The Hidden Monopolies That Raise Drug Prices
The article does a good job of starting to explain the forces, but it&#x27;s actually even more complicated.<p>A number of the PBMs are cross invested in pharmacies and insurance companies, and the incentives of 2-3 large pharmacies that control the majority of the market (and how they get paid) is very different than how small pharmacies get paid.<p>Additionally the way the generic market works vs the branded (patented) meds is completely different. (and the system of how drugs move from patented to generic is _nothing_ like the way patents work in software)<p>Which is all to say, it&#x27;s a fascinating space.  It&#x27;s very ripe for innovation.<p>If you&#x27;re interested in this kind of thing at Blink we&#x27;re building a price transparency and payment platform that both routes over and routes around PBMs and gives a unified fair price for everyone in the US.<p>If you&#x27;re interested in roughly what the wholesale price is plus a very small markup, you can find it on <a href="https:&#x2F;&#x2F;blinkhealth.com" rel="nofollow">https:&#x2F;&#x2F;blinkhealth.com</a><p>And we&#x27;re hiring.   <a href="https:&#x2F;&#x2F;www.blinkhealth.com&#x2F;careers" rel="nofollow">https:&#x2F;&#x2F;www.blinkhealth.com&#x2F;careers</a><p>Also the re-importing from Canada is a total red herring.  As is implied in the term &quot;re-importing&quot; these drugs are made here in the US, there is nothing special about sending them to Canada and bringing them back.  There just needs to be a payment platform that allows people to pay the wholesale price with a small markup (vs the &quot;Average Wholesale Price&quot; which is often a 2000-3000% markup over the real wholesale)<p>Finally one of the challenges with moving to a centrally managed pricing solution like what works so well in Canada and most of Western Europe is right now R&amp;D into pharmaceuticals is largely financed by the opportunity size available in the US market.  If you were to just adopt the centralized model tomorrow R&amp;D would grind to a stop, at least for some period of time until we found new ways to finance it.