Process for Evaluating a Prescription Dispensed at a Loss

January 2024 added another layer of complexity to the usual beginning of the year formulary changes and price changes, the transparency of DIR fees. As our Regional Directors have been visiting pharmacies all across the country a few themes have surfaced. The number one, however, is declining reimbursements and the solution we hear most often is to transfer the prescription out of the store. In some cases that may be an effective solution, but we have heard from a few owners that they have put a process in place to evaluate which prescriptions they should keep. Here is what other owners have put in place.

Entire Patient Profile Concentric Circles - Rx - Entire Patient - Family - Extended Family - Referrals


You find a prescription that you used to make money on and now it is at a loss.

Take these simple steps to evaluate what action you should take by looking at the entire patient and their sphere of influence.

1. Look at the entire patient profile.

If looking at the overall patient profile shows that you are breaking even or only slightly on the plus side, you should continue to serve the patient. We don’t know exactly how all the formulary changes; price changes and DIR fees will shake out, so it is better to keep the patient and take care of them.

2. Review immediate family profiles.

Once you complete the patient profile and it is at a loss overall, take the next step and look at the rest of the immediate family. Are you serving their spouse, partner, children, or parents? As you review the entire immediate family in aggregate, how does it look to your store? How much of an impact are you making on their health and how much do they mean to your business?

3. How impactful is extended family?

You may not have the immediate family in your patient population, but you may have cousins, aunts, uncles, or in-laws. Each of these family members can be influential to your business. If you asked the patient to transfer their prescription(s) to another store, do you run the risk of their extended family leaving your store too?

4. Potential for referrals

Right now, how good are you and your staff at asking for referrals? Be honest with yourself. Each time you provide exceptional service, do you ask if the patient knows someone who would benefit from your exceptional service? Is this patient someone who you could ask if their family, friends, colleagues, or neighbors would appreciate your gold level service?

5. Add services your patients need

Maybe you have found that none of the first four steps pan out and the prescription is at a loss. Based on their profile what else can you offer that is of value? Some ideas we heard were supplements, OTC symptom relief, age-related, seasonal or travel vaccines, or even DME for those stores who offer it.


Need Guidance on How To Implement This in Your Store?

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