Ganther J M, Kreling D H
School of Pharmacy, University of Wisconsin, Madison 53706, USA.
J Am Pharm Assoc (Wash). 1999 May-Jun;39(3):346-52. doi: 10.1016/s1086-5802(16)30448-x.
To measure the effect of a change in an insurance company's reimbursement formula on prescription department gross margins for all prescriptions and subgroups of prescriptions.
Retrospective descriptive analysis.
Wisconsin.
Two units of a chain pharmacy.
Reimbursement changed from usual and customary price to average wholesale price less 10% plus a $2.00 dispensing fee for single-source products, and maximum allowable cost plus a $2.00 dispensing fee for multisource products.
Gross margins for prescriptions dispensed in the month before and after the reimbursement change.
The average estimated gross margin decreased 26.9% after the change in reimbursement, and the effect on the average gross margin for generic prescriptions was nearly twice that of the effect on the average gross margin for brand name prescriptions. The effect of the reimbursement change on different therapeutic classes ranged from an increase of 0.7% in the cardiovascular class to a decrease of 68.2% in the eyes, ears, nose, and throat class. The effect of the reimbursement change was greater for low-cost prescriptions than for high-cost prescriptions.
The large effect of the reimbursement change, combined with continued growth in third party prescriptions, raises concerns about whether pharmacies can accept third party contracts with low reimbursement rates and still maintain current profitability and service levels.
衡量保险公司报销公式的变化对所有处方及处方亚组的药房毛利润的影响。
回顾性描述性分析。
威斯康星州。
一家连锁药店的两个分店。
报销方式从通常的习惯价格改为单源产品按平均批发价减去10%再加上2美元配药费，多源产品按最高允许成本加上2美元配药费。
报销方式改变前后当月所配处方的毛利润。
报销方式改变后，平均估计毛利润下降了26.9%，对通用处方平均毛利润的影响几乎是对品牌名处方平均毛利润影响的两倍。报销方式的改变对不同治疗类别的影响范围从心血管类增加0.7%到眼、耳、鼻、喉类减少68.2%。报销方式改变对低成本处方的影响大于对高成本处方的影响。
报销方式的巨大变化，再加上第三方处方的持续增长，引发了人们对药房是否能够接受低报销率的第三方合同并仍维持当前盈利能力和服务水平的担忧。
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