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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.
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.
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.
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.
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.....
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.