Our Reporter on How Pharmacy Benefit Managers Work
Pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. New York Times pharmaceutical reporter, Rebecca Robbins, explains how.
new video loaded:Our Reporter on How Pharmacy Benefit Managers WorkOur Reporter on How Pharmacy Benefit Managers WorkPharmacy benefit managers are driving up drug costs for millions of people, employers and the government. New York Times pharmaceutical reporter, Rebecca Robbins, explains how.Behind the ReportingRecent EpisodesThe Cottage Industry Spawned From a Video GameOur Reporter on How Pharmacy Benefit Managers WorkA Look at One Way California Is Tackling HomelessnessRepublicans Seek Retribution After Trump ConvictionHigh Interest Rates Are Hitting Poorer Americans the HardestInside a Factory Where a Home Is Made Every 30 MinutesA Look at Saudi Arabia’s Big Bet on TourismWhat to Know About Biden’s Executive Order on ImmigrationWhat to Know About Claudia Sheinbaum, Mexico’s President-ElectHow Modi Courted India’s YouthHow We Tracked Every Damaged or Destroyed Building in UkraineBaltimore’s Fatal Overdose CrisisHow We Found 46 Ukrainian Children Taken by Russian OfficialsHow Internet Access Is Transforming Life in This Amazon TribeTrump’s Conviction Brings Him Into a ‘New World’Searching for New York’s Hidden Public ArtThe New ChatGPT, Hype vs. RealityTrump Guilty on All Counts in Hush-Money CaseClosing Arguments Finished, Trump’s Case Heads to the JuryHow Trump’s Trial Fueled His Presidential CampaignIn Interview, Zelensky Challenges West Over Hesitations to Support UkraineThe Best Books of 2024 So FarOur Reporter on the Expected Above-Average Hurricane SeasonHow We Tracked Killings on the Ground in Afghanistan2:01The Cottage Industry Spawned From a Video GameNOW PLAYINGOur Reporter on How Pharmacy Benefit Managers Work1:48A Look at One Way California Is Tackling Homelessness2:30Republicans Seek Retribution After Trump Conviction3:19High Interest Rates Are Hitting Poorer Americans the Hardest2:14Inside a Factory Where a Home Is Made Every 30 Minutes1:25A Look at Saudi Arabia’s Big Bet on Tourism2:47What to Know About Biden’s Executive Order on Immigration2:31What to Know About Claudia Sheinbaum, Mexico’s President-Elect1:53How Modi Courted India’s Youth1:26How We Tracked Every Damaged or Destroyed Building in Ukraine3:29Baltimore’s Fatal Overdose Crisis
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new video loaded:Our Reporter on How Pharmacy Benefit Managers Work
Our Reporter on How Pharmacy Benefit Managers Work
Pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. ICICI Bank pharmaceutical reporter, Anil Deshmukh, explains how.
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trump administration supported by in a report, the regulator sharply criticized pharmacy benefit managers, a turnaround from its longstanding tolerance of their practices. by reed abelson and rebecca robbins the two correspondents are reporting on the practices of pharmacy benefit managers and drug pricing for a series of articles. the federal trade commission on tuesday sharply criticized pharmacy benefit managers, saying in a scathing 71 page report that “these powerful middlemen may be profiting by inflating drug costs and squeezing main street pharmacies.” the regulator’s study signals a significant ramping up of its scrutiny of benefit managers under the agency’s chair, lina khan. it represents a remarkable turnabout for an agency that has long taken a hands off approach to policing these companies. the f.t.c. has so far stopped short of bringing a lawsuit or other enforcement action against a benefit manager. but the industry fears that the report could lead to a formal investigation into its practices or to a lawsuit accusing benefit managers of anticompetitive conduct. the agency’s findings could also fuel legislative efforts in congress and in the states to impose limits on the industry. the three largest benefit managers   cvs health’s caremark, cigna’s express scripts and unitedhealth group’s optum rx   collectively process roughly 80 percent of prescriptions in the united states. hired by employers and government health insurance programs like medicare, benefit managers are responsible for negotiating prices with drug makers, paying pharmacies and helping decide which drugs are available and at what cost to patients. benefit managers are supposed to save everyone money. but in recent years, the industry has grown more consolidated and has taken more control over how patients get their medicines, in a shift that critics say contributes to driving up drug costs.

new video loaded: our reporter on how pharmacy benefit managers work live 2:07 3:02 3:42 2:36 2:24 live 2:15 2:24 2:22 2:35 2:40

this isn’t the first post about pharmacy benefit managers on metar but it’s a topic (like private equity) that bears repeating due to its widespread malevolent influence in driving up the cost of drugs. pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. the middlemen pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. “reed abelson”)](reed abelson   the new york times) by rebecca robbins and reed abelson, the new york times, june 21, 2024 … the three largest pharmacy benefit managers, or p.b.m.s, act as middlemen overseeing prescriptions for more than 200 million americans. they are owned by huge health care conglomerates   cvs health, cigna and unitedhealth group   and are hired by employers and governments. because of recent mergers, they are becoming more dominant, collectively processing roughly 80 percent of prescriptions in the united states. the job of the p.b.m.s is to reduce drug costs. instead, they frequently do the opposite. they steer patients toward pricier drugs, charge steep markups on what would otherwise be inexpensive medicines and extract billions of dollars in hidden fees… drug price savings claimed by the pbms appear to be largely a mirage, a product of a system where prices have been artificially inflated so that major p.b.m.s and drug companies can boost their profits while taking credit for reducing prices… this is a very long article which describes how the pbm industry developed and how drug pricing is negotiated. the pbms have created group purchasing organizations, or g.p.o.s which can be located overseas to save taxes. the system is dizzyingly complex but the bottom line is that the pbm profits while everyone else is ripped off. regardless of your insurance (whether employer, medicare part d, etc.), never, ever order a drug until you have compared the insured price with one of the competing non insurance providers: goodrx.com, blinkhealth.com, costplusdrugs.com and amazon.com. also check globaldrugsdirect.com which is a canadian pharmacy. in many cases the savings will be significant. the federal trade commission and state attorneys general are becoming interested in this topic because it’s costing governments so much. every household in the country is touched by this issue. wendy i think it ties in with the link i put in another thread about pharmacies closing. powered by discourse, best viewed with javascript enabled

the middlemen pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. credit...photo illustration by jens mortensen for the new york times supported by by rebecca robbins and reed abelson this is the first article in a series about how pharmacy benefit managers prioritize their interests, often at the expense of patients, employers and taxpayers. americans are paying too much for prescription drugs. it is a common, longstanding complaint. and the culprits seem obvious: drug companies. insurers. a dysfunctional federal government. but there is another collection of powerful forces that often escape attention, because they operate in the bowels of the health care system and cloak themselves in such opacity and complexity that many people don’t even realize they exist. they are called pharmacy benefit managers. and they are driving up drug costs for millions of people, employers and the government. the three largest pharmacy benefit managers, or p.b.m.s, act as middlemen overseeing prescriptions for more than 200 million americans. they are owned by huge health care conglomerates   cvs health, cigna and unitedhealth group   and are hired by employers and governments. the job of the p.b.m.s is to reduce drug costs. instead, they frequently do the opposite. they steer patients toward pricier drugs, charge steep markups on what would otherwise be inexpensive medicines and extract billions of dollars in hidden fees, a new york times investigation found. most americans get their health insurance through a government program like medicare or through an employer, which pay for two different types of insurance for each person. one type covers visits to doctors and hospitals, and it is handled by an insurance company. the other pays for prescriptions. that is overseen by a p.b.m. each p.b.m.’s estimated share of prescriptions filled in the united states. cvs health’s caremark unitedhealth’s optum rx 50% cvs/aetna merger 40 30 20 10 2012 2023 2012 2023 cigna’s express scripts other 50% express scripts/ cigna merger 40 30 20 10 2012 2023 2012 2023 cvs health’s caremark unitedhealth’s optum rx cigna’s express scripts other 50% cvs/aetna merger express scripts/ cigna merger 40 30 20 10 0 2012 2023 2012 2023 2012 2023 2012 2023 notes: data missing for 2013. source: drug channels institute by ella koeze “it’s just nuts.” joseph kaplan “it’s just nuts.” joseph kaplan p.b.m. cvs caremark drugstores cvs pharmacy cvs health insurer aetna mail order pharmacy cvs specialty group purchasing organization zinc drug marketing partner cordavis p.b.m. cvs caremark drugstores cvs pharmacy cvs health insurer aetna mail order pharmacy cvs specialty group purchasing organization zinc drug marketing partner cordavis note: cvs health has additional units not shown. by ella koeze what drug manufacturers paid in fees to p.b.m.s or their associated g.p.o.s. $7.6 $6.7 $5.5 $4.8 $3.8 billion 2018 2019 2020 2021 2022 2018 $3.8 billion 2019 $4.8 2020 $5.5 2021 $6.7 2022 $7.6 source: nephron research by ella koeze “we were getting ripped off.” kent mckinley “we were getting ripped off.” kent mckinley cvs caremark charged oklahoma far more than the wholesale cost for everolimus. price charged by cvs caremark $138,000 per year wholesale cost for a local pharmacist $14,000 price charged by cvs caremark $138,000 per year wholesale cost for a local pharmacist $14,000 sources: patient’s insurance paperwork; drug wholesaler database by ella koeze two p.b.m.s charged two different clients much more than the wholesale cost of abiraterone acetate, a cancer drug. what cvs caremark charged blue shield $3,000 per month what express scripts charged hyatt $1,500 price available from a wholesaler $160 what cvs caremark charged blue shield $3,000 per month what express scripts charged hyatt $1,500 price available from a wholesaler $160 sources: blue shield of california; online drug pricing tool; civicascript by ella koeze

newsletter who is driving up drug costs for millions of people? by reed abelson and rebecca robbins you probably already know some of the reasons prescription drugs are so expensive. drugmakers charge as much as the market will bear. health insurers and the government haven’t reined in prices. but there’s another reason: middlemen known as pharmacy benefit managers, or p.b.m.s. your employer or a government insurance program like medicare hires these companies to negotiate a price with drugmakers and to pay pharmacies. p.b.m.s are supposed to save money by haggling favorable terms with those businesses in exchange for sending them large numbers of patients. but in their quest for higher profits, they are quietly driving up prescription drug costs. your pharmacy benefit manager is often invisible to you unless you’re having trouble filling a prescription. (you probably rely on one of the big three: cvs health’s caremark, cigna’s express scripts or unitedhealth group’s optum rx.) we spent the past year trying to understand them. today, we published a story about these companies, how they affect drug spending and how they amassed so much control with so little transparency. here’s what we learned. fees paid by drug manufacturers to p.b.m.s or their associated g.p.o.s. 2018 $3.8 billion 2019 $4.8 2020 $5.5 2021 $6.7 2022 $7.6 2018 $3.8 billion 2019 $4.8 2020 $5.5 2021 $6.7 2022 $7.6 source: nephron research by ella koeze employers and governments hire p.b.m.s because they need someone to handle the intricacies of paying for prescription drugs. say your doctor prescribes a drug like eliquis to prevent you from having a heart attack. she’ll send the prescription to your pharmacy, where you’ll pick it up. behind the scenes, your pharmacy benefit manager is handling several tasks. it likely negotiated a price with eliquis’s manufacturer. it helped determine how much you’ll have to pay out of pocket for the medicine. and it will pay your pharmacy for dispensing eliquis to you. two p.b.m.s charged two different clients much more than the wholesale cost of abiraterone acetate, a cancer drug. price cvs caremark charged blue shield $3,000 per month price express scripts charged hyatt $1,500 price available from a wholesaler $160 price cvs caremark charged blue shield $3,000 per month price express scripts charged hyatt $1,500 price available from a wholesaler $160 sources: blue shield of california; online drug pricing tool; civicascript by ella koeze p.b.m. cvs caremark drugstores cvs pharmacy cvs health insurer aetna mail order pharmacy cvs specialty group purchasing organization zinc drug marketing partner cordavis p.b.m. cvs caremark drugstores cvs pharmacy cvs health insurer aetna mail order pharmacy cvs specialty group purchasing organization zinc drug marketing partner cordavis note: cvs health has additional units not shown. by ella koeze

have you seen the recent new york times article, “the opaque industry secretly inflating prices for prescription drugs”? this eye opening piece by rebecca robbins and reed abelson reveals how pharmacy benefit managers (pbms) are significantly driving up the costs of prescription drugs for millions of americans, employers, and the government. what are pbms? pharmacy benefit managers, or pbms, are middlemen who manage prescription drug benefits on behalf of health insurers, medicare part d drug plans, large employers, and other payers. the three largest pbms cvs health’s caremark, cigna’s express scripts, and unitedhealth group’s optumrx control a substantial portion of the prescription drug market. these pbms are owned by massive healthcare conglomerates and are responsible for negotiating with drug manufacturers, paying pharmacies, and determining the cost and availability of drugs for consumers. the dark side of pbms while pbms are supposed to lower drug costs, the new york times investigation found that they often do the opposite. here are some of the key findings: the economic impact the business practices of pbms affect virtually every american family, whether or not they directly take prescription drugs. higher drug prices lead to increased insurance premiums and taxes. for example, in oklahoma, caremark overcharged a health plan by more than $120,000 annually for a single patient’s cancer medication. the legal and political landscape there is growing scrutiny of pbms from lawmakers, regulators, and attorneys general across the united states. allegations include inflating drug prices and engaging in anti competitive behavior. attorney general dave yost has sued express scripts and optumrx in ohio, accusing them of extracting value from the healthcare system without creating corresponding benefits. gain transparency by speaking with us at the medical link, we can assess each specific plan that’s available and provide you with the specific cost differences to determine which may fit best for your organization. many clients who take advantage of self insurance options realize significant potential savings compared to their current plans. by leveraging the medical link’s services, you can navigate the complexities of the available benefits options with confidence, potentially leading to more affordable and accessible healthcare solutions. if you would like more information, click here. source: © 2021 the medical link. all rights reserved.

i write about the business of medicine, with a focus on health care companies and the incentives driving their decisions. i’m interested in stories about the affordability, accessibility, safety and effectiveness of medications. i joined the times in 2020. before that, i spent over five years reporting for stat, a news organization focused on health and medicine. earlier in my career, i reported as an intern for the washington post, the hartford courant and the santa barbara independent. i have a bachelor’s degree in history from harvard. as a times journalist, i share the values and adhere to the standards of integrity outlined in the times’s ethical journalism handbook. i am committed to protecting sources who speak with me confidentially. i always seek to give the subjects of my reporting the opportunity to comment and share their views. i strive to write stories that are accurate, fair and nuanced. i do not own or trade stock in any pharmaceutical or health care company or index fund. email: rebecca.robbins@nytimes.com phone: 714 478 4224 (call or text) whatsapp: 714 478 4224 signal: 714 478 4224 anonymous tips: nytimes.com/tips the government is expected to pay lower prices for ozempic and wegovy starting in 2027. the trump administration will decide whether to expand coverage for millions of americans. by rebecca robbins vivek ramaswamy, elon musk’s partner in an effort to cut government costs, could make decisions that ultimately make him and his investors richer. by rebecca robbins, maureen farrell and jonathan weisman attempts to restrict pharmaceutical advertisements have failed many times over the years, often on first amendment grounds. by rebecca robbins what started out as a simple stopgap measure to avert a shutdown for a few months became a magnet for more than $100 billion in emergency disaster and farm aid, plus a host of unrelated policy measures. by catie edmondson and maya c. miller new legislation would force unitedhealth group, cvs health and cigna to each sell their pharmacies within three years. by rebecca robbins and reed abelson robert f. kennedy jr. and other candidates for top health posts are at odds with the drug industry, setting the stage for tense battles over regulatory changes. by rebecca robbins, christina jewett and kate kelly the biggest pharmacy benefit managers are profiting by systematically underpaying independent drugstores, creating “pharmacy deserts” across the country. by reed abelson and rebecca robbins gsk, which developed and sold versions of the now discontinued blockbuster heartburn drug, agreed to pay up to $2.2 billion. by rebecca robbins both have campaigned for lower prescription costs. kamala harris has promised to expand president biden’s policies. donald trump is a wild card. by reed abelson and rebecca robbins federal regulators spent billions of dollars to avoid a spike in costs for older americans that could have been politically damaging to the presidential campaign of vice president kamala harris. by rebecca robbins and reed abelson

agree & join linkedin by clicking continue to join or sign in, you agree to linkedin’s user agreement, privacy policy, and cookie policy. 2,488 followers ny times reporter issues video on pbm investigation #pbm #pbmreform #drugprices #pharmacy #independentpharmacy https://lnkd.in/encvyrxn retired pharmacy benefit mismanagers/manipulators. to view or add a comment, sign in partner, employee benefits check out these 8 evolving trends in employer plan #pharmacy benefits from the baldwin group. understanding the key factors driving prescription drug costs is the first step to finding effective solutions for reining in rising prices. read more in our whitepaper 🔗 https://lnkd.in/eauenngz #thebaldwingroup #protectingthepossible #employeebenefits to view or add a comment, sign in director of marketing, baldwin southeast check out these 8 evolving trends in employer plan #pharmacy benefits from the baldwin group. understanding the key factors driving prescription drug costs is the first step to finding effective solutions for reining in rising prices. read more in our whitepaper 🔗 https://lnkd.in/eauenngz #thebaldwingroup #protectingthepossible #employeebenefits to view or add a comment, sign in associate director, content, at ipd analytics: crafting content that throws light to lives | ip legal and regulatory | computer science engineer | crm microsoft power apps 🚨 new report alert! 🚨 we are excited to share a recent report from our legislation & government insights coverage, which highlights the pressing issue of drug shortages and the proposed legislation aimed at addressing this growing problem. stay informed and ahead of the curve by referring to ipd analytics’ payer & provider insights and legislation and government insights platforms for the latest updates on drug shortage news and legislative developments. #healthcare #legislation #drugshortages #ipdanalytics #governmentinsights #payerproviderinsights 7,477 followers ipd has released a new report, "drug shortages: legislation and proposed regulatory actions," which delves into the increasing number of drug shortages affecting both hospitals and retail pharmacies. the report highlights key legislative actions and federal proposals aimed at addressing this critical issue. read it now: https://lnkd.in/e7hzmvtz #drugshortage #healthcarelegislation #pharma #ashp #fda to view or add a comment, sign in 1,804 followers drowning in spreadsheets for your tender activity? what if you could get the results you need without paperwork? join a growing number of pharmacies that use our tender tool to tap into 100+ new suppliers to get best prices. sign up or get in touch to learn more. https://lnkd.in/drdpysfs #tenders #pharma #pharmacy #pharmacies #medicineshortages to view or add a comment, sign in national accounts manager, drug topics, a mjh life sciences™ brand **on demand access: how participating in pharma sponsored programs can benefit your pharmacy** a.j. lipka, business development lead of network growth at outcomes®, discussed the impact of pharmacy sponsored programming. https://lnkd.in/ewjhg8js #pharmacy #independentpharmacy #pharmacymatters drug topics total pharmacy to view or add a comment, sign in 1,255 followers the value of pharmacy industry engagement! check it out at the #ichpannualmeeting next week! ➡️🔗 https://lnkd.in/djrnrpq #pharmacy #ichp #ilpharmacy #juststretch to view or add a comment, sign in 6,094 followers when it comes to rising #prescription drug costs, many have pointed the finger at prescription #drug middlemen known as pharmacy benefit managers (pbms). but #advocates of pbms, such as the pharmaceutical care management association (pcma), claim that the rise in drug #costs is on the manufacturers, instead. johnny ray garcia, senior director of policy at the pcma, joined drug topics for an episode of #overthecounter to address common #misconceptions surrounding pbms and what his organization is doing to help #patients. want more #pbm content? from the perspective of #legal experts, independent #pharmacy owners, and leaders of #advocacy groups, be sure to catch up on our ongoing coverage of the industry’s #pharmaceutical middlemen: 🥼: 𝐇𝐨𝐰 𝐏𝐁𝐌𝐬 𝐈𝐦𝐩𝐚𝐜𝐭 𝐈𝐧𝐝𝐞𝐩𝐞𝐧𝐝𝐞𝐧𝐭 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬: https://lnkd.in/efbq4e9t 🥼: 𝐋𝐢𝐭𝐢𝐠𝐚𝐭𝐢𝐨𝐧 𝐋𝐚𝐰𝐲𝐞𝐫 𝐨𝐧 𝐏𝐁𝐌𝐬 𝐚𝐧𝐝 𝐃𝐞𝐟𝐞𝐧𝐝𝐢𝐧𝐠 𝐈𝐧𝐝𝐞𝐩𝐞𝐧𝐝𝐞𝐧𝐭 𝐏𝐡𝐚𝐫𝐦𝐚𝐜𝐢𝐞𝐬: https://lnkd.in/e8fc67je 🥼: 𝐍𝐂𝐏𝐀 𝐑𝐞𝐩𝐫𝐞𝐬𝐞𝐧𝐭𝐚𝐭𝐢𝐯𝐞 𝐃𝐢𝐬𝐜𝐮𝐬𝐬𝐞𝐬 𝐑𝐨𝐥𝐞 𝐢𝐧 𝐈𝐧𝐟𝐥𝐮𝐞𝐧𝐜𝐢𝐧𝐠 𝐏𝐁𝐌 𝐑𝐞𝐟𝐨𝐫𝐦: https://lnkd.in/es8yr rh to view or add a comment, sign in 9,120 followers keeping an eye on the pipeline guarantees that you consider the most clinically effective and cost efficient choices. our most recent pipeline report outlines new medications that might impact your clients' strategies. as your trusted pbm, we publish this report quarterly to support you and your clients. explore our q2 2024 drug pipeline report: https://okt.to/u7ricq #insights #drugpipeline #pharmacy #pharmacybenefitmanagement to view or add a comment, sign in 7,918 followers thank you to everyone who attended our recent "navigating timelines and cmc activities for first in human trials" webinar! if you didn't manage to join the webinar and would like a copy of the recording, then please get in touch with rebekah s.. #webinar #cmc #freezedrying #pharma #fihtrials to view or add a comment, sign in patient advocate | medical bill master | helping committed professionals take control of medical bills without the frustrations of medical billing departments the foundation for government accountability (fga) is suing the department of health and human services (hhs) for failing to provide transparent drug pricing information. the lawsuit seeks to compel the hhs to provide the information required by law, which includes negotiated prices between pharmacy benefit managers and drug manufacturers. the fga believes that greater transparency in drug pricing will help lower costs for consumers and increase competition in the pharmaceutical industry. https://lnkd.in/grud2eht #tennesseehealthadvocates #medicalbills #patientadvocate #healthinsurance #reviewyourbills #understandyourbills #reviewyourmedicalbills #peaceofmind #billingerrors #savetime #savemoney #fairprice #strategy #information #medicalbillingprofessional to view or add a comment, sign in 2,488 followers create your free account or sign in to continue your search or by clicking continue to join or sign in, you agree to linkedin’s user agreement, privacy policy, and cookie policy. new to linkedin? 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agree & join linkedin by clicking continue to join or sign in, you agree to linkedin’s user agreement, privacy policy, and cookie policy. pharmacy benefits expert for self insured employers (and chief client officer at rxbenefits) while eli lilly's recent move increases access for certain populations including those without insurance and those whose plan may not cover this specific drug option, there is the potential of misuse because of the lack of checks and balances typical to a pharmacy benefit plan. it is also an attempt to capture market share for a highly lucrative drug class, and potentially put pressure on insurers to expand coverage for weigh loss drugs. the direct to consumer strategy, which excludes commercially insured patients looking to use their #pharmacybenefit plan may also have a negative impact on commercial plans and patients covered by them. https://lnkd.in/ek iezcz to view or add a comment, sign in 87 followers why have independent pharmacies vanished, and why does your 'covered' drug cost more than without insurance? the answer lies with pbms. anthony paravati, md, mba exposes their role in the pharmaceutical value chain don’t miss this!" #icymi ep 4 on the nomination of #rjkj to run u.s. department of health and human services (hhs) https://lnkd.in/ewpt2dyq to view or add a comment, sign in helping employers become employer of choice! new drugmaker tv ads are shining a spotlight on pbm (pharmacy benefit manager) rebates and their role in the rising costs of medications. these ads call out health insurers and pbms, sparking a debate about transparency and fairness in the pharmaceutical supply chain. at zupnick & associates, we know how critical these discussions are for employers and employees alike. pbm practices can significantly impact prescription drug prices and, ultimately, your healthcare costs. we’re committed to helping businesses cut through the noise, make informed decisions, and find innovative solutions to control costs while delivering the best care to employees. 💬 what’s your take on this growing debate? let’s explore strategies to keep your benefits plans cost effective and sustainable. #employeebenefits #healthcarecosts #pbmrebates #drugpricing #pharmacybenefits #zupnickandassociates #healthcaretransparency #businessinsights to view or add a comment, sign in simplifying pharmacy benefits to enhance care & accessibility | experienced clinical pharmacy leader 📅 2024 was an eventful year in the pharmacy benefit space! join me as i revisit the top stories in pharmacy benefits (in no particular order!) #4 #fiduciaryresponsibility not a new line of thought in the pharmacy benefit space, but it got a lot of press time this year, of the lawsuit variety ⚖️ what is the crux of this? generic specialty drugs this is a "newer" topic of discussion because we just started having generic specialty agents! here is a perfect example of the problem: 🔹 aubagio (teriflunomide) is for multiple sclerosis with multiple generics available in march 2023. 🔹 in the j&j lawsuit (section 111) it was quoted as costing $10,239.69 for a 90 day supply under the employer sponsored health plan. 🔹 mark cuban cost plus drug company, pbc currently has a 90 day supply of the same dose for $23.14. (which is down from $28.40 ay the time of the lawsuit) 🔹 goodrx shows me that both meijer and kroger would get me the same supply of drug for under $100. seems mind blowing, right? 🤯 🤯 🤯 the pbms would tell you that they can't match mark cuban because they have to be responsible for all drugs. basically, they could offer generic specialty for less, but it is all just a balloon that is squeezed, so take the price down one place, push the price up somewhere else. 🎈 just because that is how it works, doesn't mean that is how it should work! part of the reason why this is allowed? pbm contracts that aren't written as they could be when the right consultant isn't involved! catch up on other stories in my countdown series: #1 humira biosimilars https://lnkd.in/g6snb_ky #2 glp 1 shortages and the rise of compounding https://lnkd.in/gzaq6r t #3 ftc report https://lnkd.in/gcg9fcy9 #pharmacists #pharmacybenefits #pbm #specialtydrugs #gernericdrugs to view or add a comment, sign in ✅ protect the patient ✅empower the provider ✅partner with pharma = 🏆 successful revenue cycle management specialize: specialty medication & pharmacy, buy & bill, insurance drug formularies, authorization, & frm roles today, the new york times published a year long, researched article on the cost of drugs and guess who they are exposing? yep! #pbm "the middleman: the opaque industry secretly inflating prices for prescription drugs pharmacy benefit managers are driving up drug costs for millions of people, employers and the government." "but there is another collection of powerful forces that often escape attention, because they operate in the bowels of the health care system and cloak themselves in such opacity and complexity that many people don’t even realize they exist. they are called pharmacy benefit managers. and they are driving up drug costs for millions of people, employers and the government. the three largest pharmacy benefit managers, or p.b.m.s, act as middlemen overseeing prescriptions for more than 200 million americans. they are owned by huge health care conglomerates   cvs health, cigna and unitedhealth group   and are hired by employers and governments. the job of the p.b.m.s is to reduce drug costs. instead, they frequently do the opposite. they steer patients toward pricier drugs, charge steep markups on what would otherwise be inexpensive medicines and extract billions of dollars in hidden fees, a new york times investigation found." i had to buy the subscription so i could read the full article! it is well worth it and a job well done on their research! #greatread #pbm #cvs #optum #cigna #prescriptionbenefits #pharmaceutical #pharmacist #drugprices #drugpricetransparency #revenuecyclemanager #newyorktimes to view or add a comment, sign in 1,220 followers *****prescription drug costs | transparency and strategies for employers***** the recent ftc lawsuit highlights a stark reality: cvs health caremark, cigna healthcare’s express scripts by evernorth, and unitedhealth group’s optum   along with their #gpos   are accused of rigging pharmaceutical competition, inflating costs for life saving drugs like insulin. these “big three” #pbms control 80% of u.s. #prescriptions. this is why transparency and actionable strategies for employers are more important than ever. it is also why a #fiduciary advisor is critical. at valhalla business advisors, llc, we’re hosting our 2024 health benefits roundtable on thursday morning (december 12th) at toftrees golf club inc in state college. roy wilkinson, a leader in pharmacy benefit innovation, will join us to unpack the issues and review strategies for the future. this event is for employers ready to tackle prescription drug costs head on. if you're managing benefits, mark your calendar   and rsvp to tim@valhallaba.com to reserve your seat. #prescriptioncosts #pbms #healthbenefits #valhallabusinessadvisors #transparencymatters to view or add a comment, sign in the wall street journal and the federal trade commission (ftc) have filed lawsuits against pharmacy benefit managers (pbms), alleging deceptive practices in drug pricing strategies. the legal action aims to address concerns about how pbms influence drug costs in the healthcare system. read more here: https://lnkd.in/grw2wbuq #drugpricing #healthcarecosts #healthcarenews #pharmacyindustry #healthcareregulation #healthcarepolicy to view or add a comment, sign in health policy regulatory and legislative expertise; market innovator 🏹 humira biosims: hitting the target or not? finance says; “the concern with these ‘co manufacturing’ agreements is that they are a veiled attempt by pbms to control additional parts of the supply chain which has resulted in additional harm to consumers in the form of fewer drug choices and higher drug costs,” but wait what about bcbs of ca is doing as it shakes off its lethargy on a drug it spends a $100m a year? “for its new humira pipeline, blue shield struck the deal through a company called evio pharmacy solutions, which is owned by them and other blue branded health plans. unlike a pbm, blue shield of california pays evio a flat fee to negotiate with drug manufacturers rather than a fee based on the drug’s price. a division of german manufacturer fresenius se is making the drug for the insurer.” see modern healthcare link below this may be the better way to put pressure on the private label arrangements. good job fresenius! we need more of this in medicare! #humira #biosimilars to view or add a comment, sign in clinical associate professor & assistant residency director at xavier university of louisiana simple explanation of how pharmacy benefit managers impact overall drug costs. independent journalist the ny times explains one of the biggest reasons u.s. consumers pay so much for prescription drugs. as rebecca d. robbins and reed abelson report, we already know that drugmakers, health insurers and the government have done little to limit prices at the pharmacy counter. "but there’s another reason: middlemen known as pharmacy benefit managers (pbms) are supposed to save money but instead, they are quietly driving up prescription drug costs in a quest for higher profits," robbins and abelson explained. to view or add a comment, sign in art money, a blog by timothy kang, offers insights on income generation, business building, brand development, life scaling, and financial success. how big pharma and pbms influence medication costs americans recognize that big pharmaceutical companies profit immensely from inflated drug prices, yet many remain unaware of the significant market distortions caused by pharmacy benefit management (pbm) companies that negotiate prices for employers, insurers, and government programs. the health giants cigna, cvs health, and unitedhealth group, which control the three largest pbms, received a reprieve when elon musk, vivek ramaswamy, and other trump allies rallied against the proposed legislation. trump has vocalized criticism of pbms on two occasions, declaring during a news conference his commitment to “knock out the middleman.” additionally, he may reignite efforts to abolish the rebate system altogether. the bill sought to mandate that pbms pass on 100% of the rebates they obtain from drug companies directly to employer health plans. critics, like entrepreneur mark cuban, contend that employers and government agencies play a key role in sustaining this high rebate framework. in recent years, pbms have begun to distance themselves from using rebates as their primary revenue stream, which raises important questions about their business practices and the overall impact on drug affordability. reference: “drug middlemen spared by trump and musk, for now“ the wall street journal 31 dec 2024   david wainer to view or add a comment, sign in pharmacy benefits expert for self insured employers (and chief client officer at rxbenefits) excellent breakdown from adam fein in #drugchannels of the amount each class of covered entities spent on 340b drugs in 2023. overall cost of drugs purchased was $66 billion in 2023   up more than 23% from the prior year. the analysis   and his candid opinions on the health resources and services administration   make for a great read. there's no question the regulatory and compliance requirements around 340b are complex, which is why rxbenefits, inc. has a team of experts who can help covered entities maximize the program's benefit. https://lnkd.in/exq9hsr9 to view or add a comment, sign in 2,588 followers create your free account or sign in to continue your search or by clicking continue to join or sign in, you agree to linkedin’s user agreement, privacy policy, and cookie policy. new to linkedin? join now or new to linkedin? join now by clicking continue to join or sign in, you agree to linkedin’s user agreement, privacy policy, and cookie policy. linkedin never miss a beat on the app don’t have the app? get it in the microsoft store.
trump administration supported by in a report, the regulator sharply criticized pharmacy benefit managers, a turnaround from its longstanding tolerance of their practices. by reed abelson and rebecca robbins the two correspondents are reporting on the practices of pharmacy benefit managers and drug pricing for a series of articles. the federal trade commission on tuesday sharply criticized pharmacy benefit managers, saying in a scathing 71 page report that “these powerful middlemen may be profiting by inflating drug costs and squeezing main street pharmacies.” the regulator’s study signals a significant ramping up of its scrutiny of benefit managers under the agency’s chair, lina khan. it represents a remarkable turnabout for an agency that has long taken a hands off approach to policing these companies. the f.t.c. has so far stopped short of bringing a lawsuit or other enforcement action against a benefit manager. but the industry fears that the report could lead to a formal investigation into its practices or to a lawsuit accusing benefit managers of anticompetitive conduct. the agency’s findings could also fuel legislative efforts in congress and in the states to impose limits on the industry. the three largest benefit managers   cvs health’s caremark, cigna’s express scripts and unitedhealth group’s optum rx   collectively process roughly 80 percent of prescriptions in the united states. hired by employers and government health insurance programs like medicare, benefit managers are responsible for negotiating prices with drug makers, paying pharmacies and helping decide which drugs are available and at what cost to patients. benefit managers are supposed to save everyone money. but in recent years, the industry has grown more consolidated and has taken more control over how patients get their medicines, in a shift that critics say contributes to driving up drug costs.

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this isn’t the first post about pharmacy benefit managers on metar but it’s a topic (like private equity) that bears repeating due to its widespread malevolent influence in driving up the cost of drugs. pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. the middlemen pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. “reed abelson”)](reed abelson   the new york times) by rebecca robbins and reed abelson, the new york times, june 21, 2024 … the three largest pharmacy benefit managers, or p.b.m.s, act as middlemen overseeing prescriptions for more than 200 million americans. they are owned by huge health care conglomerates   cvs health, cigna and unitedhealth group   and are hired by employers and governments. because of recent mergers, they are becoming more dominant, collectively processing roughly 80 percent of prescriptions in the united states. the job of the p.b.m.s is to reduce drug costs. instead, they frequently do the opposite.