Best practices

How Independent Pharmacies Can Offset Costs from PBMs

March 20, 2024

For patients today, the cost of staying healthy continues to rise — driven partly by higher insurance costs, increasing OTC prices, and other fees being hiked. The last line of defense for these patients is often independent pharmacies, but these community-minded practices are now even feeling the squeeze of the current macroeconomic environment.

One of the largest contributing factors to rising costs comes from the actions of Pharmacy Benefit Managers, or ‘PBMs’. These organizations, which act as intermediaries between pharmacies, insurers, and drug manufacturers, influence drug pricing and reimbursement rates significantly. Shockingly, research has found that PBMs are charging double the amount of fees now as compared to only 5 years ago.

For independent pharmacies, the rising costs associated with PBMs pose a real challenge to their success and ability to serve their communities effectively. Luckily, while community pharmacies are waiting for possible legislation to curb the effects of PBM policy, there are a few steps they can take to set their practices up for success.

Let’s explore the steps independent pharmacies can take to offset costs from PBMs.

Diversify Revenue Streams for Your Pharmacy 

The main sticking point in regards to PBMs is the increase in certain medications that they cause. This may mean your pharmacy is less likely to stock medications that PBMs have driven the price up on, and in turn, your patients have to head to big box stores to fill their prescriptions and you lose out on 100% of those patients’ refills. 

By diversifying your revenue streams, you can potentially eat the costs of stocking these medications — and keep patients at your pharmacy. 

Fortunately, there are a few different ways independent pharmacies can diversify the way they generate revenue. Thanks to COVID-era rules being extended, pharmacies can now offer more services like vaccinations and other medical services.

Advocate for Fair Reimbursement as an Industry Standard

On top of the changes you can make to your practice and the kinds of services your pharmacy offers, it’s important to stay informed about and involved with regulatory changes to PBMs and the pharmaceutical industry. 

Join local and national organizations designed to educate individual practices and band together to advocate for policy changes. By collaborating with industry associations and legislative bodies, you can amplify your voice and push for regulatory changes that protect your patients, their economic interests, and the longevity of your pharmacy.

Embrace New, Patient-Forward Technology

Another way to reduce the impact of rising PBM costs is to lower your overhead and improve efficiency within your practice. Consider investing in tools designed to streamline your workflow, improve inventory management, automate patient outreach, and bring more flexibility to the way your pharmacy is run.

For example, adopting online checkout and signature capture technology can enable you to spend less of your time checking out patients and doing manual data entry, and more time connecting with patients in person to improve adherence and delivering the educational instruction they need to stay healthy. 

These are just a few of the key changes your pharmacy can incorporate to offset the money you lose to PBMs. Nimble is committed to helping pharmacies thrive, even in the face of economic challenges. If you’d like to learn more about how we can help, book time to chat with our team, today.

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