エピソード

  • Independent Pharmacy Ops & PBM Survival main episode for 2026-07-20
    2026/08/24
    In this episode, we tackle the mounting pressure independent pharmacies face as PBM reimbursements tighten and DIR fees erode already slim margins on routine prescriptions. Learn how to shift from reactive frustration to proactive control by analyzing your own dispensing data, spotting problematic claims, and building small but reliable revenue buffers without waiting for contract cycles. Discover practical steps to review DIR reports in minutes, compare per-claim fees year-over-year, test cash-pay services already in your workflow, and decide which appeals are worth the effort. These tactics deliver immediate visibility and modest cash-flow improvements while longer negotiations continue.

    Key takeaways:
    - Track DIR accrual patterns in your last 30 days of claims to identify high-fee plans.
    - Compare current per-claim fees against the same month last year, adjusting for volume.
    - Launch one simple cash-pay offering, such as adherence packaging, and measure acceptance over seven days.
    - Appeal only the claims where the time required justifies the potential recovery.

    📩 Have questions or want to share your experience? Reach out at independent@senseofthisshit.com.
    https://www.spreaker.com/podca...
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    4 分
  • Independent Pharmacy Ops & PBM Survival main episode for 2026-07-13
    2026/08/17
    In this episode, Blake breaks down how independent pharmacy owners can fight back against shrinking PBM reimbursements tied to shifting performance metrics. Instead of absorbing the hits on core dispensing, the focus shifts to mapping DIR accrual math on the ten highest-volume drugs to reveal exact fee impacts. From there, owners learn to launch one cash-pay service—such as medication synchronization or a simple wellness screening—priced outside network contracts to create a steadier revenue stream that reduces reliance on PBM payments.

    Key takeaways:
    - Sort claims data by volume and reimbursement, then calculate DIR fees on each to track 90-day gaps and target the top three loss leaders.
    - Select and test a non-network service with three patients this week, refining pricing and wording based on real feedback.
    - Compare new cash revenue against DIR reductions after 30 days to decide on expansion or inventory tweaks.

    📩 Have questions or want to share your experience? Reach out at independent@senseofthisshit.com.
    https://www.spreaker.com/podca...
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    4 分
  • Navigate DIR Accrual Playbooks: 10-Min Cash-Pay Services for PIC Managers
    2026/07/11
    In this episode, we tackle the ongoing challenge of direct and indirect remuneration fees draining independent pharmacy revenue. Learn practical 10-minute daily playbooks designed for PICs and managers to track DIR accruals accurately and offset them with cash-pay services that bypass PBM contracts—no buy/sell transitions involved. Discover how to pull and sort 30-day claims data each Monday, mark expected fees as liabilities immediately, and shift high-fee payers when possible. We'll also cover launching simple cash-pay offerings like immunizations and dermatology compounding using existing inventory, setting flat prices, training staff with quick scripts, and reviewing results weekly to measure impact. These steps fit seamlessly into your workflow, helping balance budgets without extra meetings or setups.

    Key takeaways:
    - Use a simple spreadsheet to monitor DIR fees in real time and adjust cash flow proactively.
    - Start with one in-stock service, test pricing with patients, and track interest daily.
    - Add compounding formulas only after initial services stabilize, training one tech to keep time under 15 minutes per session.
    - Review combined DIR and cash-pay numbers every Friday to validate the approach.

    📩 Have questions or want to share your experience? Reach out at independent@senseofthisshit.com.
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    4 分