Not dead yet!
Well-Known Member
This was in the news yesterday:
http://prospect.org/article/hidden-monopolies-raise-drug-prices-0
------------- Excerpt:
(Definition: PBM - pharmacy benefit manager - the company name on your pharmacy benefit card)
The Hidden Monopolies That Raise Drug Prices
How pharmacy benefit managers morphed from processors to predators
David Dayen
March 28, 2017
{...}
Why haven’t PBMs fulfilled their promise as a cost inhibitor? The biggest reason experts cite is an information advantage in the complex pharmaceutical supply chain. At a hearing last year about the EpiPen, a simple shot to relieve symptoms of food allergies, Heather Bresch, CEO of EpiPen manufacturer Mylan, released a chart claiming that more than half of the list price for the product ($334 out of the $608 for a two-pack) goes to other participants—insurers, wholesalers, retailers, or the PBM. But when asked by Republican Representative Buddy Carter of Georgia, the only pharmacist in Congress, how much the PBM receives, Bresch replied, “I don’t specifically know the breakdown.” Carter nodded his head and said, “Nor do I and I’m the pharmacist. … That’s the problem, nobody knows.”
This lack of transparency enables PBMs to enjoy multiple hidden revenue streams from every other player. “It’s OK to have intermediaries, we have Visa,” says David Balto, an antitrust litigator and former top official with the Federal Trade Commission. “But these companies make a fabulous amount of money, even though they’re not buying the drug, not producing the drug, not putting themselves at risk.”
The PBM industry is rife with conflicts of interest and kickbacks. For example, PBMs secure rebates from drug companies as a condition of putting their products on the formulary, the list of reimbursable drugs for their network. However, they are under no obligation to disclose those rebates to health plans, or pass them along. Sometimes PBMs call them something other than rebates, using semantics to hold onto the cash. Health plans have no way to obtain drug-by-drug cost information to know if they’re getting the full discount.
{...}
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On a personal note, this is why you can't get sudafed even if you DO have a prescription for it. When it became restricted, I tried with a prescription to get a month's worth and was unable. However I know it is manufactured because decades ago I was prescribed it and it worked fine. It was a blue and green capsule with little pellets inside, not the white caplets you get now. Many drugs are probably now OTC to avoid the PBM trap, even though they are "new" (example, Nexium).
It also leads to orphan drugs, that are described in medical journals, but can't be successfully prescribed because they are never stocked by anyone anymore. It's kind of like the reason why you have no control over what your supermarket carries, the distributor decides such things. By just ignoring a drug, they can effectively remove it from the market and doctors lose that tool.
http://prospect.org/article/hidden-monopolies-raise-drug-prices-0
------------- Excerpt:
(Definition: PBM - pharmacy benefit manager - the company name on your pharmacy benefit card)
The Hidden Monopolies That Raise Drug Prices
How pharmacy benefit managers morphed from processors to predators
David Dayen
March 28, 2017
{...}
Why haven’t PBMs fulfilled their promise as a cost inhibitor? The biggest reason experts cite is an information advantage in the complex pharmaceutical supply chain. At a hearing last year about the EpiPen, a simple shot to relieve symptoms of food allergies, Heather Bresch, CEO of EpiPen manufacturer Mylan, released a chart claiming that more than half of the list price for the product ($334 out of the $608 for a two-pack) goes to other participants—insurers, wholesalers, retailers, or the PBM. But when asked by Republican Representative Buddy Carter of Georgia, the only pharmacist in Congress, how much the PBM receives, Bresch replied, “I don’t specifically know the breakdown.” Carter nodded his head and said, “Nor do I and I’m the pharmacist. … That’s the problem, nobody knows.”
This lack of transparency enables PBMs to enjoy multiple hidden revenue streams from every other player. “It’s OK to have intermediaries, we have Visa,” says David Balto, an antitrust litigator and former top official with the Federal Trade Commission. “But these companies make a fabulous amount of money, even though they’re not buying the drug, not producing the drug, not putting themselves at risk.”
The PBM industry is rife with conflicts of interest and kickbacks. For example, PBMs secure rebates from drug companies as a condition of putting their products on the formulary, the list of reimbursable drugs for their network. However, they are under no obligation to disclose those rebates to health plans, or pass them along. Sometimes PBMs call them something other than rebates, using semantics to hold onto the cash. Health plans have no way to obtain drug-by-drug cost information to know if they’re getting the full discount.
{...}
----end
On a personal note, this is why you can't get sudafed even if you DO have a prescription for it. When it became restricted, I tried with a prescription to get a month's worth and was unable. However I know it is manufactured because decades ago I was prescribed it and it worked fine. It was a blue and green capsule with little pellets inside, not the white caplets you get now. Many drugs are probably now OTC to avoid the PBM trap, even though they are "new" (example, Nexium).
It also leads to orphan drugs, that are described in medical journals, but can't be successfully prescribed because they are never stocked by anyone anymore. It's kind of like the reason why you have no control over what your supermarket carries, the distributor decides such things. By just ignoring a drug, they can effectively remove it from the market and doctors lose that tool.
![ME/CFS lecture | Dr Nancy Klimas | 2011 [Chronic Fatigue Syndrome / SEID / New Zealand] - YouTube](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
