LogFAQs > #977134176

Dat_Cracka_Jax posted...

You don't get to refuse a prescription just because you lose money on it. If you are contracted with the PBM and in network, you fill the claim.

StealThisSheen posted...

Wait, a pharmacy can refuse to fill a prescription just to save money?

We don't have an obligation to go out of business by filling prescriptions that lose tons of money. We're not some multibillion dollar chain. We see the profit (positive or negative) of every fill in real time. We shop for the best deals on drug purchases every day and constantly modify inventory points to minimize the amount of drugs sitting idle on our shelves. We don't have the power to negotiate individually with PBMs. In fact, the coalition we are part of has completely cut off from one of the major PBMs because independent pharmacies aren't going to keep the lights on by hemorrhaging money. When patients ask their insurance company why independents are no longer in network, that company basically tells them that those pharmacies were given an offer and refused to cooperate.

Also, I have literally heard about PBMs suggesting pharmacies blame backorders if they can't afford to fill a drug at loss.