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CVS Limit Drugs Offered---Huge $ Making Scheme-Express Scripts,+500% Profit since 2003,

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posted on Dec, 2 2016 @ 06:58 PM
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This may make your blood boil. Go "free" market!!!



Pharmacy benefit manager is basically a buyer for pharmacies and the gate keeper to what drugs you can get under your (crappy) insurance plan. And to everyone's surprise this is being abused to make huge profits, WHAT????


Pharmacy benefit managers act as middlemen between drug companies and patients, pharmacists and insurers. They determine which medicines are covered, and at what co-pay or co-insurance level, for 210 million Americans' health plans. They're abusing this role to rake in enormous profits — at the expense of patients' health.


They make huge purchases in bulk save huge $$ but rarely pass it on the customer. I think we need to reduce regulations./sarc



The problem is that, in practice, PBMs rarely pass the rebates they wrench away from drug companies along to pharmacies, insurers or patients. PBMs instead hoard the cash. Express Scripts, the nation's largest PBM — which boasted a market cap of $43 billion in early November — has increased its profit per adjusted prescription 500% since 2003.


The PBM's can influence what drugs are offered to patients with diseases like MS. If they won't carry the top 3 treatments(like CVS) this will put pressure on other makers of different treatments to lower prices. But for MS the Dr's prescribe a very specific drugs, and if it isn't covered people can't afford the $15,000 a month drug.


When PBMs decrease coverage, patients suffer. Consider the plight of the 400,000 Americans with multiple sclerosis, a neurological disease that causes pain, fatigue and a loss of muscle control.

CVS Health, the nation's second-largest PBM, excludes three top multiple sclerosis treatments in order to pressure the makers of other treatments into giving steeper discounts. That's dangerous for MS patients whose doctors purposely prescribed one of those three treatments to help them manage their disease.

When drugs aren't covered by a PBM-determined insurance plan, many patients give up and stop taking the medications, rather than appeal for an exemption. One study, examining 60,000 Americans, found that when PBMs excluded drugs, almost half of patients simply stopped taking those medicines.
www.investors.com...
edit on 2-12-2016 by seasonal because: (no reason given)

edit on 2-12-2016 by seasonal because: (no reason given)

edit on 2-12-2016 by seasonal because: (no reason given)

edit on 2-12-2016 by seasonal because: (no reason given)




posted on Dec, 2 2016 @ 07:41 PM
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a reply to: seasonal

Who are the real drug dealers? I think we all know the answer. I'd like to know how many Americans die a year because we pay more than other countries for drugs made here.



posted on Dec, 2 2016 @ 07:57 PM
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a reply to: CriticalStinker

No silly we pay more so the other countries can pay less, BS. We pay more because the regulations are lax. When you can limit access for profit, there is a huge problem. When you can buy in bulk and have unlimited savings and unlimited profits, there is a need for regulations to protect the consumer.



posted on Dec, 2 2016 @ 08:28 PM
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a reply to: seasonal

PBM's are mostly clinical pharmacists. What they do is look at a request for a medication that isnt on the formulary, and look to see if it is appropriate therapy, there are no drug interactions and has the patient tried other medications required for approval for the new drug.

Example: Dr writes an rx for dexilant, for acid reflux. It is denied by the insurance company and the case goes to a clinical pharmacist. They look at the patient case to see if the patient had tried at least 2 other proton pump inhibitors and they didnt work. If they did, it gets approved, if not, it wont.

At least this is my experience (I am a retail pharmacist) in dealing with PBM's.



posted on Dec, 2 2016 @ 08:34 PM
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a reply to: annoyedpharmacist
The story paints a different picture. Does the story pass your smell test?



posted on Dec, 2 2016 @ 08:37 PM
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Prescription drug market is one of those examples that really hurt free market arguments. As a libertarian in theory its hard to support it. Especially considering that I have asthma now and they pulled some trickery on patents for the delivery method for inhalers. $200 dollars a month for QVAR, $10 in europe. Can get it shipped from Canada for $60.



posted on Dec, 2 2016 @ 08:41 PM
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The prescription drug market is also the biggest hurdle the legalization of marijuana has to overcome.

Won't never be legal in the US without the drug companies getting their share.

Medical marijuana is their foothold.



posted on Dec, 2 2016 @ 08:45 PM
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a reply to: seasonal

I could see them pressuring the manufacturers to try and decrease price to increase profit margin......drug prices are out of control. I lose money on 25% of my rxs dues to decreasing Medicare reimbursement rates and increasing drugs costs.....only Pharmacies that are going to be left are the big boys, independents are losing their buts....

Basically even if they take the meds off the formulary, PBM's dont carry drugs they deal with approval, a medical exception report can be filed by the patient in the form of a Prior Authorization request. Dr's hate this because it requires tons of documentation.....but I have found that if a medication is MEDICALLY NECESSARY and there are no other alternatives, that most times (not all) the medication gets approved.


edit on pm1212201616America/Chicago02p08pm by annoyedpharmacist because: (no reason given)



posted on Dec, 2 2016 @ 08:52 PM
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a reply to: RickinVa

I have been saying it for years, get the people off opana and percocet and try other things, like GASP, pot. I see so many oldsters who are hopelessly addicted to opiates and dont even realize it.....very sad.



posted on Dec, 2 2016 @ 09:24 PM
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a reply to: seasonal

Quite simply, if the drug companies and intermediaries aren't going to be strictly regulated, then they should have all protections stripped. They want a free market, give them one. No more patents.

Any member of Congress who doesn't agree and act to either fully regulate or fully deregulate should lose the legal ability to obtain prescribed medication.



posted on Dec, 2 2016 @ 09:31 PM
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My father was a big pharma sales manager. So I hear a lot about how things operate. He told me several times that the pharmacies, who they sell to directly, normally charge the first patient for the full amount of what they paid for the bottle. Then all the scripts after that are pure profit. So, as I see it the the whole industry and each provider is looking to make as much as possible. I used to buy pharmaceuticals in other countries I was in and the meds are cheap. You can go over the border to Mexico and get meds a lot cheaper that in the US.



posted on Dec, 2 2016 @ 09:34 PM
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a reply to: spirit_horse

The system has to collapse to work again.



posted on Dec, 2 2016 @ 09:37 PM
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a reply to: dogstar23

I agree, let the flood gates open across the whole world. Ship it right to our homes. Screw'em.



posted on Dec, 2 2016 @ 09:45 PM
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originally posted by: seasonal
a reply to: dogstar23

I agree, let the flood gates open across the whole world. Ship it right to our homes. Screw'em.


For example, you can buy 400 1mg Xanax from Argentina for $100. Try that here.

Warning: Don't start buying meds outside the border because you can be charged for drug trafficking by shipping it into the US.



posted on Dec, 2 2016 @ 10:08 PM
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a reply to: spirit_horse

Free market for corps, not for the people.



posted on Dec, 2 2016 @ 10:11 PM
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a reply to: spirit_horse

There is no way I would get away with charging someone say 325.00 for a bottle of januvia, on one rx alone.....I would be out of business over night. I know people want to try and blame the Pharmacies for the prices, but I HAVE ZERO input as to a copay set by insurance companies.

In fact, I am contractually obligated to accept the copay even if I lose a boat load of money, just to keep in network with the plan. I 100% blame the drug companies for going crazy with costs.

Example: Doxycycline, use to treat tick bites in my neck of the woods is a HUGE seller in my pharmacy. Well, there was a manufactured (my opinion it was done on purpose) shortage in the drug. The price was about 10.00 a bottle of 50 when it went backordered (ie impossible to find), when it came back it was over 500.00 a bottle a few months later. We lost our asses......price eventually went back down, but the drug companies are doing this to MANY drugs that have been around forever and used to be dirt cheap. They manufacture a shortage, increase demand ARTIFICIALLY and jack up the price 300% or more.....



posted on Dec, 2 2016 @ 10:17 PM
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originally posted by: annoyedpharmacist
a reply to: spirit_horse

There is no way I would get away with charging someone say 325.00 for a bottle of januvia, on one rx alone.....I would be out of business over night. I know people want to try and blame the Pharmacies for the prices, but I HAVE ZERO input as to a copay set by insurance companies.

In fact, I am contractually obligated to accept the copay even if I lose a boat load of money, just to keep in network with the plan. I 100% blame the drug companies for going crazy with costs.

Example: Doxycycline, use to treat tick bites in my neck of the woods is a HUGE seller in my pharmacy. Well, there was a manufactured (my opinion it was done on purpose) shortage in the drug. The price was about 10.00 a bottle of 50 when it went backordered (ie impossible to find), when it came back it was over 500.00 a bottle a few months later. We lost our asses......price eventually went back down, but the drug companies are doing this to MANY drugs that have been around forever and used to be dirt cheap. They manufacture a shortage, increase demand ARTIFICIALLY and jack up the price 300% or more.....


That is ridiculous. I have been on meds for 25 years and they were very inexpensive. They have been around since WWII. In the last many years I have watched the prices quadruple. My father was in the business in the 60's and 70's. He introduced Lasix to the Market in Florida and Michigan. Back then at leas it was the practice of the pharmacies to do what I mentioned above. Today things are more regulated and of course prices are insane. When I was in the hospital and had like 23 major surgeries some of the antibiotics were $10,000 a pouch for the IV.



posted on Dec, 2 2016 @ 11:07 PM
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People who work can't get raises because their insurance costs are going up a lot. Especially the drug coverage part. Also the deductibles are going up and the copays that the employer provides. Twelve grand a year for a workers policy is what a lot of employers pay. Ten years ago there was better coverage at around half the price. An outpatient clinic visit was fifty bucks, now it is a hundred sixty five plus any extras they can charge for.

There is something seriously wrong with our countries healthcare and pharmaceutical costs.



posted on Dec, 3 2016 @ 01:56 AM
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Shows who is calling the shot's,seems certain corporations can make disgusting amounts of money off the public,yet these same liberals demonize"big" buisness,tax them so they have to leave the country,some definate house cleaning in order



posted on Dec, 3 2016 @ 03:15 AM
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originally posted by: spirit_horse
Warning: Don't start buying meds outside the border because you can be charged for drug trafficking by shipping it into the US.


Actually, it's not an issue, by and large.

If you have a prescription for it, it's no issue whatever. If you DON'T have one, and it's not a schedule med, it's still no issue whatever, as long as you buy 'in reasonable quantities', and that's generally 90 days worth.

I wouldn't try buying scheduled narcs from overseas without a scrip. But with one, no probs at all.




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