A recent survey revealed that the average price of 60 tablets of acetaminophen 300 mg with codeine 30 mg listed for $24.96 at a pharmacy. Yet, dispensing physicians are billing $50.09 for the same quantity of the same product.
If the insurance companies actually reimburse at this rate to physicians, all pharmacists I know have a serious bone to pick with them. We would be very excited if our reimbursement from prescription benefit managers (PBMs) were the more modest rate of $24.96. Sadly, that is not the case.
The fact of the matter is that PBMs reimburse much less than that to pharmacies. A reimbursement that provides $4 above the cost of the drug alone on a prescription can be considered one of the better reimbursements. That $4 has to pay for the bottle, the label, the computer hardware and software required to bill the insurance company, the rent, the electricity, the pharmacist’s time and labor and any help the pharmacist may utilize in preparing and dispensing the medication, such as a clerk or technician. Sometimes, reim- bursement is less than the cost of medication to the pharmacy.
Pharmacists dispense powerful metabolic agents that have the ability to cause great harm when used inappropriately or accidentally. Along with great benefit comes great hazard. Today’s pharmacist is expected to determine that the drug and dosage on a prescription is appropriate, prepare a product with the correct ingredients with correct and proper instructions, determine if other medications the patient may be taking are safe in combination with the new prescription, and meet specific guidelines required by the Food and Drug Administration, the Drug Enforcement Agency and the state board of pharmacy regulations — all while attending to interruptions from the phone, co-workers or people walking up asking, "Can I ask you a quick question?"
At a $4 mark-up per prescription, this is the best value in medicine today.
It’s also a marvel that more people are not injured because of the insane demands placed upon the pharmacist. Many times, I have received prescriptions that change the dosage of a medication and, upon contacting the prescriber, I find the dosage change was not intended at all.
The next time you visit a pharmacy and notice that the pharmacist and staff are quite harried and it takes them 30 minutes or more to process your prescription, it is because of this declining reimbursement that does not allow sufficient staffing to prepare your personal prescription order in a timely fashion.
Do not be surprised if we start seeing news stories of people harmed because they got the wrong medication or incorrect directions supplied with that medication because the poor pharmacist on duty is expected to process a certain number of prescriptions in a given time period without the assistance needed to properly oversee the whole procedure.
