If it's that much trouble, then pharmacists should wash their hands of the whole affair, says Fred Holmes, a benefits consultant and national practice leader, group health, at Buck Consultants in Toronto. If a drug isn't eligible they shouldn't try to manipulate the system to see what is covered. I have no sympathy with pharmacists who do this. They're forgetting that reimbursement is between the employer, the insurance company and the employee. Dave Malian, a pharmacist and manager of pharmacy and drug services at Green Shield Canada, based in Windsor, ON, says it's not that easy.
Pharmacists do the extra work because they want to help their patients.
Still, Malian strongly suggests that pharmacists leverage their relationships with customers by getting them to complain to their employers about problems they've had with their drug plans. Clearly, remuneration to pharmacists for claims processing is another solution. After all, PBMs receive a fee every time a claim is submitted, whether rejected or accepted. But the likelihood of this happening for pharmacists is remote. But in most cases they figure there's enough competition in the pharmacy industry and that dispensing fees are enough.