Most of the “facts” in this video are true. One false statement – the top 4-5 PBM are now owned by the larger insurance companies. The PBM industry was created from a UAW union contract in late 1969 when they wanted a more standardized way for union members to submit their Rx receipts for reimbursement of Rxs that they had paid for. Somewhere between then and now, these PBMs became licensed insurance companies.
Back in the 1940s, Congress gave insurance companies an exemption to the Sherman Antitrust Act https://en.wikipedia.org/wiki/McCarran%E2%80%93Ferguson_Act. Back in the day, the DOJ told pharmacies they could not create an entity to negotiate reimbursements from a PBM, that was “price fixing”.
At one time, the PBM contracts with Pharmacies PROHIBITED pharmacies from telling pts if their cash price was less than the copay their PBM wanted them to pay, if the pt asked if the pharmacy’s cash price was less than the PBM copay, the pharmacist was allowed to tell the pt the true about the cash price that the pt could pay. During the Trump administration either Trump did an EO or Congress passed a law that made it illegal for such clauses to be in the PBM contract.
Actually, it was our Congress that gave the PBMs the idea of getting kickbacks, discounts, and rebates. In the early 70s, Congress decided that because the Feds spent so much on medications on Medicaid Rxs. The Federal government deserved a 10% discount/rebate/kickback from the pharmas for any Rx paid for by Medicaid.
It would appear that since the insurance/PBM industry has one of the largest pots of money to lobby Congress, it would seem that all that money spread around Congress, that industry gets Congress to give them what they want.
Filed under: General Problems
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