LogFAQs > #956774237

mustachedmystic posted...

Can anyone here enlighten us on the profit margin on prescription meds? I cant imagine its very much, but what do I know.
edit: I am talking about the pharmacies margin, in case anyone didnt understand.

pharmacies actually get kind of fucked by insurance companies when it comes to getting paid for dispensed prescriptions. basically when a pharmacy fills a prescription, they bill the patients insurance and the insurance company sends a copay amount that the patient has to pay. So a pharmacy gets that portion of the medication cost immediately when a patient picks up and pays for a prescription. But getting the rest of the payment from the insurance company takes a few weeks and often times they reimburse pharmacies for less than the full amount based on various factors. For example, insurance companies can lower the amount they reimburse a specific pharmacy based on how many of their members are refilling and picking up their medications on time from that pharmacy (in their view, the less on-time a patient is with refilling and picking up their medications, the worse health outcomes they have, which in turn would result in extra costs for the insurance company).

essentially insurance companies can kind of do whatever they want with no transparency when it comes to paying for claims, and the profit margins on prescriptions are low (and in a lot of cases negative). pharmacies have compensated for this by trying desperately to increase the number of prescriptions they fill, while at the same time not adequately staffing up because they want to cut costs wherever possible.

not that these retail pharmacies still wouldnt be stingy on staffing if they were getting better reimbursements from insurance companies, but filling prescriptions isnt a profitable venture on its own.

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I am the nucleus.