07/16/2026
Unfortunately, this is not an isolated event and occurs multiple times each and every day. To make matters worse for the local pharmacies, the recent insurance changes forced upon our city employees is causing these types of disruptions to patient care and negative reimbursement on nearly every single claim processed. When a pharmacy tells you they are unable to fill your prescription, it definitely isn't because they don't want to take care of you, but it is impossible for them to take care of any patients if they are forced to close. These types of tactics used by PBMs (insurance companies) are ultimately punishing patients by delaying care and forcing patients to find a new pharmacy once their pharmacy is forced to close their doors.
This week, we had a patient whose long-acting insulin was on backorder. He waited two days for it, and then we decided to go ahead and try to get it changed a different insulin that was available.
We call the doctor, switch to a different long-acting insulin. Insurance says no. Try another one. Also no. Try a third. Still no, but use the name brand.
So we run the name brand. Finally covered.
Here's the part that makes me want to scream.
Original insulin acquisition cost: $92
Generic option #2: $120
The "covered" name brand: $411
The cheaper options? Conveniently not covered or on backorder. The most expensive one? No problem at all.
And after ALL of that? We were reimbursed $8.27 LESS than what we paid for the medication itself.
He's diabetic. He had already been waiting THREE DAYS. There was absolutely no way I wasn't going to fill it for him.
But I am so tired of being forced into these impossible choices. So tired of a system that punishes pharmacies for doing the right thing. So tired of watching patients get caught in the crossfire of corporate greed and political games.
Yesterday I showed the emotional toll this takes on independent pharmacies. Today I'm showing the facts. This is what it actually looks like.
Why should HE suffer because the system is broken? He shouldn't have to.
And neither should I.
Make it make sense.
