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Small pharmacy
Old 02-17-2014, 05:07 PM   #1
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Small pharmacy

We use a local small local pharmacy. Close to home, convenient, never crowded.

Well my first refills of existing meds under my new ACA policy went through fine. Second batch there's a problem with my $5.00 generic cluster headache medicine. Pharmacist calls DR. says it's no longer covered. I agree to try something else, even though I know that it's never worked before. As I expected no help for headaches.

Checking on BCBS website says its covered. I call and speak with someone, yes it's covered $5.00 copay. I call pharmacy explained what they needed to do, please fill my prescription.

Couple hours later the pharmacist calls me and admits there's no problem with my insurance coverage. Her problem is the reimbursement from the insurance company is too low, she lost money last month, and will not refill scrip. Says she doesn't want to lose our business. Told her to send it to Walmart. As bad as I hate going to Walmart, I'm not going to be lied to. When next refills come due, guess I'll be moving them too.

Bottom line we tend to trust pharmacists, there's at least one thats a bold a$$ liar. Be careful don't believe everything your told.

MRG
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Old 02-18-2014, 07:56 AM   #2
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Now, I hope we can all get equally upset with the new Affordable Care Act as you have with your pharmacist.
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Old 02-18-2014, 08:13 AM   #3
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Bottom line we tend to trust pharmacists, there's at least one thats a bold a$$ liar. Be careful don't believe everything your told.

MRG
At least they 'fessed up and admitted the truth. Independent family businesses have a hard time competing against the big guys.

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Now, I hope we can all get equally upset with the new Affordable Care Act as you have with your pharmacist.
If you want to discuss the ACA please do so in a separate thread so this one doesn't get hijacked.
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Old 02-18-2014, 08:56 AM   #4
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Pharmacies contract with insurers just like other providers do. They accept a negotiated (lower) level of reimbursement in exchange for that insurer's larger patient group (i.e., more potential customers outweighs the lower margin.) IMO, that pharmacist would be foolish to risk losing her contract with BCBS -- and all those patients -- over one prescription. I would tell BCBS that the provider was attempting to deny me the contractual service at the agreed upon price -- a serious charge they cannot ignore.

That said, chain pharmacies often provide a reasonable alternative to independent shops. For convenience, I just use the pharmacy in the grocery store, since I'm there every week anyway.

(Not sure what any of this has to do with the ACA, by the way. It's always worked this way.)
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Old 02-18-2014, 09:05 AM   #5
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...........(Not sure what any of this has to do with the ACA, by the way. It's always worked this way.)
All medical related problems from January 1st, 2014 onward, are the fault of the ACA.
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Old 02-18-2014, 09:10 AM   #6
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Not sure if this is relevant here or not, but has to do with small businesses... local pharmacies, groceries and some mom and pop franchises. Not for ACA, but for products that are promoted with the use of coupons.
Because of the threat of misuse by the local proprietor, in order to redeem the coupon value from the vendor, the small business may have to submit proof that it actually had the product on hand (invoices showing the purchase by the small business). While this may not apply to the original post, it is one of the problems facing small businesses. The individual mom and pop store survival is often less based on the actual sales and profit than on the overwhelming burden of paperwork.
Been there, done that... w*rk during the day, and hours of paperwork at night.

In particular, another problem for smaller independent pharmacies is that of maintaining supplies of time-determined medicines, such as the shingles vaccine which has a short lifetime.

While the economies of scale have produced lower prices, many, if not most downtowns have turned into ghost towns. A matter of progress of course, but for us geezers, a sad reminder of the old days.
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Old 02-18-2014, 09:59 AM   #7
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Pharmacies contract with insurers just like other providers do. They accept a negotiated (lower) level of reimbursement in exchange for that insurer's larger patient group (i.e., more potential customers outweighs the lower margin.) IMO, that pharmacist would be foolish to risk losing her contract with BCBS -- and all those patients -- over one prescription. I would tell BCBS that the provider was attempting to deny me the contractual service at the agreed upon price -- a serious charge they cannot ignore.

That said, chain pharmacies often provide a reasonable alternative to independent shops. For convenience, I just use the pharmacy in the grocery store, since I'm there every week anyway.

(Not sure what any of this has to do with the ACA, by the way. It's always worked this way.)
This has nothing to do with ACA, same pharmacist told me that my old COBRA policy would no longer pay for this prescription as of 1/1/14. I don't believe that either(now).

Think I will contact BCBS about the pharmacy's refusal to comply with their contact. I did find the business owners, I may give them a call. Probably will wait till all our scripts are transferred, and I calm down.

I do understand the difficulty for small businesses to complete. That's why we would routinely wait a day for some prescriptions.

As far as fessing up, it was only when the truth was her last resort that she admitted what was going on. The woman lied to me, and my DRs nurse(think that crosses another line). I guess I need to work on forgiveness. Thanks all. Caveat emptor.
MRG
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Old 02-18-2014, 10:41 AM   #8
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Sounds like fraud to me.
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Old 02-18-2014, 10:52 AM   #9
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Originally Posted by MRG View Post
We use a local small local pharmacy. Close to home, convenient, never crowded.

Well my first refills of existing meds under my new ACA policy went through fine. Second batch there's a problem with my $5.00 generic cluster headache medicine. Pharmacist calls DR. says it's no longer covered. I agree to try something else, even though I know that it's never worked before. As I expected no help for headaches.

Checking on BCBS website says its covered. I call and speak with someone, yes it's covered $5.00 copay. I call pharmacy explained what they needed to do, please fill my prescription.

Couple hours later the pharmacist calls me and admits there's no problem with my insurance coverage. Her problem is the reimbursement from the insurance company is too low, she lost money last month, and will not refill scrip. Says she doesn't want to lose our business. Told her to send it to Walmart. As bad as I hate going to Walmart, I'm not going to be lied to. When next refills come due, guess I'll be moving them too.

Bottom line we tend to trust pharmacists, there's at least one thats a bold a$$ liar. Be careful don't believe everything your told.

MRG
a large chain - Dr. calls in prescription for my wife. I call pharm. to see if
it is ready, they say "Dr. did not send prescription yet" I say "Yes he did"
they put me on hold and come back and say "it will be ready in 15 minutes"
anything insurance is a big Pain in the As%^.
The pharmacy never checked when I called.
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Old 02-18-2014, 11:14 AM   #10
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a large chain - Dr. calls in prescription for my wife. I call pharm. to see if
it is ready, they say "Dr. did not send prescription yet" I say "Yes he did"t
they put me on hold and come back and say "it will be ready in 15 minutes"
anything insurance is a big Pain in the As%^.
The pharmacy never checked when I called.
I called in a prescription to a big mail-order pharm for my husband, waited 24 hours and called in on the patient line to request the shipment. "The doctor didn't call in the prescription." Me, "Are you really sure the doctor didn't call it in?" Them, "No, he (sic) didn't call it in." Me, "That's weird because I am the doctor and I distinctly remember calling it in." Things are better with electronic prescribing now, although still not perfect.
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Old 02-18-2014, 03:13 PM   #11
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Sounds like fraud to me.
Me too, it's wrong. I did learn of the pharmacist code of ethics, seems they use honestly and integrity wording. (See below)

I've called BCBS, they're sending me an appeal/grievance form to complete. Explained I would never trust that pharmacy again, she said that's how all their investigations start out. She also indicated there was a section for the MO. insurance commission, please fill that out too.

I'm not contacting the business owners. Far as I know the owners may support this behavior. They can get the surprise when BCBS, or state insurance comission contacts them.
MRG

IV. A pharmacist acts with honesty and integrity inprofessional relationships.
A pharmacist has a duty to tell the truth and to act withconviction of conscience. A pharmacist avoids discriminatorypractices, behavior or work conditions that impair professionaljudgment, and actions that compromise dedication to the bestinterests of patients.

http://www.uspharmd.com/pharmacist/p...ode_of_ethics/
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Old 02-18-2014, 03:22 PM   #12
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While the economies of scale have produced lower prices, many, if not most downtowns have turned into ghost towns. A matter of progress of course, but for us geezers, a sad reminder of the old days.
In some ways yes, in some ways no. When the first Home Depot opened near where we lived at the time I was reluctant to buy there because I liked the old "Mom 'n Pop" hardware store that I'd been going to for ten years. Came the time I wanted a simple mailbox to replace a rusty one.

The old store had it: $15

Home Depot had the identical item: $7.50 not on sale.

Decided I didn't like the old hardware store that much. They closed about two months after HD opened.
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Old 02-22-2014, 09:24 PM   #13
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I never had bought a drug until after i had a HA two years ago. I hadn't signed up for drugs when I got on Medicare. Left the hospital after my HA and wife went to the pharmacy to get prescription filled . Generic was $179. For a months supply. Before the end of the month, I found a script save card on the Internet . Printed it out and filled in my name. Back to pharmacy and $179 was reduced to $49.00. I sent a email to Walgreens complaining, and day later the pharmacy called and said that they have a $130.refund. For me. Then someone said check with Costco. I take the prescription there to find out how much it would cost. Guy checks and says $29.
I think heck thats pretty good ...20 bucks less. BUT that$29. Was for THREE months. Costco is cheeper than Canadian pharmacies.
And you don't even have to be a member. If your not a member, you pay an extra 10%.
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Old 03-07-2014, 05:28 PM   #14
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Costco really has it together. Wish I had one closer to where I live.
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Old 03-07-2014, 05:53 PM   #15
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This has nothing to do with ACA, same pharmacist told me that my old COBRA policy would no longer pay for this prescription as of 1/1/14. I don't believe that either(now).

I think folks are mentioning ACA because you made it a point of your original post. When I read it, I wondered why you mentioned it since it was irrelevant.

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Well my first refills of existing meds under my new ACA policy went through fine. Second batch there's a problem with my $5.00 generic cluster headache medicine
You would have had the same situation even if the refill was not "under my new ACA policy." This is related to your Part D insurance and the fact that the insurance reimbursement to the drug store plus your $5.00 copay is less than the drug store is paying for the drug.

I think mom and pop drug stores without real price negotiation leverage with the drug companies will be gone shortly.
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Old 03-07-2014, 06:28 PM   #16
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Like all the other "mom and pops"... Believe me I know..we had one.
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Old 03-07-2014, 06:48 PM   #17
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Costco really has it together. Wish I had one closer to where I live.
My vet prescribed meds for our dogs that Costco would fill. (Relatively) cheaply. Very good deal for us as the meds were expensive.
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Old 03-07-2014, 07:33 PM   #18
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Costco really has it together. Wish I had one closer to where I live.
You can shop online. Even at its pharmacy!
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Old 03-08-2014, 10:03 AM   #19
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I think folks are mentioning ACA because you made it a point of your original post. When I read it, I wondered why you mentioned it since it was irrelevant.



You would have had the same situation even if the refill was not "under my new ACA policy." This is related to your[sic] (Medicare) Part D insurance and the fact that the insurance reimbursement to the drug store plus your $5.00 copay is less than the drug store is paying for the drug.

I think mom and pop drug stores without real price negotiation leverage with the drug companies will be gone shortly.
Perhaps your comment about my [sic] (Medicare) Part D insurance, is the reason I mentioned ACA in my initial post. I didn't want folks confused on what type of insurance I had. An "irrelevant" qualification. Even with it, someone's confused about what type of insurance.

As far as small pharmacy's not having price negotiation leverage, true. It doesn't give them permission to lie to their customers. If they need to lie to stay competitive, they should go out of business. If a pharmacy lies to my Doctor about my benefits to improve their bottom line, it's about trust and ethics. I don't see this behavior as different than other types of ethical breaches, such as diluting medications, providing sugar pills, or any other alteration to medications.

Sorry for my poor communication skills,
MRG

Jury awards woman $2.2B in diluted drug case
KANSAS CITY, Mo. (AP) — A jury awarded $2.2 billion Thursday to a cancer patient whose pharmacist watered down her chemotherapy drugs. As the jurors left the courtroom, each of them hugged the woman, Georgia Hayes, who brought the first of more than 400 lawsuits against former pharmacist Robert R. Courtney.
http://usatoday30.usatoday.com/news/...ugs-case_x.htm
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