Pharmacist. Advocate. PBMs (middlemen) profit while people ration meds. If youāve overpaid or been under-reimbursed, youāre not aloneā and Iām fighting for you.
A PBM-free or transparent fixed-fee healthcare model in the U.S. would conservatively save $90ā130 billion per yearārepresenting 14ā20% of total prescription drug spending.
These savings come not from rationing care or suppressing innovation, but from eliminating opaque middlemen who profit from rebate distortions, spread pricing, and formulary manipulation.
#EndPBMs #PBMReform #PatientsOverProfit
Hereās the analysis:
@tjparker@Pharmassists Thatās a purposely specific example. You know what I mean.
If thatās the true model, itās set up to fail. And short sighted.
@mcuban The system is built for max profit under the guise of ābringing our heart to your health,ā then raping your doctor and/or pharmacy, over billing at every level, which in turnāincreases your premium
Crazy? The pharmacy has to buy the bagel for $400 from a big wholesaler, then get rebates to try to get their cost down to the $7. Which they can only do if they buy 90 plus percent of their generic bagels from their big primary wholesaler. If they buy generic bagels elsewhere, like @costplusdrugs does, and it exceeds 10 pct of their total buys from the wholesaler, they get hit with chargebacks and fees that wipe out any chance of making money on bagels .
Which means they pay more for generic bagels. Which means customers pay more for bagels because everyone lists the price at $400
And the wholesalers use that $400 RETAIL price for the starting point of their WHOLESALE pricing.
By doing this, the PBMs get to use the $400 price as their starting point for pricing as well.
In any other industry other than this bizarro bagel world, the wholesalers would compete for the best price from the bagel manufacturers and then compete for the business of pharmacies.
Itās the most upside down bizarre business I have ever seen
"...These middlemen in the drug supply chain donāt discover new medicines. They donāt manufacture them. They donāt even physically dispense most prescriptions. Yet they rake in tens of billions of dollars each year by driving up costs for everyone else ā especially patients battling cancer, HIV, heart disease, and autoimmune conditions..."
https://t.co/XER3tBDLEI
You mean that itās ācoveredā ā which was decided by the PBM, not the insurance.
Insurance companies do not manage their own medication formularies. None that I know of. They contract to third parties, PBMās. They decide what gets covered, at what price, at what copay, and at what pharmacy.
The worst part? Theyāll typically only ācoverā medications that they get a rebate from the manufacturer for (ie pay-to-play)
The problem: these rebates are not paid by the MFG. The patient, insurance, employer, and taxpayer pay for these rebatesāwhich largely line the pockets of the said PBM.
This creates multiple problems. The largest problem being that the cost of the medication is now more expensive (x + %rebate). This increases your cost, the pharmacies cost, the insurances cost, the wholesalers cost and reimbursement, your employers cost, the taxpayers cost, and most importantlyāyour copay. Then, big pharma gets to claim a tax-break for increasing the cost of your medication for this rebate.
Thereās more to this nuanced problem. But, Iām not going to inundate you with facts. Instead, check out my profile to see how PBMās are scamming you, me, taxpayers, the sick, and just about everyone in-between š
Mitochondria are microscopic. You cannot diagnose āmitochondrial challengesā by glaring at a child in an airport. What you can do is prey on parents fears with pseudoscience, while ignoring the real crises our kids face, like gun violence, food insecurity, and lack of healthcare.
Pay attention to this excerpt: āWe are seven months into the new administration, and no CDC subject matter expert from my Center has ever briefed the Secretary.Ā Ā I am not sure who the Secretary is listening to, but it is quite certainly not to us.ā
Agreed.
Stop entering into contracts that will cause you to dispense underwater just to increase your *potential* patient population.
Adopt cash-only models. Develop a membership model. Itās being done around the country already.
Leave their networks. If patients lose access because a pharmacy leaves network, it creates patient pressure on employers, insurers, and PBMs.
This is something pharmacies rarely leverage but desperately need. Make this their problem, not ours.
Take our profession back, one pharmacy at a time
PBMās increase list prices from the original price proposed by manufacturers. See insulin prices circa 2008.
Those rebates also get tacked onto the drugs acquisition cost. The PBM keeps a large portion of that rebate.
Moreover, manufacturers are not rebating anything out of the kindness of their hearts. In fact, raising the price of a medication, for a PBM rebate specifically, is a tax break for ābig pharmaā
In summary, rebates actually increase drug costs (proof if you simply google it), are incentivized by the government, and the āsavingsā are not actual patient savingsā theyāre largely pure PBM profit for ānegotiatingā their own rebate.
The result? Incentivizing higher drug prices through rebates and tax breaks.
Check out my profile for more information.
Itās worse than you know.
Cutting out middlemen (PBMās) does lower costs.
The ācoverageā people think theyāre getting is mostly a shell game built to funnel profit, not savings.
@FTC@JusticeATR
If pharma companies just cut out all those annoying middlemen and sold medicines directly to consumers, wouldn't that cut the prices that people pay?
Yes, but... not so much, @elaineywchen finds. Because most consumers' drug costs are mostly covered by insurance, and they don't have hundreds of dollars a month to buy discounted drugs.
https://t.co/XgkJurCKHO
@TexasPharmD@tjparker@mcuban New models must be adopted, quickly.
They arenāt going anywhere, they make too much $ and have contractual strangleholds on the industry.
But ideally, conventional PBMās can be phased out, eventually.
@tjparker@mcuban Tell that to:
New Zealand (Pharmac, saving NZ30-50M/year)
UK (NHS/NICE, substantially lower drug $)
Germany (AMNOG, >20% discount on new drugs)
Canada (pCPA, C$50M saved on just 10 drugs/3yr)
Australia (PBS, lower $per-capita)
US VA (substantially lower drug $)