Pharmacies lose money on PBM reimbursements

Pharmacy Benefit Managers (PBM) are reimbursing pharmacies below cost and it's not an isolated incident. (click to read the full article on this topic) When we asked state pharmacy associations all around the country about this problem, their members flooded our inbox. Their PBM contracts require them to dispense both generic and brand name medication to patients at a loss. We all know that a pharmacy can't keep doing that and stay afloat. 

Each of the following examples show situations in which a pharmacies took a loss because PBM reimbursement was lower than the cost of a medicine. Documentation—with the patient and pharmacy information redacted for privacy reasons—came from U.S. pharmacies.

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If you are a pharmacist who is losing money because of low PBM reimbursements, email us at editors@safemedicines.org

FL-red

Florida

This pharmacy lost $33 selling COLPD medicine to a patient

A 30-day supply of roflumilast costs this pharmacy $43.86. The PBM reimbursed them for $11.22, which is a loss of $32.64. The cheapest generic for the drug is $15, but even that costs the pharmacy money.

Transaction record for the sale of roflumilast, April 2024
Delaware-transparent

Delaware

HIV/AIDs treatment caused this pharmacy to lose $15

This pharmacy filled a 30-day supply of Biktarvy for a patient. The drug itself cost the pharmacy $3700.36 and the PBM reimbursed them for $3685.18, which is a loss of $15.18.

Acquisition cost for Biktarvy
Reimbursement for Biktarvy
MN-red-transparent

Minnesota

A $15 loss on an insulin pen

The Minnesota pharmacist purchased this Levemir Flexpen pen for $443.73. They dispensed it to the patient, and the PBM compensated them for $428.27. They lost $15 on this prescription.

Acquisition cost for Levemir Flexpen
Reimbursement record for Levemir Flexpen, November 2023

Ozempic caused the pharmacy to lose $15

The pharmacist purchased this diabetes medicine for $900.68. They dispensed it to the patient. They were compensated by the PBM for $875.18. They lost $15 on this prescription.

Acquisition cost for Ozempic - $900.68 with volume discount
Reimbursement for Ozempic
ND-red-transparent

North Dakota

A loss of $103 for an ADHD drug?

The pharmacist purchased dexmethylphenidate for $2.7448 per pill. They dispensed 60 pills, which cost them $164.69. They were compensated by the PBM for $60.94 and paid a dispensing fee of $0.75. They lost $103 on a single patient. Imagine if every time a patient walked in the door you lost $100. How long would you be in business? Read the dispensing receipt and the wholesale receipt below.

Acquisition cost of dexmethylphenidate
Reimbursement for dexmethylphenidate

This blood thinner dispensed by the pharmacy at a loss of $60.

The pharmacist paid $1,581.32 for Eliquis, dispensed it, and was reimbursed $1,521.09 with no dispensing fee. This single prescription cost the pharmacy $60.23.

A loss of $142 on life-saving HIV medicine

The pharmacist paid $6,088.72 for a 90-count bottle of Descovy pills and was reimbursed $5,946.21, costing the pharmacy $142.51.

A loss of $25 on an injection for diabetes

The pharmacist purchased Trulicity for $896.44 and dispensed it to the patient. They were compensated by the PBM for $870.75 and paid no dispensing fee, so they lost $25.69.  Read the dispensing receipt and the wholesale receipt below.

Trulicity acquisition cost
Reimbursement for Trulicity
SC-red-transparent

South Carolina

A loss of $65 for a drug that prevents seizures

The pharmacy paid $161.10 for 90 600mg tablets of felbamate, which they dispensed to the patient. The PBM reimbursed the pharmacy $95.07 for the medicine and paid them a dispensing fee of $0.85. They lost $65.18 on this prescription.

Transaction record for the sale of felbamate

A $104 loss for a topical steroid

The pharmacy paid $171.97 for clobetasol lotion, which they dispensed to the patient. The PBM reimbursed the pharmacy $67.49 for the medicine and paid them a dispensing fee of $0.45. They lost $104.03 on this prescription.

Transaction record for the sale of clobetasol

$43 down because a patient needed estrogen patches

The pharmacy paid $106.85 for estradiol patches, which they dispensed to the patient. The PBM reimbursed the pharmacy $63.36 for the medicine and paid them a dispensing fee of $0.50. They lost $43.02 on this prescription.

Transaction record for estradiol

Dispensing blood thinner cost this pharmacy almost $36

The pharmacy paid $1,544.40 for 90 Xarelto tablets, which they dispensed to the patient. The PBM reimbursed the pharmacy $1,508.58 for the medicine and paid them no dispensing fee. They lost $35.82 on this prescription.

Transaction record for Xarelto

Epinephrine injection meant a $35 loss for a pharmacy

The pharmacy paid $279.30 for this emergency injector, which prevents death from anaphylaxis. The PBM reimbursed the pharmacy $243.75 for the injector and paid them a dispensing fee of $0.10. They lost $35.45 on this prescription

Transaction record for epinephrine

A testosterone prescription cost the pharmacy $47

The pharmacy paid $55.44 for this medicine, which they dispensed to the patient. The PBM reimbursed the pharmacy $7.60 for the medicine and paid them a dispensing fee of $0.90. They lost $46.94 on this prescription.

Transaction record for testosterone

Dispensing a narcolepsy drug cost the pharmacy $34

The pharmacy paid $64.08 for 180 modafinil tablets, which they dispensed to the patient. The PBM reimbursed the pharmacy $29.56 for the medicine and paid them a dispensing fee of $0.50. They lost $34.02 on this prescription.

Transaction record for Modafinil

Painkiller created a loss for the pharmacy of more than $70

The pharmacy paid $322.17 for 28 tablets of hydromorphone, which they dispensed to the patient. PBM reimbursed the pharmacy $251.29 for the medicine and paid them a dispensing fee of $0.25. They lost $70.63 on this prescription.

Transaction record for hydromorphone

A $113 loss for a blood pressure medicine

The pharmacy paid $440.09 for verapamil which they dispensed to the patient. The PBM reimbursed the pharmacy $327.04 for the medicine and paid them no dispensing fee. They lost $113.05 on this prescription.

Transaction record for verapamil