Pharmacy benefit managers’ business practices have led to soaring prescription drug prices that make life-saving medications unaffordable for millions of Americans.
It is good news that reining in the PBM's is a bipartisan issue. This should have been solved months ago. Trump should be told by Congress, if it passes, any veto will be overturned.
PBMs are in business to profit from positioning themselves as the middlemen of every Rx transaction. The more they spend (of a client's Healthcare dollars), the more they make., facilitating a misaligned incentive when it comes to reducing Rx costs . Their role should simply be to process the Rx claims on a per Rx fee basis with no incentive or capacity to influence the price of those claims. True savings in prescription medications will come when there is no correlation between profit from processing the medication claim and the True Cost of the product. Example: The exact same prescription product from a Canadian Pharmacy at $168 costs $8710 in the USA. No PBM interference. I am NOT suggesting we purchase Rxs from Canada as a fix. Remove unnecessary price influence by the PBMs; pay PBMs claims processing fees; ensure Pharma accommodates the now reduced need for Rebates, fees, etc formerly paid to the PBMs, and maybe we can start paying that $168 right here at home and pass the savings back to the employers and our government programs currently being exploited.
We have been talking about closing our pharmacy because of low reimbursements by greedy PBMs. This bill needs to pass sooner than later. We can’t wait a whole year, we will be closed by then and our thousands of patients will be without us. We were unable to pay our wholesaler yesterday. This is no way to run a business even though we are a very busy pharmacy.
Why isn’t DOGE looking into this wasteful practice?? Insurance companies are ripping off our government!
It's not just the PBMs; TPAs and health plans are guilty as well. There is a case in Maryland Federal Court about a health plan concealing rebates from employers.
It's taken so long after the Part D bill that W ushered in that decoupled physicians from the high cost drugs they recommended. Back then, the expensive chemotherapy was always an Oncologist's recommended first choice. Same happened with Rheumatolgists.
It is good news that reining in the PBM's is a bipartisan issue. This should have been solved months ago. Trump should be told by Congress, if it passes, any veto will be overturned.
PBMs are in business to profit from positioning themselves as the middlemen of every Rx transaction. The more they spend (of a client's Healthcare dollars), the more they make., facilitating a misaligned incentive when it comes to reducing Rx costs . Their role should simply be to process the Rx claims on a per Rx fee basis with no incentive or capacity to influence the price of those claims. True savings in prescription medications will come when there is no correlation between profit from processing the medication claim and the True Cost of the product. Example: The exact same prescription product from a Canadian Pharmacy at $168 costs $8710 in the USA. No PBM interference. I am NOT suggesting we purchase Rxs from Canada as a fix. Remove unnecessary price influence by the PBMs; pay PBMs claims processing fees; ensure Pharma accommodates the now reduced need for Rebates, fees, etc formerly paid to the PBMs, and maybe we can start paying that $168 right here at home and pass the savings back to the employers and our government programs currently being exploited.
We have been talking about closing our pharmacy because of low reimbursements by greedy PBMs. This bill needs to pass sooner than later. We can’t wait a whole year, we will be closed by then and our thousands of patients will be without us. We were unable to pay our wholesaler yesterday. This is no way to run a business even though we are a very busy pharmacy.
Why isn’t DOGE looking into this wasteful practice?? Insurance companies are ripping off our government!
It's not just the PBMs; TPAs and health plans are guilty as well. There is a case in Maryland Federal Court about a health plan concealing rebates from employers.
PBMs are a scourge on healthcare
It's taken so long after the Part D bill that W ushered in that decoupled physicians from the high cost drugs they recommended. Back then, the expensive chemotherapy was always an Oncologist's recommended first choice. Same happened with Rheumatolgists.
This will be more difficult than imagined given the deep pockets of the Pharmaceutical Care Management Association.