Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
As the owner of a small independent pharmacy in rural Montana, I am sickened by the action of the PBMs and how they cheat the public and increase drug prices both directly and indirectly. Directly, PBMs increase a patients copays by using a "Clawback". This is when the PBM not only does not pay a penny on the medication, but actually charges an additional secret fee they add to the patient copay and don't tell them. They also put "Gag Clauses" in the pharmacy contract that does not allow the pharmacist to discuss it with the patient. Indirectly, the PBMs will not allow many brand name medications to be on formulary unless they increase the cost of the medication so that the PBM can keep more as a rebate. There are numerous lawsuits and even investigations into this practice, yet it continues. Until PBMs are regulated, drug prices will not come down. Seperately, generic companies overseas are paying other generic makers not to make certain medications so there is less competition. Prices have skyrocketed. Example: Promethazine suppositories which have been around for decades, used to cost $3.00 to $4.00 a dozen. Now the cheapest brands are $89.00 to $120.00 per dozen.