Pharmacy Benefit Managers (PBMs) robbing America
(PBMs) Pharmacy Benefit Managers run up your costs,decide your fate and get rich in the process.
The Affordable Care Act has revived the bygone era of the shady middleman-someone who gets rich by cutting deals and keeping secrets from both buyers and sellers.
While the information age has made this classic character virtually obsolete due to the Internet's ability to easily connect buyers and sellers, monopolies and the government continue to provide life support.
The Affordable Care Act has combined the worst abuses by both monopolies and government by providing windfall profits and unfettered power to favored middlemen-Pharmacy Benefits Managers (PBMs)
Fifteen years ago, Pharmacy Benefit Managers just processed prescriptions. Now, PBMs are an impenetrable barrier between drug makers, doctors, and pharmacists. PBMs decide which drugs will be covered by insurance, how much they'll cost, and how much pharmacies will make. They have the clout to dump medications that aren't profitable to them, denying patient access. One-half to two-thirds of a typical prescription's cost can go to PBMs.
PBMs own a large share of the online pharmacies, and have a considerable interest in the mega-pharmacies. They also dictate which products drug manufacturers to produce, how much to produce, and how much they'll get paid.
This kind of power was given to PBMs just a few short years after the three largest PBMs faced six major court cases over allegations of fraud, misrepresentation, unjust enrichment through secret kickback schemes-as well as failure to meet ethical and safety standards. All three PMBs settled with the plaintiffs. Their damages totaled hundreds of millions.
Obamacare gives big tax breaks to and few regulations for PBMs. As a result, the PBMs have become a darling of Wall Street. CVS Caremark is the largest PBM in the U.S. is number 12 on the Fortune 500. Express Scripts well they come in at number 20. How does that work? They are built to control cost, yet they rank as richest companies in the US. Hmmmm, who getting screwed here? You got it
The greatest cost of the power wielded by PBMs, however, may be the human cost. The financial burden of these secretive PBMs will be borne by the elderly, the sick, businesses, and as always, the taxpayers.
PBMs have used their power to decide what each pharmacy pays for their drug supplies and how much they can charge, putting a harsh squeeze on the little guys-the 23,000 independent community pharmacies. These independent neighborhood pharmacies only account for 30 percent of prescriptions filled-and that dwindling quicky.
PBMs use their clout to push through regulations that make it nearly impossible for many small and independent pharmacies to survive. Independent community pharmacies have long been a lifeline for many, providing personal care that online and mega pharmacies simply can't.
Bill Bulpin has owned Oak Harbor's Island Drug on Washington state's Whidbey Island for 28 years. His philosophy is simple: "Look the customer in the eye, deal with them one-on-one and get to know them by name. Our customers love coming here because we?re like family. We are their service and information center."
Pharmacist Theresa Tolle owns Bay Street Pharmacy in Sebastian, Fla. Bay Street sponsors "Stroke of Hope," a support group for stroke victims and their families.
Tolle explains her pharmacy's benefit to the community's most vulnerable:
A mom came in who had a sick 4 year old child with acute asthma. The child was on a Medicaid HMO plan which required him to have the nebulizer mailed to his home several days later! (A nebulizer changes liquid medication into a mist for infants and small children, who have difficulty with an inhaler.)
So, did I teach this mom how to use an inhaler with her 4 year old? NO! Because I have the autonomy to "call the shots" as an owner, I donated a nebulizer and nebulizer medications to this family.
I greeted a sobbing mom with this news and I had a follow-up call from her pediatrician and a neighbor thanking me!
There is nothing more rewarding than simply being able to "do the right thing" as a business owner! I could not have done that if I was employed by someone else. I am grateful that God has given me this platform in my community to help those in need.
Like many independent pharmacies, Tolle?s faces the challenge of making ends meet. Her income is declining from rising drug costs and lower allowable prices-all decreed by PBMs.
Last year, HR 4577 was introduced in Congress to help the independent pharmacies and their patients by sharing some of the breaks given to the online and mega pharmacies.
Although the bill attempts to chip away at the PMBs' power, its focus is very narrow. Congress has yet to look at the big picture and ask why we need the PMBs. They are transistor radios in a Spotify world, eating up over half of a prescription's cost.
This article was written by a contributor of Watchdog Arena, Franklin Center's network of writers, bloggers, and citizen journalists.
While the information age has made this classic character virtually obsolete due to the Internet's ability to easily connect buyers and sellers, monopolies and the government continue to provide life support.
The Affordable Care Act has combined the worst abuses by both monopolies and government by providing windfall profits and unfettered power to favored middlemen-Pharmacy Benefits Managers (PBMs)
Fifteen years ago, Pharmacy Benefit Managers just processed prescriptions. Now, PBMs are an impenetrable barrier between drug makers, doctors, and pharmacists. PBMs decide which drugs will be covered by insurance, how much they'll cost, and how much pharmacies will make. They have the clout to dump medications that aren't profitable to them, denying patient access. One-half to two-thirds of a typical prescription's cost can go to PBMs.
PBMs own a large share of the online pharmacies, and have a considerable interest in the mega-pharmacies. They also dictate which products drug manufacturers to produce, how much to produce, and how much they'll get paid.
This kind of power was given to PBMs just a few short years after the three largest PBMs faced six major court cases over allegations of fraud, misrepresentation, unjust enrichment through secret kickback schemes-as well as failure to meet ethical and safety standards. All three PMBs settled with the plaintiffs. Their damages totaled hundreds of millions.
Obamacare gives big tax breaks to and few regulations for PBMs. As a result, the PBMs have become a darling of Wall Street. CVS Caremark is the largest PBM in the U.S. is number 12 on the Fortune 500. Express Scripts well they come in at number 20. How does that work? They are built to control cost, yet they rank as richest companies in the US. Hmmmm, who getting screwed here? You got it
The greatest cost of the power wielded by PBMs, however, may be the human cost. The financial burden of these secretive PBMs will be borne by the elderly, the sick, businesses, and as always, the taxpayers.
PBMs have used their power to decide what each pharmacy pays for their drug supplies and how much they can charge, putting a harsh squeeze on the little guys-the 23,000 independent community pharmacies. These independent neighborhood pharmacies only account for 30 percent of prescriptions filled-and that dwindling quicky.
PBMs use their clout to push through regulations that make it nearly impossible for many small and independent pharmacies to survive. Independent community pharmacies have long been a lifeline for many, providing personal care that online and mega pharmacies simply can't.
Bill Bulpin has owned Oak Harbor's Island Drug on Washington state's Whidbey Island for 28 years. His philosophy is simple: "Look the customer in the eye, deal with them one-on-one and get to know them by name. Our customers love coming here because we?re like family. We are their service and information center."
Pharmacist Theresa Tolle owns Bay Street Pharmacy in Sebastian, Fla. Bay Street sponsors "Stroke of Hope," a support group for stroke victims and their families.
Tolle explains her pharmacy's benefit to the community's most vulnerable:
A mom came in who had a sick 4 year old child with acute asthma. The child was on a Medicaid HMO plan which required him to have the nebulizer mailed to his home several days later! (A nebulizer changes liquid medication into a mist for infants and small children, who have difficulty with an inhaler.)
So, did I teach this mom how to use an inhaler with her 4 year old? NO! Because I have the autonomy to "call the shots" as an owner, I donated a nebulizer and nebulizer medications to this family.
I greeted a sobbing mom with this news and I had a follow-up call from her pediatrician and a neighbor thanking me!
There is nothing more rewarding than simply being able to "do the right thing" as a business owner! I could not have done that if I was employed by someone else. I am grateful that God has given me this platform in my community to help those in need.
Like many independent pharmacies, Tolle?s faces the challenge of making ends meet. Her income is declining from rising drug costs and lower allowable prices-all decreed by PBMs.
Last year, HR 4577 was introduced in Congress to help the independent pharmacies and their patients by sharing some of the breaks given to the online and mega pharmacies.
Although the bill attempts to chip away at the PMBs' power, its focus is very narrow. Congress has yet to look at the big picture and ask why we need the PMBs. They are transistor radios in a Spotify world, eating up over half of a prescription's cost.
This article was written by a contributor of Watchdog Arena, Franklin Center's network of writers, bloggers, and citizen journalists.
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