PRICING PROBLEMS
NOT AN EASY FIX
We have spent a lot of time researching the pricing problems that are now an everyday event and causing many problems throughout the Pharmacy community. It is not an easy fix because many of our partners are causing this, not just one PBM, not just any wholesaler, not just any pricing guide. It should be noted here that First Data is no longer supplying its clients any AWP pricing. AWP now equals WAC X 120%.
Branded Drugs:
Branded manufacturers seem to like to increase their pricing during the first week of the month. As some PBM’s receive their updates from the pricing guides either weekly or monthly, their data base is not updated for at least a week, but if updated monthly, this increases to at least 4 weeks. The problem here is that the wholesalers update daily. When I send in a pricing problem report, many times the PBM’s have not seen the price increase in their data base, so it is rejected. The solution is for us to be given notice by the wholesalers or preferably the manufacturers (which was common practice in years past). 30 day buy-ins should be permitted by our stores at the old price.
Generic Drugs:
The above problem with Branded products works here also, but that is just the start of a very convoluted situation. It seems generic manufacturers are having breakfast meetings deciding who will and who will not manufacture a product. There are shortages of active ingredient, which we know is nonsense, and is being investigated by some government agencies. When a popular drug that was being manufactured by multiple companies all of a sudden is available only through one manufacturer, and the price is increased overnight by 1000% to 2000% – Are we looking at an antitrust violation? When it is mentioned to the PBM that it is only available from one manufacturer & should not be reimbursed as a generic – they have no answer because the pricing guides do not give them this information.
With the above said, the average generic prescription price has increased substantially over the past few years. With professional fees being lowered and with MAC prices being lowered; Gross profits at store level are taking a big hit.
MAC pricing: How are they calculated? This is a question that we have asked many PBM’s without any PBM giving us their procedure. Do the so called “MAC committees” meet weekly, monthly, or quarterly? No response. Are they including in their calculation drugs that have been discontinued by the manufacturer, but still listed by the pricing guides? Absolutely!
There is still only one way to fight back and let the PBM’s and Plans know that we are watching. Please continue to visit our website www.kpparx.com – Our website offers everyone (members & non-members) accessibility to our Pricing Problem Report on the home page. We receive these problems and pass them on to the proper administrator. Most PBM’s, excluding Prescription Solutions, accept these reports for review and are making some effort to resolve these problems. Not as quickly as we would like, but much faster than if no one complains. I send Prescription Solution problems to multiple Managed Care Organizations (MCO’s) to submit because they will not accept from us.
If you were using PARD/Keystone Fax forms, please switch over to the website.