"It's a scam of major proportions. When we're trying to find billions of dollars to fund health care reform, this is an area that absolutely has to be cleaned up."—Rep. Stephen Lynch (D-Mass.), June 24, Dow Jones Newswires
The sale of prescription drugs is tightly controlled by an ever-consolidating number of pharmacy benefit managers. They determine which drugs a plan covers and what the co-payments will be. These companies were originally hired by large employers and other health plan sponsors to rein in soaring drug costs. Instead, they have concocted a complex system that places their robust fees and profits above their clients' interests, not to mention the patient's.
(PBMs are middlemen who are unregulated by federal or state law. They are neither insurers nor providers of services)
(This is) costing employers, unions, the government and patients billions of dollars in higher insurance premiums. Quantifying exactly how high this "PBM premium" is can be difficult.
i wonder, where do pbm's fit in the health debate - are they lumped in with payers or pharm. who does the bidding for them?
ReplyDeletein our office, they represent an extraordinary, time intensive burden - even long after the patient encounter is in the history books. to learn that they too sap billions from the 'system' is just delightful.
From the NYTimes:
ReplyDelete'The House bill would require DRUG COMPANIES to provide larger discounts, or rebates, on medications dispensed to low-income people enrolled in both Medicare and Medicaid. It would also require DRUG MAKERS to provide 50 percent discounts on brand-name drugs in the doughnut hole, until the coverage gap was eliminated.'
does this bill attempt to regulate or squeeze PBM's, or do they instead get another free pass?
http://www.nytimes.com/2009/08/31/health/policy/31drug.html?_r=1&ref=health&pagewanted=print
http://www.newsday.com/long-island/nassau/pharmacists-want-drug-pricing-secrecy-removed-1.1451022?print=true
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