While there are several ways that one can get billed an unforeseen amount for healthcare in the US, the pharmacy isn’t usually it. Claims are adjudicated over a switch before you pick up your drug. You know, the pharmacy benefit or insurance knows, and the pharmacy knows who each is paying how much by the time the prescription is sold at the point of sale.
If you don’t have a pharmacy benefit or insurance, because a pharmacy is obligated to charge nobody less than certain payors, pharmacies will set up in house discount cards to give cash-paying patients a break.
Change Healthcare, a pharmacy switch that’s a subsidiary of Optum, is one of the switches that process a great share of claims. Optum is a pharmacy benefit that has administers several plans, including some of these in house discount/cash plans, manufacturer discounts, and traditional employer-sponsored plans.
It’s an interesting, little-seen bit of US healthcare infrastructure that causes some chaos across pharmacies, patients, and prescribers, when down.
If there is an opportunity, aside the pharmacy’s perpetual inventory, this could be inferred from PBM data, the wholesaler, an EDI trading partner like a 340B TPA or a DSCSA compliance vendor, or a manufacturer.
Assuming the patient isn’t locked into a pharmacy by their PBM, there might be incentive for the pharmacy to expose their inventory. Otherwise, the PBM or the manufacturer may have incentive to know or share that their beneficiaries or end users have access to drug. 503B compounding pharmacies and GPOs would have an incentive to know which drugs are difficult to purchase.
Market failures and special access programs notwithstanding, almost any drug can be delivered by the wholesaler to the pharmacy next day.
I'm not knowledgeable about your market or how your product works, just interested in technology and discussions here, so take this at face value.
To me your product looks like a service. I'm skeptical of any service that is a one-time payment versus some type of subscription. With a subscription I'm inclined to believe there's maintenance. With a one-time payment, I'm inclined to believe that either the product isn't sustainable without growth, will become ad-supported, or will fold.
If you don’t have a pharmacy benefit or insurance, because a pharmacy is obligated to charge nobody less than certain payors, pharmacies will set up in house discount cards to give cash-paying patients a break.
Change Healthcare, a pharmacy switch that’s a subsidiary of Optum, is one of the switches that process a great share of claims. Optum is a pharmacy benefit that has administers several plans, including some of these in house discount/cash plans, manufacturer discounts, and traditional employer-sponsored plans.
It’s an interesting, little-seen bit of US healthcare infrastructure that causes some chaos across pharmacies, patients, and prescribers, when down.