Highway robbery is ILLEGAL … EXCEPT for (PBM) Prescription Benefit Managers

Metformin ER (Glucophage XR)

Metformin ER (Glucophage XR) is an inexpensive drug used to treat type II diabetes. It helps control blood sugar in combination with diet and exercise. This drug is slightly more popular than comparable drugs. It is available in brand and generic versions. Generic metformin ER is covered by most Medicare and insurance plans, but pharmacy coupons or cash prices may be lower. The lowest GoodRx price for the most common version of metformin ER (Glucophage XR) is around $3.00, 69% off the average retail price of $9.98.
This is apparently how the “PBM highway robbery game is played”.. The above is from www.goodrx.com
This shows that the AWP (Average Wholesale Price) is $1667.77 and CVS/Caremark paid the pharmacy a total of $155.21 – $40 from the pt & Caremark $115.21 and in turn CVS/Caremark sent the pt’s insurance company a bill for $1212.33
And what did CVS/Caremark do to earn $1057.12 administrative fee ?
Not much more than what a Visa/MC/Amex/Discover does when a person uses them to pay a purchase.  For which a charge card will charge the seller a 2%-3% service charge.
Is Anthem insurance that STUPID about the price or is there some “back door” kickback/rebate/discount from CVS/Caremark  to Anthem…
Everyone – especially members of Congress – is complaining about the cost of Rx medication.   Maybe the fact that the insurance/PBM industry has one of the largest pot of money to hire lobbyists has something to do with Congress’ lack of knowledge what is really behind the high cost of Rx meds ?

One Response

  1. Do you really think Congress is unaware of PBM or like in so many other dealings, are Congressmen/woman also getting a piece of the pie from PBM? I wouldnt put anything pass any politician. The corruption in politics today can go up against any government in the .

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