This huge story is not getting any TV attention because, well, TV has been bought by Big Pharma. No one on TV will cover it because their advertisers won't like it. Without pharma advertising, TV would have collapsed a long time ago, hollowed out by social media. My original Medicare drug plan uses Express Scripts, so this does interest me.
This is a nice development that will undoubtedly impact OptumRx, Caremark, and the various PBMs used by the Blues. Legal action is slow, but it can truly impact and address the behavior of bad actors.
The problem is, unless they're dismantled, done away with, and their c-suite doing prison time, they already have a plan in place to mitigate the fall out and charge consumers in another way. These companies never lose money, NEVER.
Insurance is legalized gambling with our health for corporate profit. The companies are the “house” and the “healthcare by insurance” model is a scam, rigged so they never lose.
True health care should not be for profit. Our current system incentivizes $ over health. A sucker’s bet.
For the sake of “life, liberty & the pursuit of happiness” supposedly enshrined in our constitution, we must change to single-payer health coverage - Medicare for all. Negotiate fees, drug prices, etc. as 35 of the 36 wealthiest countries do.
It will increase security, societal and civic participation, provide healthy workers & students to contribute to our shared future.
Universal healthcare is a base-line national “benefit” worthy of increased taxes on the corporations & the wealthy (say, at least back to pre-Reagan era levels), as well as taxing non-income benefits like the stock value they use to borrow even more $$ to invest & make more non-income wealth!
Excellent article Wendell. Will TriCare also take a deep dive into the insidious costs being billed to the VA for veterans’ prescription drug benefits? Over the course of 20 years, how many hundreds of billions of dollars have been scammed by ESI over the years?
There seems to be no depths to the things these companies will do in the pursuit of profits. I wonder if somewhere there is a Mob Boss reading this saying; "Damn. That's pretty gutsy."
The number that got me is Evernorth did $6.9 billion pre-tax last year. The FTC deal Cordani is bragging about promises $7 billion in savings over ten years. So 700 million a year, maybe, against seven billion in profit. That's not even a rounding error, that's the cost of keeping the lights on in the compliance department. And they paid no fine. Zero. They agreed to bring Ascent back from Switzerland which they were already planning to do. Potter the part that kills me is this settlement is going to be exhibit A when they fight the RICO case, like, we already cooperated, what more do you want. The Plumbers saw that coming I think.Cordani called it a win. On an earnings call.
Amazing what Insurance companies have been getting away with. Between this and all the ‘services’ fraud it’s amazing that regulators have not caught all of this taxpayer money going to fraudsters.
The Ascent structure is a masterclass in contract engineering. We review approximately 100 PBM contracts a year, and the pattern of reclassifying rebates as “fees” or “administrative payments” to avoid pass-through obligations is not unique to Express Scripts. It shows up in subtler forms across the industry. The contract says “100% of rebates passed through,” but the definition of “rebate” has been narrowed so precisely that substantial manufacturer payments never qualify. Most employers read the guarantee and assume they’re protected. They’ve never read the definition.
If you watch tv at all, you must have noticed that about 95% of the ads are from drug companies, trying to sell you their newest expensive( in the US) drug, often for hundreds of dollars a pill. If it were not for them( and rain gutters and windows) tv would have no ads at all, and hence would go out of business. Do you think tv execs care if the ad is truthful or not?
This huge story is not getting any TV attention because, well, TV has been bought by Big Pharma. No one on TV will cover it because their advertisers won't like it. Without pharma advertising, TV would have collapsed a long time ago, hollowed out by social media. My original Medicare drug plan uses Express Scripts, so this does interest me.
👍💯Well said
This is a nice development that will undoubtedly impact OptumRx, Caremark, and the various PBMs used by the Blues. Legal action is slow, but it can truly impact and address the behavior of bad actors.
The problem is, unless they're dismantled, done away with, and their c-suite doing prison time, they already have a plan in place to mitigate the fall out and charge consumers in another way. These companies never lose money, NEVER.
Representatives and senators can be reached at 202-224-3121. It is time to get Rico out of our healthcare and support The Medicare for ALL acts now.
Insurance is legalized gambling with our health for corporate profit. The companies are the “house” and the “healthcare by insurance” model is a scam, rigged so they never lose.
True health care should not be for profit. Our current system incentivizes $ over health. A sucker’s bet.
For the sake of “life, liberty & the pursuit of happiness” supposedly enshrined in our constitution, we must change to single-payer health coverage - Medicare for all. Negotiate fees, drug prices, etc. as 35 of the 36 wealthiest countries do.
It will increase security, societal and civic participation, provide healthy workers & students to contribute to our shared future.
Universal healthcare is a base-line national “benefit” worthy of increased taxes on the corporations & the wealthy (say, at least back to pre-Reagan era levels), as well as taxing non-income benefits like the stock value they use to borrow even more $$ to invest & make more non-income wealth!
Excellent article Wendell. Will TriCare also take a deep dive into the insidious costs being billed to the VA for veterans’ prescription drug benefits? Over the course of 20 years, how many hundreds of billions of dollars have been scammed by ESI over the years?
There seems to be no depths to the things these companies will do in the pursuit of profits. I wonder if somewhere there is a Mob Boss reading this saying; "Damn. That's pretty gutsy."
It stinks. "Something smells in Denmark." I think corruption permeates the entire private healthcare industry.
The number that got me is Evernorth did $6.9 billion pre-tax last year. The FTC deal Cordani is bragging about promises $7 billion in savings over ten years. So 700 million a year, maybe, against seven billion in profit. That's not even a rounding error, that's the cost of keeping the lights on in the compliance department. And they paid no fine. Zero. They agreed to bring Ascent back from Switzerland which they were already planning to do. Potter the part that kills me is this settlement is going to be exhibit A when they fight the RICO case, like, we already cooperated, what more do you want. The Plumbers saw that coming I think.Cordani called it a win. On an earnings call.
They say money is the root to all evil 😈 and it sure is 😈
Racketeer influenced and corrupt organizations let that sink in.
Again, another radiating article, which serves as an anitibiotic for this bacterial infection. Thank you for using your experience to sanitize.
👍💯 very well said 👏👏
Boycott Cigna and Express Scripts.
I would love to sign on to this suit. I've been harmed by them SO many times I've lost count.
Very informative. Thank you, Wendell.
Amazing what Insurance companies have been getting away with. Between this and all the ‘services’ fraud it’s amazing that regulators have not caught all of this taxpayer money going to fraudsters.
👍💯👏👏
The Ascent structure is a masterclass in contract engineering. We review approximately 100 PBM contracts a year, and the pattern of reclassifying rebates as “fees” or “administrative payments” to avoid pass-through obligations is not unique to Express Scripts. It shows up in subtler forms across the industry. The contract says “100% of rebates passed through,” but the definition of “rebate” has been narrowed so precisely that substantial manufacturer payments never qualify. Most employers read the guarantee and assume they’re protected. They’ve never read the definition.
If you watch tv at all, you must have noticed that about 95% of the ads are from drug companies, trying to sell you their newest expensive( in the US) drug, often for hundreds of dollars a pill. If it were not for them( and rain gutters and windows) tv would have no ads at all, and hence would go out of business. Do you think tv execs care if the ad is truthful or not?
Usual American business practices in our new age
Thank you for this. My Medicare uses Express Scripts, so I’m curious to see the outcome.