occur to you that the only way PBMs know what we pay is because the wholesalers tell them? Why do they do that? The reason is because all of them either owned PBMs or were incentivized by PBMs to provide this information. For what purpose? I’ll let you decide.
Others believe that belonging to groups is the answer. The fact is it doesn’t matter which PSAO or GPO you belong to, the prices are virtually the same. There is no give left. However, GPOs are necessary.They provide an island of sanity in this sea of insanity. Find one that fits your needs and JOIN! Go to conventions! Network with your colleagues! We are not each other’s enemies so let’s try being each other’s friends!
Ken and Jim Fields who own ApproRx, a pharmacist oriented PBM, and are innovative pharmacists in their own rights, will tell you, we are not playing the same game anymore. Our ONLY option is to CHANGE. Yes, that is right CHANGE. I know that it kills us to think about it but the way we have existed since the 50?s is not going to get it done. Joining together to demand lower and lower prices from wholesalers is fruitless. There are only pennies to be gained. You think Walgreens is buying significantly lower on brand names? Wrong! Why do you think they chose to stand down Express Scripts and lose that business? Because there is no money there!
Until we learn to let go of the past we will continue to wallow in self-pity and eventually drown. We MUST begin now to offer something that the PBMs need. That is a way to lower cost to their clients without milking dispensing costs. Even ES knows that there is a limit to those savings. They are at the bottom. ES is just trying to gain market share with this merger to buy time. They know their old way of doing business is ending. Transparency is here. Group by group, employers and government are going to demand accountability and ES cannot provide it and still make money.
Preventative care is the answer everyone is seeking. Active health coaching is a pharmacist’s dream. Instead we dream that one day all independents will work together. It is just not going to happen. There are dreamers and there are doers. ApproRx and RxAlly are actively providing answers TODAY. However, even they cannot do it without us.
What is the number one thing that is costing the health care system? You know the answer and it is inarguable. Obesity. The amount of money to be made by providing the answer to this problem is immeasurable. Provide a solution for the majority of the players in this scenario beginning with the patient, and the HMOs, PBMs, employers, government, ACOs and any other initials that you want to throw out there, will beat our door down for our services.
Argue this point all you want. Lampoon me all you want. The only thing holding pharmacists back from the future is us…and our need to find the easy way out. I’ve got news for you; there is no easy way out. However, I will make this one GUARANTEE. Continue to spend all of your energy trying to find a solution within this current system in which we all operate and the only thing you will find is the end of your business.
Change is inevitable and the time is here. Those who embrace it will be around to fight another day. Those who don’t….