PBMs

[Marvin the Martian]

Indiana looks to take on their expenses to PBMs. Amazingly, Indiana law doesn't require the managers to turn back all of the money they save Indiana. The article says Indiana is one of the few states without that requirement. What the heck?

It in no way makes sense to negotiate with a CVS affiliate to determine what cost CVS will charge as if the affiliate was a neutral broker (just to pick on the CVS /Caremark relationship as an example). There must be a better way.

The company behind the report, RxConnection, LLC, said a contractual loophole called “off-setting language” allows PBMs to keep more money they’re supposed to pay back to the state.​

​

”Indiana is one of the few states that allows this to even happen to begin with, and so that’s an area that definitely needs to be addressed,” State Sen. Andrea Hunley (D-Indianapolis) said.​

https://fox59.com/news/politics/indiana-paid-7-billion-to-pharmacy-benefit-managers-in-five-year-period-according-to-new-report/

 

[Spartans9312]

Indiana looks to take on their expenses to PBMs. Amazingly, Indiana law doesn't require the managers to turn back all of the money they save Indiana. The article says Indiana is one of the few states without that requirement. What the heck?

It in no way makes sense to negotiate with a CVS affiliate to determine what cost CVS will charge as if the affiliate was a neutral broker (just to pick on the CVS /Caremark relationship as an example). There must be a better way.

The company behind the report, RxConnection, LLC, said a contractual loophole called “off-setting language” allows PBMs to keep more money they’re supposed to pay back to the state.​

​

”Indiana is one of the few states that allows this to even happen to begin with, and so that’s an area that definitely needs to be addressed,” State Sen. Andrea Hunley (D-Indianapolis) said.​

https://fox59.com/news/politics/indiana-paid-7-billion-to-pharmacy-benefit-managers-in-five-year-period-according-to-new-report/

I missed this post Marv….PBMs are the devil when it comes to prescription costs.

I know of one guy already retired that graduated pharmacy school in my class.

Guess what he does…..owns a PBM

 

[Marvin the Martian]

I missed this post Marv….PBMs are the devil when it comes to prescription costs.

I know of one guy already retired that graduated pharmacy school in my class.

Guess what he does…..owns a PBM

It seems many on the right and left hate PBMs, why can't we do something about them? In theory, a middleman negotiating lower prices for bulk business could work. But paying CVS to negotiate with CVS seems patently ridiculous.

 

[Spartans9312]

It seems many on the right and left hate PBMs, why can't we do something about them? In theory, a middleman negotiating lower prices for bulk business could work. But paying CVS to negotiate with CVS seems patently ridiculous.

The contracts that the chains are signing are hogwash. Granted, I’ve been out of the contractual end for a decade. But…I’m sure they are no better.

As an example….Pharmacies are reimbursed by a contract that states something similar to: AWP - % + $1

The difference between AWP and acquisition cost on a brand name drug was 18%.

The contracts will be AWP -16% + $1 on the good end…now you used to be able to make good money on generic drugs but they are now subject to MAC (maximum allowable cost).

Now you see why there aren’t many independent pharmacies.

 

[Marvin the Martian]

The contracts that the chains are signing are hogwash. Granted, I’ve been out of the contractual end for a decade. But…I’m sure they are no better.

As an example….Pharmacies are reimbursed by a contract that states something similar to: AWP - % + $1

The difference between AWP and acquisition cost on a brand name drug was 18%.

The contracts will be AWP -16% + $1 on the good end…now you used to be able to make good money on generic drugs but they are now subject to MAC (maximum allowable cost).

Now you see why there aren’t many independent pharmacies.

If CVS makes money on the PBM side, can it afford not to make as much on the pharmacy side? In other words, the PBM subsidizes its ability to sell for less than an independent can.

If we believed competition lowered prices, PBMs wouldn't exist. Insurance companies would come up with a reward system for using lower-cost options.

This leads me to, I just started looking at Part D insurance for Medicare. Those kids out there may not know the Medicare site allows one to put in all one's drugs, and the cost of the drugs will be returned by insurance plan/pharmacy. So, one can decide if saving $15 a month on insurance is cost-effective. I'm not sure why that sort of thing wouldn't work with most people on high-deductible plans by listing the out-of-pocket costs for medicine by pharmacy.

And wow, is Levothyroxine expensive on Medicare. Others have told me their doctors have told them not to use generics, as the QC is bad. I don't know if that is true or just effective marketing, but the cost of Levo is too high to keep using on Medicare.

 

[mcmurtry66]

If CVS makes money on the PBM side, can it afford not to make as much on the pharmacy side? In other words, the PBM subsidizes its ability to sell for less than an independent can.

If we believed competition lowered prices, PBMs wouldn't exist. Insurance companies would come up with a reward system for using lower-cost options.

This leads me to, I just started looking at Part D insurance for Medicare. Those kids out there may not know the Medicare site allows one to put in all one's drugs, and the cost of the drugs will be returned by insurance plan/pharmacy. So, one can decide if saving $15 a month on insurance is cost-effective. I'm not sure why that sort of thing wouldn't work with most people on high-deductible plans by listing the out-of-pocket costs for medicine by pharmacy.

And wow, is Levothyroxine expensive on Medicare. Others have told me their doctors have told them not to use generics, as the QC is bad. I don't know if that is true or just effective marketing, but the cost of Levo is too high to keep using on Medicare.

PBMs obfuscation, lack of transparency, pure evil. Big, big business

 

[Spartans9312]

If CVS makes money on the PBM side, can it afford not to make as much on the pharmacy side? In other words, the PBM subsidizes its ability to sell for less than an independent can.

If we believed competition lowered prices, PBMs wouldn't exist. Insurance companies would come up with a reward system for using lower-cost options.

This leads me to, I just started looking at Part D insurance for Medicare. Those kids out there may not know the Medicare site allows one to put in all one's drugs, and the cost of the drugs will be returned by insurance plan/pharmacy. So, one can decide if saving $15 a month on insurance is cost-effective. I'm not sure why that sort of thing wouldn't work with most people on high-deductible plans by listing the out-of-pocket costs for medicine by pharmacy.

And wow, is Levothyroxine expensive on Medicare. Others have told me their doctors have told them not to use generics, as the QC is bad. I don't know if that is true or just effective marketing, but the cost of Levo is too high to keep using on Medicare.

You’ve got it figured out.

As to Levothyroxine are you sure you weren’t looking at pricing for the capsules?

 

[Marvin the Martian]

You’ve got it figured out.

As to Levothyroxine are you sure you weren’t looking at pricing for the capsules?

Ah, maybe? I will look again, thanks.

 

[Marvin the Martian]

As to Levothyroxine are you sure you weren’t looking at pricing for the capsules?

Thanks, that was it. That makes a huge difference.

 

[Mas-sa-suta]

If CVS makes money on the PBM side, can it afford not to make as much on the pharmacy side? In other words, the PBM subsidizes its ability to sell for less than an independent can.

If we believed competition lowered prices, PBMs wouldn't exist. Insurance companies would come up with a reward system for using lower-cost options.

This leads me to, I just started looking at Part D insurance for Medicare. Those kids out there may not know the Medicare site allows one to put in all one's drugs, and the cost of the drugs will be returned by insurance plan/pharmacy. So, one can decide if saving $15 a month on insurance is cost-effective. I'm not sure why that sort of thing wouldn't work with most people on high-deductible plans by listing the out-of-pocket costs for medicine by pharmacy.

And wow, is Levothyroxine expensive on Medicare. Others have told me their doctors have told them not to use generics, as the QC is bad. I don't know if that is true or just effective marketing, but the cost of Levo is too high to keep using on Medicare.

Eliquis retail cost $511.80 monthly. $6,142 annually.
3 million US users.

Creating $18.4Billion (less programs) revenue annually.

One (1) med.