Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics #00241

Submission Number:
South Dakota
Initiative Name:
Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I'm own a small pharmacy in Brandon, SD. I help my customers to the best of my abilities but am worried about the future of my profession. Pharmacy Benefit Managers (PBMs) and their position in health care is one of the biggest concerns. For profit health insurance is increasing the cost of care. Every year copays increase, premiums increase, and coverage gets worse while insurance companies show RECORD profits. And with the current system, it will never change. If an insurance company makes $1B, they will always give it to the stock holders rather than the customers. Since they have no transparency, they can "PROVE" anything they want. They can say they saved health care $millions because they can cherry pick any numbers they want without rebuttal. Further, with vertical integration and mergers, the health care industry is becoming an oligarchy with only a few players controlling everything. If you don't bend to whatever terms they give you, they throw you out of their network and overnight you lose 1/3 of your customers. PBMs say they are saving money but in reality they are causing the costs of medications to increase by requiring kick backs from drug companies to prefer certain medications. The drug companies agree but increase the cost of the medication accordingly to compensate. Example, generic Copaxone is $2K per month less than the brand yet many insurance companies will only pay for the brand. How could this possibly make financial sense unless they were getting $ to force people to get the brand. This is one of MANY examples. One of the most frustrating parts is that PBMs are the middleman. They DON"T DO ANYTHING other than paperwork. They don't make medication, they don't research, they don't distribute, they don't counsel patients, they don't have inventory, THEY DON"T DO ANYTHING. Yet, they have put themselves in a position to control a large portion of health care with few rules and even less over site. If you want to decrease the cost of health care, get rid of FOR PROFIT insurance companies. Immediate 20% savings. If that is too aggressive, at least make them transparent so everyone can see how disgusting their business practices are. Thank you.