Medicare and Medicaid reimbursements have been very low in the shoals and one reason we lost doctors they the years. I think it is better now.
Most health care providers have teamed up to split the cost and others have went under the umbrella of the hospital. My dentist made the move years ago. Same with my eye doctor, known those two guys since childhood.


Walmart kinda blazed that business model trail.

Something has to give as the current system has morphed into something unsustainable

Map with elected officials can be found here:

https://www.sos.alabama.gov/alabama-votes/elected-official-map

Senator and representative contact info can be found here:

https://alison.legislature.state.al.us/senate-leaders-members?tab=1

Call them, email them a million times. They respond to pressure.

This isn't true. It's a scare tactic by PBMs. This is a PBMs excuse to cause people to be against needed reform that would keep them honest. Look up spread pricing by PBMs and ask yourself why it's legal. They're robbing you and the pharmacy and made $194 billion in 2024.

There are no taxes on prescriptions. This is just a bill to help pharmacy's get paid instead of PBMs reimbursing pharmacies below cost and keeping all the money for Caremark, prime, Optum, etc.

Y'all look up PBMs spread pricing.

Example: totally made up but pretty accurate.
Pharmacy pays $43 for drug (plus costs of label, bottle, tech, lights, licensing, etc)
PBM charges insurance ($126)
Patient has $10 copay
PBM pays pharmacy $26
Pharmacy gets $36 total (loses $17)
PBM pockets $100 spread

And it happens over and over and over again.

Thx you for reading the fine print. I’m mean that seriously.

Biden cut Medicare’s reimbursement 8% in the last 4 years. Our private practice doesn’t accept Medicaid due to not making any money. They are killing us primary care docs even though studies have shown we save patients and the health care system a bunch of money by catching diseases earlier/helping people get more healthy etc. specialists who do surgeries don’t feel near the cut as insurances pay for procedures but not preventative visits

Maybe small independent pharmacies need to form a national bargaining group to negotiate their fees with the PBM's. If pharmacies only make pennies on certain prescriptions then they must be making money elsewhere. Most independent pharmacists I know seem to be living well. Something needs to change but more regulations vs free market may not be the answer.

Cost increases almost always are passed on to the consumer in the end correct? You’re saying that you are absorbing the cost if it is passed on to these PBMs Will they not increase prices? And I would really appreciate it if you could give us an explanation of what they exactly are and their function. Thanks

More taxes = more government = more taxes = less freedom
Less taxes = less government = less taxes = more freedom

Maybe PBMs are the problem and why Americans pay more for meds than other countries

Not knowing but it appears to me it follows the simple rule of costing more under the guise of saving money, while benefiting themselves more than the other parties.

Does all of this fall under Obama’s goal of destroying the healthcare system to rebuild it under their terms.
Come to think of it, Obama and his minions have sought to destroy the very fabric of America to rebuild it to their desires. He even said so

Insurance companies have a negotiated amount they will allow their customers to pay for a certain medicine if they get their prescription filled at an in-network pharmacy. This amount is negotiated by the PBM's. A pharmacy/pharmacist does not have to be an in-network provider for any insurance companies. Same goes for doctors, etc.

But you may not have many customers if you are not in-network with several insurance plans. If you agree to be an in-network pharmacy, then you have agreed to their reimbursement rates. So if the rates are not acceptable, then they should stop being an in-network provider.

This is how I understand it, but if I have any or all of it wrong please correct me.

IDK

Our local Keller being in Huntsville Hospital system denied I think it was United Healthcare Insurance
Asked my eye doc/friend about it and it was cause of the slow pay/renegotiate process. I’d asked several others and they said that was the problem.
Got all that fixed I guess.

The system is rigged and problematic

It is very rare for us (independent pharmacies) to choose which plans we are preferred or non preferred in. The way it works is I choose a wholesaler (McKesson, cardinal or AmerisourceBergen) and they tell us who we are to be associated with. They do the negotiating and contract selection for us. It truly is a case of take it or leave it

Good. Now get rid of PBMs.

Wow! Has it always been this way or has it evolved into the suppliers dictating what you get to charge for the prescription drugs they sell to you? Guess that explains why several pharmacies sell much more than just prescription drugs.

Neither is Kyle South. He resigned a couple years ago to be the director of the chamber of commerce in Tuscaloosa.

It has always been like this to a certain degree but has slowly gotten worse over time

I know very little about PBMs and the pharmacy business, and I suspect that most of the posters on here don't either. But Cal does, and if he says this bill needs to pass then I want to support it. The last thing in the world that I want is to have to go to Walgreens for my prescriptions.

Its why major grocery stores are able to service more insurance plans than smaller ones. When I dropped my employer insurance for Medicare Advantage, The Boss and I had to switch over to Publix. Star Market was not in network. Rarely do I go in just to get prescriptions. I usually walk out with $100 of groceries as well. To Publix, prescriptions are just a loss leader.

This is the best example of what's going on, and needs to be understood by anyone voting on this. Its not a "free market system" I believe it's a similar situation for Primary care physicians as well. Their reimbursement rates are so low, that's why they cant afford to spend any time with a patient and are just in and out, unless you have something severe going on.