Ugh, my stomach is just churning after this read. I am grateful for this forum/substack because this all needs to get pulled into the light. As a physician, I am sickended by this information, and I am firmly set against these profit mongering companies. I am sharing this information a lot and people are just astounded.
I am a nurse, former pharmaceutical rep, and Certified SHIP Medicare Advisor. It is true that most people in general, as well as most healthcare professionals, do not understand the complex healthcare
for generics there are also multiple tactics but a big one is "effective rate guarantees" where the PBM guarantees the client/plans a certain discount off AWP (average wholesale price) as an aggregate across all generic rx claims. At least for MEDD (I'm less familiar with commercial contracts) ESI for example also maintains an aggregate generic effective rate across their entire book of business.
Ugh, my stomach is just churning after this read. I am grateful for this forum/substack because this all needs to get pulled into the light. As a physician, I am sickended by this information, and I am firmly set against these profit mongering companies. I am sharing this information a lot and people are just astounded.
Profits by denials...
I am a nurse, former pharmaceutical rep, and Certified SHIP Medicare Advisor. It is true that most people in general, as well as most healthcare professionals, do not understand the complex healthcare
industry. Thank you for your articles.
Thank you for this article. I referenced it in Ask a Patient Health News to help make consumers aware.
https://mailaskapatient.moosend.com/show_campaign/85eac143-c094-49d5-bb86-131c6cc18f52
Employers continue to feed these monsters. As gatekeepers, they have the key to fix the problem, but most are too ignorant.
I want to know who owns/funds GoodRX, etc. Please.
Same question as me Sunday below. How does it all work?
Wendell, I still do not understand how PBMs generate money for the insurance companies. Could you explain again and give an example.
Eric Bricker has a few great trainings on PBMs. Here's a link to one: https://youtu.be/vT0NNXYjQ_Y.
can find an example here: https://www.drugchannels.net/2019/02/how-health-plans-profitand-patients.html
for generics there are also multiple tactics but a big one is "effective rate guarantees" where the PBM guarantees the client/plans a certain discount off AWP (average wholesale price) as an aggregate across all generic rx claims. At least for MEDD (I'm less familiar with commercial contracts) ESI for example also maintains an aggregate generic effective rate across their entire book of business.