Retail Pharmacy

Retail Pharmacy Profitability on 90 Days’ Supply Prescriptions

IndustryRetail Pharmacy
ProblemA retail pharmacy chain was concerned whether aggressive third party 90 day reimbursement rates were profitable and if third party contracts should be continued for 90 days’ supply. The retail pharmacy chain feared they were losing money overall on 90 day prescriptions, particularly with brand medications.
PHSI SolutionPHSI first collected and analyzed the claims of the largest third party plans served by the pharmacy chain. The prescriptions were categorized into four prescription types: 30 day generic, 30 day brand, 90 day generic, and 90 day brand. These segmented claims allowed PHSI to evaluate the profitability of each group independently.
ResultsAfter reviewing the claims data, PHSI was able to demonstrate the value of the 90 day contracts with the client. PHSI explained that while there was some loss on selected 90 day brand prescriptions, they are marginally profitable. However, 90 day generic prescriptions are the most profitable of the four segments analyzed. The ratio of profitable 90 generic prescriptions more than made up for the few unprofitable brand prescriptions. The resulting analysis supported the overall profitability of 90 day at retail contracts and provided insight for the client on the various profit margins for each subgroup of prescriptions.

Generic Discount Programs – Monitoring and Measuring Uptake and Retention

IndustryRetail Pharmacy
ProblemA mid-sized regional pharmacy chain implemented a generic discount and free antibiotic program with assistance from PHSI. Years later, senior management wanted to measure the value these programs brought to the pharmacy. The chain lacked the resources needed to analyze the data and evaluate the financial impact of the programs.
PHSI SolutionThe client provided PHSI with transaction data used to measure uptake and retention from the generic discount and free antibiotic program. PHSI also measured patient, prescription and dollar volume for each program segment and determined the additional business program patients bring to the pharmacy in the form of non-program prescriptions.
ResultsPHSI continues to monitor drug movement, producing actionable reports with recommendations allowing the client to fine tune their program to meet sales and profit objectives.

Pharmacy Chain Pricing Support

IndustryRetail Pharmacy
ProblemA pharmacy chain needed to revise their prescription pricing strategy as they implement a new pharmacy practice management system. In addition, the system needed to display the preferred generic drug manufacturers to pharmacy users in order to assure proper drug product selection to control and ensure uniformity across the chain.
PHSI SolutionPHSI worked with the pharmacy administrator to develop pricing formulas that allowed the company to properly price their prescriptions and assure profitability. PHSI created files which included the necessary pricing information and proper references for preferred generic drug products. These files make it easier for pharmacists to select the most cost effective drug when substituting for the brand.
ResultsThe pharmacy chain was able to implement their new pharmacy management system on schedule and with up-to-date, accurate retail cash pricing and algorithms. The pharmacy chain’s administrative implementation work load was decreased.

PHSI Helps Supermarket Chain Move Toward Providing Pharmaceutical Care

IndustryRetail Pharmacy
ProblemA division of a national supermarket pharmacy chain was exploring the idea of implementing patient care services but had been unable to determine, prepare, and present a business case to senior management on how to proceed.
PHSI SolutionAfter identifying the client’s needs, wants, and desires, PHSI targeted strategic areas that needed to be addressed including software, training, marketing, opportunity cost analyses, compensation, and payment for services.
ResultsA business plan was developed and presented to senior management driving the stalled project to completion.

Pharmacy Validates Business and Information Technology Practices

IndustryRetail Pharmacy
ProblemA client needed to validate a recently completed project that documented business and information technology practices for its pharmacy operations. They wanted a best practices comparison with leading organizations in the industry.
PHSI SolutionPHSI evaluated the new business practices relative to industry best practices and provided the client with a report outlining the findings through a GAP analysis.
ResultsThe client used the research to plan enhancements to its own product development list to improve pharmacy efficiency and profitability.

U&C Pricing Strategy Critical for Chain Expansion

IndustryRetail Pharmacy
ProblemAlthough well over 90% of customers have prescription drug coverage, those who do not have coverage pay the usual and customary (U&C) cash price for their prescriptions. The U&C price impacts third party reimbursement through the lower of provision in pharmacy network contracts. A client was planning an accelerated expansion and needed to maintain a consistent U&C pricing strategy across their chain.
PHSI SolutionPHSI developed a U&C pricing strategy that required minimal day to day maintenance based on the client’s pricing philosophy. Specific pricing strategies were set for top-selling brand and generic drugs, and a default strategy was determined based on current third-party reimbursement rates. PHSI understood and took into account the constraints of the client’s pharmacy practice software in order to make pricing maintenance manageable.
ResultsPHSI provided a consistent strategy for U&C pricing at every pharmacy in the chain. Top-selling drugs were priced so that the client remained competitive in the cash market but increased third party profitability.

PHSI Tests Pharmacy’s Dispensing System Software

IndustryRetail Pharmacy
ProblemA pharmacy chain developed a new dispensing system that required case use development and systems testing before deployment to identify software defects and fixes.
PHSI SolutionPHSI developed test cases to validate the system functionality and matched business requirements to test case scenarios. PHSI consultants identified defects and provided direction to programmers to fix errors prior to rollout. Fixes were tested and verified.
ResultsThe client reduced the time and effort needed to convert to their new dispensing system and eliminated costly errors by leveraging PHSI's pharmacy and technology expertise.

PHSI Conducts PBM and Health Plan Training for National Retail Pharmacy Chain

IndustryRetail Pharmacy
ProblemA national retail pharmacy chain promoted an internal associate to manage PBM and health plan agreements but lacked the resources to train the individual on third party terminology that exists in network agreements. The chain needed an outside resource with PBM and health plan experience to provide a new perspective on contracting issues.
PHSI SolutionPHSI and the pharmacy chain developed a training outline of topics to be covered in the training session. PHSI reviewed the chain’s third party agreements and amendments to create a template of terms and conditions that the chain should include or exclude in their agreements. A PHSI consultant created role playing scenarios to train the new associate in negotiating favorable terms and differentiating “must have” elements from “nice to have” terms.
ResultsThe training session dramatically shortened the learning curve for the associate on this critical component of pharmacy profitability.

Client Developed Successful Free Antibiotic and Generic Discount Programs

IndustryRetail Pharmacy
ProblemA mid-sized regional pharmacy chain felt that they were at a competitive disadvantage due to the lack of a generic discount and/or free antibiotic program. Senior management was concerned about losing patients to pharmacies offering these programs. The chain lacked the resources needed to create and evaluate the financial impact, determine quantity and day’s supply limits, and manage the program.
PHSI SolutionPHSI evaluated existing free antibiotic and generic discount programs and used the chain’s claims data to determine the potential cost of matching existing programs. PHSI created a sample drug list and repriced these medications developing a detailed cost and margin analysis for implementing the program. PHSI created management reports to calculate changes in profit margins and estimated prescription volume.
ResultsThe client introduced free antibiotic and generic discount programs allowing them to stay competitive in the market. PHSI receives a claims file to monitor and fine tune the program to meet the client’s sales and profit objectives.