Lipitor My Lipitor

Did you read the news last week?  Pfizer announced they would offer their brand Lipitor to PBM customers at the generic copay rate.  Wow, what good corporate citizens.  There were many newspaper articles that said Pfizer would give up at least half of their profit on each 90 day supply of Lipitor (about $100). Considering the cost of 90 Lipitor to be around $450 dollars for 90 tablets,that would be a $200 dollar profit after expenses like: TV advertising, cost of sales people, etc.  I just looked at my reimbursement to dispense a 90 day supply of Lipitor from one of the top 3 PBM's (hint: Express Scripts) and guess what my reimbursement just happened to be?  Let me tell you. (I hope I don't get arrested) I was paid $451.45 for the cost of the drug and a 25 cent dispensing fee.  So if the newspapers got it right, I made a large $1.45 for buying the product, stocking it in a legal licensed pharmacy, having a professional dispense the product to the patient, and, including a bottle and label to boot.  If you are keeping score, it's Pfizer $200 and me $1.45.  The difference is Pfizer's $200 is net profit and mine is gross profit.  My patient paid me a copay of $9.00 today for 3 months supply and Express will send me the rest in about 30 days.  I guess the liability insurance I carry in order to fill prescriptions and the license that I have to buy from the state and the DEA license I have to buy from Uncle Sam have been reduced  (not on your life) because the payers and PBM's don't value the service I provide to my customers.  Service like coming back to the store in the middle of the night to fill a hospice prescription for a dying loved one, Service like free delivery to the elderly who don't drive or live alone, Service like holding tickets for prescriptions til pay day.  I guess the payers and PBM's don't care about their employees getting services like these.  Helping people is the reason most of us pharmacists went to pharmacy school.  It's a sad day when our society allows big business like PBM's to drive the profit down in our home town small businesses so much that many can't afford to pay their power bills.  I am happy that Lipitor users will get it for the generic copay.  I just wonder why Pfizer couldn't be a good corporate citizen and just drop the price of the Brand Lipitor to the generic price (about $200 for 90 tablets).  My cost would go down, I would stock Lipitor and not the generic (as much) and everyone would be happy.  Well, except the folks that have back door deals with Pfizer. (PBM's and many payers).  I just happen to like watching "Boardwalk Empire" on HBO.  It's about Atlantic City during prohibition and how mobsters became popular with governments and employers.  Al Capone had many back door deals to sell illegal alcohol and strong armed many businesses in order to keep his profits high.  Our government eventually got Al and set up rules that would help protect small business from ruthless businessmen like him.  It seems to me that many of the PBM's took a page right out of old Al's playbook.  (on a side note; did you know that when prohibition started Walgreen's only had 10 stores and when prohibition ended 7 years later they had 500 stores?  Talk about making hay!)  I have to start wondering when our profession is going to wake up and demand reform for payment.  Reform for product payment (prescriptions) and reform for professional services.  If we don't do it, who will?  If the Express Scripts/Medco merger goes thru then about 40% of my business will be Express Script.  Hypothetically if I do 1000 prescriptions a day I would do 400 ES/M prescriptions.  I would make about $180 bucks.  If I sold potato peelers (like the guy in New York (Joe Ades) who put his daughter thru Harvard) I would make lets see: 1 peeler for $10 or 3 for $20, and I sold 400, I would make around $2500. And no pharmacy school, no professional liability insurance, no building, no employees.  As you see, I digress.  You get the picture.  We are being insulted every day in our profession by those business people who sign these bad contracts.  No longer can we afford to do this.  Big chains don't pay what I pay for Lipitor.  Neither does mail order pharmacy, hospitals, state governments, health clinics and many many other types of pharmacy.  Community independently owned pharmacies pay the highest price for drugs in the United States.  That is why ladies and gents we are an endangered species as we exist today.  We are the subsidizers, the brokers of free service and advice.  We are determined to take care of our patients no matter what it means to our businesses.  We have to take a dose of reality and realize that we can no longer give away stuff for free (like medicine spoons and droppers just to name a few things) or our advise.  If we are to continue to serve patients there may come a day when we charge extra to put the pills in a bottle, or charge for the prescription bag.  Don't laugh, banks are doing this every day.  It seems everyone is increasing prices on goods and services except independent pharmacy.  BTW, if you agree with me, protest.  Don't stock brand Lipitor.  Switch them all !!! Be a Rebel.  Tell your patients and customers how America pays more for prescription drugs than any other country in the world.(even though we use more drugs than any other country) (kinda opposite of how Walmart works).  Ask them to help you.  Get them to talk with the mayor about that discount card the city is GIVING away. (ask them how much money the city makes on the card program).  Get involved today.  You may be selling potato peelers if you don't.
Kris
ps.. I am a pharmacist not a CPA, but even a pharmacist can tell when they are being hosed!