When I first started working in a pharmacy – in the summer of 1967 – while I was a student. There was NO PBM’s… 95%+ was brand name meds and everything was CASH… The average Rx price was $4-$5. The PBM industry was created by the national UAW contract in the fall of 1969 – that covered the big three auto makers, John Deere & International Harvester. You could say that I had a “front row seat” to watching the PBM industry evolve since the beginning.
Here is graphic that demonstrates where the $$$ you pay at the Rx dept register really goes. Looking back, as the PBM industry starting controlling more and more of all prescriptions filled … the faster the wholesale price from the pharmas went up. Today, abt 85% of all Rxs are filled with generics and the PBM’s control the price for 80%-90% of the 4 billion Rxs that we fill every year. Today the average Rx price is pushing $70.00.
The PBM now are able to DEMAND a kickback/rebate/discount from the pharmas for any med that the pharma doesn’t want to require a prior authorizations. It has been reported that money from the pharma can be up to 75% of the AWP (average wholesale price)
The new Inflation reduction act, that now laws Medicare to negotiate prices for Medicare covered medications… the Insurance/PBM industry was not included as a entity that should be included in the negotiation of Rx prices. Perhaps that we are having a national election in Nov, maybe a lot of money was put into some re-election campaigns by the insurance/PBM industry to make sure that they were not included in that new law. If you have a family, a business, or others who depend on you, visit here to get life insurance.
Filed under: General Problems
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