Exposing the Lowlife Pharmacy Benefit Managers

There is one group that seems to stay hidden from the ire of the American public.  They are called PBMs or Pharmacy Benefit Managers. Who are they?  This from a recent article in Investor’s Business Daily:

  • They act middlemen between drug companies and patients, pharmacists and insurers. They determine which medicines are covered, and at what co-pay or co-insurance level, for 210 million Americans’ health plans.
  • Just three PBMs dominate 70% of the market, and pharmaceutical companies know they will not be able to access millions of patients unless they accommodate the demands of PBMs.
  • PBMs rarely pass the rebates they wrench away from drug companies along to pharmacies, insurers or patients. PBMs instead hoard the cash.
  • Express Scripts, the nation’s largest PBM — which boasted a market cap of $43 billion in early November — has increased its profit per adjusted prescription 500% since 2003.
  •  Combined, the top two PBMs in the country deny coverage to 239 medicines.

I remember when these businesses started.  They tricked everyone into believing that they were saving money for the patient. They ARE NOT!

Here is Express Scripts’ tagline for their website:

“Millions trust Express Scripts for safety, care and convenience. Express Scripts makes the use of prescription drugs safer and more affordable.”

That word “affordable” really gets thrown around a lot these days.  To bad it never means what it is supposed to mean,

These are also the same companies that make doctors go through more and paperwork to prescribe a drug using their services.  For me, I can’t just use my EMR.  Nope.  It has to be their paperwork, hand-filled out, and then scanned.  What a pain in the ass. They are abusive and they are gaining more and more power.  Let’s just hope this administration exposes them and figures a way bring back competition and sanity to the market.

Do you remember a day when doctors could prescribe what he or she thought was right?  I do.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Exposing the Lowlife Pharmacy Benefit Managers

  1. David Dawson, MD
    February 24, 2017 at 3:05 pm

    When will we grow a backbone and tell them to go pound sand?

  2. politovski
    February 23, 2017 at 3:16 pm

    i imagine with the amount of money these pricks have stolen from us that they have bought off the current administration and congress. the swamp may be in the process of being drained, but the toads and newts and mutant creatures that lived there will likely thrive just about anywhere.

  3. stephen deputy
    February 22, 2017 at 2:03 pm

    The thing about pharmacy benefit management plans is that they oftentimes drive up the cost of healthcare to the insurance companies that they are working for. For example, I take care of children with epilepsy. About 1/3 of my patients have refractory epilepsy and need access to a wide variety of anticonvulsant medications. When these medications are denied, many times these kids will have more seizures and get admitted to the hospital which is far more expensive than the cost of the medication that they are denying. The PBM’s don’t care because the cost is to the insurance company. The insurance companies don’t seem to care which is stupid since denial of appropriate medications only worsens overall health and drives up patient expenses and claims through ER visits, hospital admissions and more advanced disease states. Penny wise and pound foolish and we, as a society and paying taxes foot the bill.

    Don’t even get me started and the constant authorizations for even generic medications that have to be approved before medications can be administered. It used to be that when I wrote a script, the patient took it to the pharmacy and got it filled with a few exceptions for more expensive medications. Now it is always a multistep process wasting tons of my office staff’s time and some of mine as well. And the procedure of needing to “fail” certain classes of medications before more appropriate medications can be approved is terrible for the patients. How would one of the CEO’s of a PBM like to have to have a couple of extra seizures on a given medication before a preferred medication (by the doctor) can be given. That would seem cruel and mean-spirited. Yet it happens to my pediatric patients all of the time…Jerks

  4. Pat
    February 21, 2017 at 11:46 am

    Great post, and a serious issue. I have a family member on some pretty expensive chronic meds that has to fight with these bastards every month to get the full prescription. My take is that they routinely throw up every asinine block possible, figuring that a certain percentage will just give up, which adds to their profit; and delaying the rest will just make them more interest on “the float.”

    But how can this scum be fought? They will have to be curbed by the same bunch we hope will curb Big Insurance, and their defense will be the same, that they are squeaking by, and that any reform will raise drug prices and hurt patients.

    • tad hominem
      February 21, 2017 at 1:45 pm

      Been dealing with them for years as a patient. don’t hold ur breath. profit profit and profit.

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