The prices of most of the drugs today are already set high right from the launchand are often subjected to steep increases year-over-year. This occurs mainly due to the financial pressures that force pharmaceutical manufacturers to reclaim costs and drive profits immediately, leading to exorbitant price charges.
In an ideal world, a pharmacy benefit management (PBM)provider can payoff hospice facilities with a discount on every medication purchased under average wholesale pricing, ranginganywhere between 70 to 80 percent. However, in reality,this is not the case. Even with a negotiated discount, the price paid by the hospicesis substantially higher than what the PBM pays the pharmacy filling the prescription—leaving a sizable markup that adds to theagency’sprofit margin.
In today’s fast-paced world, pharmacy spend has become one of the largest cost centers for skilled nursing facilities (SNFs)and long-term care (LTC) operators, second only to overhead costs. Furthermore, the process of calculating and reviewing monthly pharmacy bills is complex, coupled with the huge capital investment that providers need to spend on medication for Medicare Part A residents.