Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics #00442

Submission Number:
00442
Commenter:
Joseph Cross
State:
New Mexico
Initiative Name:
Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am an independenty pharmacy owner in rural New Mexico and this is a true story about a PBM. I was evaluating my data for 1 particular plan and their PBM reimbursements. Out of 355 claims in th 2nd quarter 2017 we showed a net average loss per claim of $.34. I called a friend who managers the pharmacy benefits for this plan and her comment was " I am shocked by how little they are paying the pharmacy vs what the PBM is charging us." I asked if they were getting charged $10 per claim as I had heard, she said they were a couple of months ago but they were now paying about half that. Where is the justice in the PBM claims processer making $5 per claim and me losing $.34 per claim when I am providing all the patient product and care. I would suggest the PBM's have gone rogue with little or no oversite and are taking money away from the health plans, patients and provideres while the PBM's report record profits. I can't tell you who the plan or the PBM because it would cause the PBM would likely terminate my contract for breaking the code of secrecy. Thanks