01/15/2026
Dear Friends
First and foremost we are not closing our doors. This post is about the steps that have to be taken to stay open.
For some time we have mentioned online and in person the current state of the insurance industry. Specifically, how the insurance companies continually pay less from month to month even as costs go up and, in many cases, reimburse the pharmacy below our cost; how they force patients to use their mail away service or use a specific big chain store. There have been many articles written on how Pharmacy Benefit Managers (PBMs) have increased their profits at the expense of pharmacies. We have seen the large chains close stores and it has been reported that independent stores across the country have closed at double the rate of the chain stores.
Over the last 6 years we have filled literally thousands of prescriptions where we have lost money. In effect we have been paying to fill your prescriptions. The reasons we have allowed this are numerous…. an elderly person living alone with no means to travel elsewhere, a very sick individual who needs to start taking the medication as soon as possible, or just simply to service our community as a whole.
However, if we are going to remain in business and continue to serve the community, we must ensure that the cost of acquiring medications is covered by the reimbursements we receive from insurance plans. Because of this, we can not fill prescriptions when the insurance reimbursement is lower than our costs.
Since the start of the new year we have spoken to some of you, but we know this will be an ongoing situation that will affect us all for some time.
If this situation affects one of your prescriptions, we will talk to you and tell you what the cash price would be. As we have mentioned before, most generic medications can be purchased for ten dollars a month. Other options include requesting a therapeutically equivalent replacement from the doctor or transferring the prescription to a chain pharmacy.
We understand that insurance and medication costs can be frustrating for everyone, and we hope we can help you navigate these challenges. Please stop by or call with any questions.
We know that all of us have to make the best decisions for ourselves and our family. If you need to transfer something do not feel bad.
You will see from the posted photos actual reimbursements from insurances. (The quality isn't great as the pictures were taken of the computer screen) The top line on each is our cost and the bottom is the profit, which in these examples are all negative, which again means we are paying to fill the prescription. You will notice one where the amount paid is negative. In this case the insurance gave the patient a copay of $12.58 and then took $6.00 for themselves. In other cases where the medication is very inexpensive they still don't reimburse correctly.
Thank you for your understanding and for being part of our Bayville Pharmacy family.
