Tuesday, August 17, 2010

It's not Skittles, Giant Eagle

After writing my post on the total devaluing of the profession of pharmacy by Giant Eagle's free diabetes medications, I felt that I needed to have a follow-up post.

I thought about continuing my thoughts about giving away the profession in a time when we, as pharmacists, are looking for revenue streams that are separate from the drug product. You know, billing for our knowledge. In case you have been asleep for a while, we are the medication experts so we ought to be compensated for knowledge. If I ask one of my attorney friends a legal question, I know that I'll see a bill in my mailbox in a few days. Why shouldn't we do the same?

I thought about writing on the effects that the free medications will have on MAC drug pricing, especially by insurers who have their own MAC list that may include more medications at lower reimbursement rates that the federal MACs.

But then something came to mind as I was driving home from school shopping with my kids.

This is outright professional negligence.

I had a theory to back up this thought, but I needed to confirm my suspicions. So during a slow moment during Monday's pharmacy fun, I placed a call to Giant Eagle that is close to my home. Ten minutes later, I had my answer.


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Let's jump back a few years to a piece of legislation that everybody in pharmacy loves....OBRA '90. Remember the part where pharmacists must perform prospective DURs?

Since OBRA '90, we have become accustomed to the DUR rejects that are returned by insurance companies. Most of the time they are a pain in the butt, but occasionally they alert us to a severe interaction with a medication that the patient is getting filled at another pharmacy. It could be at the Walgreen's down the street or the mail order facility in New Jersey, but we are alerted. We, as pharmacists, can then discuss the issue with the patient and use our professional judgement before dispensing the medication to the patient.



* * * * *



Now back to Giant Eagle.

In my discussion with the pharmacy staff member at my local Giant Eagle, the employee said that the prescriptions are basically entered into the computer and billed as cash, avoiding transmission to the insurance company. Makes sense from a business standpoint since the switch fees will be avoided.

But by not submitting the claim to the third-party, part of the prospective DUR process is being missed. The pharmacist at Giant Eagle is not going to be able to utilize the third-party's DUR process to check for interactions with medications filled at other pharmacies. To me, it looks like the grocery boys are putting the safety of their pharmacy patients at risk in order to get them into the store to but more Pop-Tarts and Doritos.

I guess that's their choice. They can side-step that part of the law. Maybe say that they asked the patient if they were taking any other medications and the patient denied taking any other meds.

But I do have a problem when that patient who had their diabetes medication filled at Giant Eagle comes to my pharmacy to fill something else. I'm going to ask about their other medications and get the I don't know or the the little white ones response. So I'm going to count on their insurance company to help me on the prospective DUR.


Oh wait.....


I won't have that available to me because Giant Eagle didn't submit a claim to the insurer. They billed it as cash and bypassed the insurance company's collection of the patient's medication history.

Because of their little marketing gimmick, Giant Eagle is endangering the health and well-being of our mutual patient. They are risking the lives of people in order to get them to buy more Jif peanut butter. I can't wait to see the first lawsuit filed over this one.


The non-pharmacists who are currently making decisions for pharmacy need to step back and realize that the products we deal with are powerful. They have the power to keep otherwise unhealthy people alive for years longer than the person may have been able to live if they didn't have the medication.

They also have the power to end a life with a single dose.

That's why trained professionals who are medication experts are the people who handle these products. That's why we need to have a complete medication history available to us. That's why the insurer's DUR is a valuable tool for us when patients jump from pharmacy to pharmacy.

We're not playing with Skittles behind the pharmacy counter.

11 comments:

Anonymous said...

First argument in this entire "scandal" that makes any sense at all. Don't care, personally, if Giant Eagle gives away every single prescription.

Isn't this a good idea for **every** prescription, though? Of course, imagine how profits would fall if all those cash Lortab/Vicodin/Percocet prescriptions were to suddenly disappear...

Retail RPh said...

I'm feeling rather fortunate that I'm not a Giant Eagle pharmacist right now. It would worry me ragged to have a boss who didn't understand pharmacy practice or law and saw my department as a potential cash cow or enticement. It's dangerous and irresponsible not only for GE pharmacists, but the rest of us as well..

Phathead said...

Anon obviously does not work in a pharmacy or is ignorant of the finances of a pharmacy.

Interesting idea. One of the things that I've been wondering is I know of several private plans in which they state that the patient must use said insurance if a product is covered and if they do not, the provider reserves the right to revoke the coverage of the participant.

Wonder how that would go over...

Anonymous said...

@phathead

I know that charging 11.99 for 12 of something that costs maybe 20 bucks for a #500 bottle is a pretty nice profit, even if you have to count it twice. How many of those "I don't have insurance" people that you didn't catch would get caught up in DUR?

You're kinda mouthy for someone who can't score a job as an intern.

Anonymous said...

Not sure 'bout what Phat says that Anon doesn't understand about finances, but a. when I used to fill in retail, the tech would tell the patient they WOULD have to file insurance if they had insurance NO MATTER WHAT. This is what happens at the doctors' offices and the urgent care clinics and so on. Patients MUST file insurance if they had it, or they were doing something illegal. IS this true or NOT? If a patient has insurance, can they say they don't to the health care provider, and 'get away' paying cash or a check. Second, b. why wouldn't it be feasible to send every prescription to a central script review agency somewhere? I know, I know, those dad gum reactionaries would say...only a quick step from there to NHS, but why not? Pharmacists and other healthcare providers SHOULD unite for continuity of care for this reason alone, across state lines, no less!

Phathead said...

@Anon 2:12pm

What I was getting it is that the average cost per prescription, last I checked, prior to drug cost is $10. That includes the price of the vial, wages, insurance, etc etc. You dispense at a loss, even though you don't see it directly on your computer screen. You see it when you audit your books at the end of the month.


And I'm not eligible to be an intern yet, so really that should say "You're kinda mouthy for someone who can't score a job in a pharmacy"

Anon@ 8:53am

There are several medicaid programs that require their patients to use their insurance, namely to curb the abuse of certain drugs. You try to get around it and pay cash and they yank ALL services from you. They can get their coverage back after a certain period along with a lengthy discussion with their worker.

I would think a centralized database would be on the way once we have centralized hospital records. Then again you'd have to get WAGs, CVS, Walmart, and all to work together... and that'll go over like a fart in church.

AP@H said...

Agree, but it's the same argument for $4 Rxs at Wal-Mart, TGT, and other retailers. Giant Eagle is neither the first or the only pharmacy contributing to fragmented patient data.

Anonymous said...

I'm a pharmacist-and my boss and I have read through the rules and regs/pbm contracts etc etc- and this is muddy muddy water they are treading through albeit dangerous. I'm more medically savvy than I am legally, but if they are submitting to the insurance usual and customary charges, but giving it to the patient for free- then contractually that is illegal. But if they are filling it as cash-keeping it off the profile-and creating a lapse in therapeutic history- then that is unethical-and probably will be deemed illegal in time. Notice how there is no waiting area in the Giant eagle pharmacies or that the pharmacists never look up- I know plenty of GE pharmacists- not one of them happy-all burned out/depressed. And some of the "stuff" I hear that goes on behind closed doors- is just outrageous- ALLEGEDLY ALLEGEDLY ALLEGEDLY.

This type of commerce coupled with mail order will be the death of the pharmacist and the advent of catastrophic medication errors and therapeutic suicide.

retailpharmacist said...

It also hasn't been brought about about the possible extra costs charged to the system.... If patients have to return to their doctors for re-evaluation of medication therapy after they had "forced" their doc to change their meds and prescribe FREE or $4 drugs that the doctor may have not have thought appropriate but prescribed to make the patient happy in the first place.

This adds up to extra office visits charged to insurance co. and the medicare system etc.

I just don't understand why the so called pharmacy associations aren't making noise in the media about the detriments of this practice by these mostly non-traditional drugstore type chains.

The AMA is always voicing their opinions in the media. The APhA rarely ever if at all.

retailpharmacist said...

It also hasn't been brought about about the possible extra costs charged to the system.... If patients have to return to their doctors for re-evaluation of medication therapy after they had "forced" their doc to change their meds and prescribe FREE or $4 drugs that the doctor may have not have thought appropriate but prescribed to make the patient happy in the first place.

This adds up to extra office visits charged to insurance co. and the medicare system etc.

I just don't understand why the so called pharmacy associations aren't making noise in the media about the detriments of this practice by these mostly non-traditional drugstore type chains.

The AMA is always voicing their opinions in the media. The APhA rarely ever if at all.

medman said...

Hats off to you, Eric you said it better than I could. As for the the prof. associations, I sent a link to the Penna Pharm Assn. Their response: "Agreed". "Good read". I believe my dues are better spent elsewhere. Since we need to take CE in Medicare D Fraud/Abuse this could be a good case study to include. How will the pt's TROOP expense be calculated correctly, maybe they'll never get out of the donut hole.
In Nov. CMS intends to survey retail pharmacies for price data. What becomes of reimbursements when data is skewed by freebies?

Hey everybody-do the right thing: Tell your newspapers, TV stations, etc.