Also also, among small business pharmacists, there is a substantial fear of dispensing ozempic or Mounjaro for anything other than very obvious diabetes, due to the fact that
1) I typically make <$10 per branded prescription like these.
2) insurers and their PBMs routinely audit pharmacies for documentation to substantiate the insurance claim. In the case that an insurer finds anything they don’t like (missing information, unclear directions from the physician, a diagnosis of weight loss, a LACK of diagnosis of diabetes, etc), the insurer recoups the full amount of the claim, not just the pharmacy’s profit. In this case, that would mean that if I dispensed ozempic and billed your insurance for it, and they later audited and recouped the full amount, I would lose ~$1000. That means I would have to dispense >100 prescriptions at that same <$10 profit in order to break even on this drug.
The reimbursement for branded drugs to small pharmacies has gotten SO bad that it’s literally impossible to source product at the price the PBM is willing to pay (outside of stupid programs like the 340b drug pricing program, or counterfeiting). This has predictable results: https://benjaminjolley.substack.com/p/pbms-3-counterfeit-drugs
Also also, among small business pharmacists, there is a substantial fear of dispensing ozempic or Mounjaro for anything other than very obvious diabetes, due to the fact that
1) I typically make <$10 per branded prescription like these.
2) insurers and their PBMs routinely audit pharmacies for documentation to substantiate the insurance claim. In the case that an insurer finds anything they don’t like (missing information, unclear directions from the physician, a diagnosis of weight loss, a LACK of diagnosis of diabetes, etc), the insurer recoups the full amount of the claim, not just the pharmacy’s profit. In this case, that would mean that if I dispensed ozempic and billed your insurance for it, and they later audited and recouped the full amount, I would lose ~$1000. That means I would have to dispense >100 prescriptions at that same <$10 profit in order to break even on this drug.
The reimbursement for branded drugs to small pharmacies has gotten SO bad that it’s literally impossible to source product at the price the PBM is willing to pay (outside of stupid programs like the 340b drug pricing program, or counterfeiting). This has predictable results: https://benjaminjolley.substack.com/p/pbms-3-counterfeit-drugs