PBM reform is a good place to start. The rise of PBMs is linked to the unbridled vertical integration in the health care industry, on the excuse that the ACA limits insurance carriers to paying out 85% of payments in benefits.... so the poor babies had to find other ways to fleece the 5.3 trillion dollar golden goose... can we catch up to the rest of the world please... how is Germany paying 1/10th of what we are charged for the GLP1 drugs sane? How is spending twice what every other OECD country pays for healthcare, with worse outcomes...sane?
We have to thank Richard Nixon and Mr. Keiser for making our healthcare system profitable.
While we are in the thanking mood, let’s give a big shout out to George W. Bush who signed Medicare Part D that was a gift to pharmaceutical companies that wrote the darned bill.
Hubby reached the $8000 donut hole in July of 2024. Afterwards, it was a blessing that the remaining five months of his prescription medication required zero copays. We are fortunate that our savings allowed us to contribute heavily towards that $8000 copayment. Most seniors do not have the ability to do so.
Because of Biden’s health reforms, the maximum copays in 2025 will only require $2000 copays.
I can only hope that Trump will continue with Biden’s prescription copay policies.
Thanks Wendell for this always illuminating and informative article about PBMs. The bipartisan anger about health care costs could very well start with breaking up PBMs who have raised the cost of prescription drugs rather than lower them. Slowly we need to dismantle the enormous health care bureaucracy which accounts for why we pay more than any other country in the world for our drugs.
PBM reform is a good place to start. The rise of PBMs is linked to the unbridled vertical integration in the health care industry, on the excuse that the ACA limits insurance carriers to paying out 85% of payments in benefits.... so the poor babies had to find other ways to fleece the 5.3 trillion dollar golden goose... can we catch up to the rest of the world please... how is Germany paying 1/10th of what we are charged for the GLP1 drugs sane? How is spending twice what every other OECD country pays for healthcare, with worse outcomes...sane?
Every few years PBMs are hauled to the Hill and zippo comes out of it. I have PTSD from dealing with them for decades.
We have to thank Richard Nixon and Mr. Keiser for making our healthcare system profitable.
While we are in the thanking mood, let’s give a big shout out to George W. Bush who signed Medicare Part D that was a gift to pharmaceutical companies that wrote the darned bill.
Hubby reached the $8000 donut hole in July of 2024. Afterwards, it was a blessing that the remaining five months of his prescription medication required zero copays. We are fortunate that our savings allowed us to contribute heavily towards that $8000 copayment. Most seniors do not have the ability to do so.
Because of Biden’s health reforms, the maximum copays in 2025 will only require $2000 copays.
I can only hope that Trump will continue with Biden’s prescription copay policies.
Thanks Wendell for this always illuminating and informative article about PBMs. The bipartisan anger about health care costs could very well start with breaking up PBMs who have raised the cost of prescription drugs rather than lower them. Slowly we need to dismantle the enormous health care bureaucracy which accounts for why we pay more than any other country in the world for our drugs.
General public do not understand the complexities of insurance Rx pricing, pharmacy closures and more. Thank you for sharing critical information!