Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am a retired person. I am absolutely furious at being scammed by the Pharmacy Benefit Manager's attitude and business practices of negotiating for 'ahem' rebates, financial consideration (steering is a word which comes to mind), and other creative ways of gaining profit off my back. The government is a top payor for over 50% of healthcare pharmacy costs -- VA, Government employees, Medicaid, Medicare, etc. But you all knew that. That's my tax dollar. IF the GOP wants to save money on Medicaid and Medicare, they should take a strong look at this. My pharmacist, in order to process claims -- government and commercial, MUST sign a CONTRACT from all PBM's saying that they will NOT address the issue of saving money by paying cash. Do you ever wonder why?? Many people over 45 are on some thyroid medication. Example: The PBM has the pharmacist charge $45 for a 30 day supply where, in fact, a cash price could be somewhere around $15. So the government or someone sucks up $30? Do you think it's the PBM. Then to add insult to injury, the PBM does a 'clawback' an additional fee called Direct and Indirect Renumeration aka DIR for the claim from the pharmacist but why just the pharmacist? Why not the prescribing doctor or patient? Who's the weakest link? I don't have to be a pharmacist to understand this situation.Nor does it take an MBA degree to understand favorable pricing to certain "classes of trade" (COT) in the pharmacy world in order to gain marketshare. Self-referral of a PBM to their owned subsidiary mail order (COT), or owned pharmacy (Chain COT). That just smacks of steering to me. Like the doctor who used to refer to their own X-ray facility or other healthcare enterprise. What happened there? Yet it's OK for a PBM. Lastly, why would a PBM mandate a brand over a cost effective generic? Trick question!! IN CONCLUSION: A) Recommend that all rebates and consideration above the normal business expenses and reasonable ROI be returned to the government or employer. (Would help the GOP from going after 'entitlement' programs.) B) Complete Transparency. C) Regulations just as doctors, hospitals, etc have. D) Pharmacy has the ability to discuss cost savings to the patient. Thank you.