Pharmacies lose money on PBM reimbursements
Pharmacy Benefit Managers (PBM) are reimbursing pharmacies below cost and it's not an isolated incident. When we asked state pharmacy associations all around the country about this problem, their members flooded our inbox. Their PBM contracts require them to dispense both generic and brand name medication to patients at a loss. We all know that a pharmacy can't keep doing that and stay afloat.
Each of the following examples show situations in which a pharmacies took a loss because PBM reimbursement was lower than the cost of a medicine. Documentation—with the patient and pharmacy information redacted for privacy reasons—came from U.S. pharmacies.
If you are a pharmacist who is losing money because of low PBM reimbursements, email us at editors@safemedicines.org
Florida
This pharmacy lost $33 selling COPD medicine to a patient
A 30-day supply of roflumilast costs this pharmacy $43.86. The PBM reimbursed them for $11.22, which is a loss of $32.64. The cheapest generic for the drug is $15, but even that costs the pharmacy money.
Delaware
HIV/AIDs treatment caused this pharmacy to lose $15
This pharmacy filled a 30-day supply of Biktarvy for a patient. The drug itself cost the pharmacy $3700.36 and the PBM reimbursed them for $3685.18, which is a loss of $15.18.
Minnesota
A $15 loss on an insulin pen
The Minnesota pharmacist purchased this Levemir Flexpen pen for $443.73. They dispensed it to the patient, and the PBM compensated them for $428.27. They lost $15 on this prescription.
Ozempic caused the pharmacy to lose $15
The pharmacist purchased this diabetes medicine for $900.68. They dispensed it to the patient. They were compensated by the PBM for $875.18. They lost $15 on this prescription.
North Dakota
A loss of $103 for an ADHD drug?
The pharmacist purchased dexmethylphenidate for $2.7448 per pill. They dispensed 60 pills, which cost them $164.69. They were compensated by the PBM for $60.94 and paid a dispensing fee of $0.75. They lost $103 on a single patient. Imagine if every time a patient walked in the door you lost $100. How long would you be in business? Read the dispensing receipt and the wholesale receipt below.
This blood thinner dispensed by the pharmacy at a loss of $60.
The pharmacist paid $1,581.32 for Eliquis, dispensed it, and was reimbursed $1,521.09 with no dispensing fee. This single prescription cost the pharmacy $60.23.
A loss of $142 on life-saving HIV medicine
The pharmacist paid $6,088.72 for a 90-count bottle of Descovy pills and was reimbursed $5,946.21, costing the pharmacy $142.51.
A loss of $25 on an injection for diabetes
The pharmacist purchased Trulicity for $896.44 and dispensed it to the patient. They were compensated by the PBM for $870.75 and paid no dispensing fee, so they lost $25.69. Read the dispensing receipt and the wholesale receipt below.
South Carolina
A loss of $65 for a drug that prevents seizures
The pharmacy paid $161.10 for 90 600mg tablets of felbamate, which they dispensed to the patient. The PBM reimbursed the pharmacy $95.07 for the medicine and paid them a dispensing fee of $0.85. They lost $65.18 on this prescription.
A $104 loss for a topical steroid
The pharmacy paid $171.97 for clobetasol lotion, which they dispensed to the patient. The PBM reimbursed the pharmacy $67.49 for the medicine and paid them a dispensing fee of $0.45. They lost $104.03 on this prescription.
$43 down because a patient needed estrogen patches
The pharmacy paid $106.85 for estradiol patches, which they dispensed to the patient. The PBM reimbursed the pharmacy $63.36 for the medicine and paid them a dispensing fee of $0.50. They lost $43.02 on this prescription.
Dispensing blood thinner cost this pharmacy almost $36
The pharmacy paid $1,544.40 for 90 Xarelto tablets, which they dispensed to the patient. The PBM reimbursed the pharmacy $1,508.58 for the medicine and paid them no dispensing fee. They lost $35.82 on this prescription.
Epinephrine injection meant a $35 loss for a pharmacy
The pharmacy paid $279.30 for this emergency injector, which prevents death from anaphylaxis. The PBM reimbursed the pharmacy $243.75 for the injector and paid them a dispensing fee of $0.10. They lost $35.45 on this prescription
A testosterone prescription cost the pharmacy $47
The pharmacy paid $55.44 for this medicine, which they dispensed to the patient. The PBM reimbursed the pharmacy $7.60 for the medicine and paid them a dispensing fee of $0.90. They lost $46.94 on this prescription.
Dispensing a narcolepsy drug cost the pharmacy $34
The pharmacy paid $64.08 for 180 modafinil tablets, which they dispensed to the patient. The PBM reimbursed the pharmacy $29.56 for the medicine and paid them a dispensing fee of $0.50. They lost $34.02 on this prescription.
Painkiller created a loss for the pharmacy of more than $70
The pharmacy paid $322.17 for 28 tablets of hydromorphone, which they dispensed to the patient. PBM reimbursed the pharmacy $251.29 for the medicine and paid them a dispensing fee of $0.25. They lost $70.63 on this prescription.
A $113 loss for a blood pressure medicine
The pharmacy paid $440.09 for verapamil which they dispensed to the patient. The PBM reimbursed the pharmacy $327.04 for the medicine and paid them no dispensing fee. They lost $113.05 on this prescription.
