folks who do not understand the industry. I know when I submit a bid to a PBM there is not an exorbitant profit built into the equation…in fact, after all of the rebates and discounts, the profit margin is unbelievably slim. I also hear how the gov. Does not negotiate prices, well here is what I do know, when I submit anything to the government I have to use a formula to get a GNUP and use that number. It is far from retail. Most of the drugs that are at issue are specialty drugs and can be more of a supply and demand play. I have actually had to accept a 64% rebate demand from a PBM, not to mention administration fees of 4.5% and an early pay discount of 2%. There was another fee as well ~3%.
For those keeping score at home, that is 73.5% off of AWP (average wholesale price)
I had always heard that the PBM’s demanded rebates/kickbacks/discounts from the pharmas of up to 50% to have one of their drugs on the PBM’s formulary and being approved without going thru a PA.
Now it is more apparent was to why insulin is now several hundred dollars for a 10 ml vial.
With a vial of insulin costing $50 a few years ago .. it is easy to see why it could now be $200 because of demands of the PBM’s to PAD THEIR POCKETS.
For every $1 that a pharma wants to raise their price to cover increased business expenses… they would have to raise the price $4 to cover the kickback money to the PBM’s.
This also explains why Canada and other countries with national health insurance… there is no for profit insurance and PBM middlemen… and thus their retail price could be 75% less expensive.
It has been stated that the Insurance/PBM industries have one of the largest pots of money to funding lobbying, so.. it is unlikely that Congress will pass any such price controls… with 435 members of the House and 33-34 members of Senate up for reelection is 10 months..
Filed under: General Problems
I’ve heard from a couple pharmacists that it’s actually cheaper for the patient to pay cash for their Rxs then run them through ins. Saves pharmacy $ and the patient. Have you heard this before? Think I have but been awhile.
And, some medicare plans with ES, the pbm’s at the last minute have made it Impossible for Indy pharmacy’s to get decent contracts with them or flat out denied them.
Why doesn’t this country do away with these rip off scammers? And get rid of these Pbm’s?
Express Scripts seems to not want small pharmacy buisinessses to participate in their preferred plans. They want to try and force patients onto mail ordering. This is horrible because patients don’t like these mail order’s. They are terrible at getting meds to them in a timely manner. Our Congress sucks, they’re doing nothing to fix healthcare. I don’t think they want to.
How isnt this illegal? It is exactly what you called it a mob shake down! I would think the slime balls running for a seat would want to pass a “price control” of some kind on medication. Its either staying pals with the mob and possibly losing there seat or demand price control an l get re elected. All this BS can make your head spin. If this makes no sense its because my head is spinning……