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.