Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics #00511

Submission Number:
J Thomas
Initiative Name:
Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
1. This panel should include at least one or two physicians who have no conflicts with Pharma companies, Pharmacy Benefit Managers (PBM's) or Hospitals. 2. Wharton school report cited had very low response rate and does not reflect the satisfaction of the patients or physicians taking care of those patients. Of course we would believe Hospital administrators would love PBM's because CEO's of Hospitals/administration may get kickbacks from the PBM's. 3. PBM's seem to remove low cost providers: ie if a high priced drug is publicly priced at $1000 but 90% discount is given to PBM then drug sells for $100. but if the same Drug is sold by low cost provider for $150 and is sold to PBM at $100 then the there is only a 30% discount. That means less money "saved" and lower kickbacks to the Hospital managers and PBM's. The PBM would want to buy it from the company who says the cost is highest and offers the greatest "discount". l PBMs don't encourage purveyors to provide low cost medications, they encourage increasing the "pre- discount" price to absurd levels and the discount to be has high as possible. Note that in the past if a patient was in the "doughnut hole" portion of Medicare they had to pay this "high fictitious" price of $1000 because they were not using" insurance benefits. Similarly when in high deductible portion of health plans or paying out of pocket, customers often has to pay the high fictitious price ie $1000 for a medication that only cost $100 through the PBM. Note that pharmacist is not allowed by law to say "ask me if there is a cash price" for the cash price could be even lower than the $100. Is it true that in some cases if customer pays full price that may be kicked back to the PBM as well? Please clarify to your panel and let us the public know. Note that such "price fixing" incentive is to now similar to hospitals, to create high fictitious pricing that no-one actually pays except if you don't have insurance. Example - CT scan is priced at $10,000 charge-master price Insurance company pays $3,000 to hospital and gets kickback from hospital for well negotiated price. Note that a CT scan actually costs between $300-500 cash price or outpatient price and the radiologist gets paid $66.00 yes sixty six dollars to read the CT scan and take much if not all of the liability even though the hospital is making all the money off of the "Technical component." How much money do PBM's make? Do they donate to Congressional and Senatorial campaigns? if so How much? Perhaps this is their real function. Please show us where PBM's report all their income and lobbying money spent. Is it true that In 2015, the three largest public PBMs were Express Scripts, CVS Health (formerly CVS Caremark) and United Health/OptumRx/Catamaran. In 2015, the largest private PBM was Prime Therapeutics, a PBM owned by and operated for a collection of state Blue Cross Blue Shield plans. Wikipedia page on PBM's is hereby incorporated, https://en.wikipedia.org/wiki/Pharmacy_benefit_management It is hoped that you will reform your panel, please add at least two unbiased physicians perhaps even with an understanding of economics (MD, MBA's) who can refute some of the pricing economic theory discussed in your panel. PBM's need to act in the best interests of the patient,not the Hospital administrators or Insurance company Administrators. Drug and medication shortages are real and should not be ignored. No reasonable reason to not have small bags of saline. What is the reason for USA to make so many medications in Puerto Rico? Is there a good reason to keep location or facilities and meds made their concealed from US? We hope your panel acts in the interests of the patients of the USA. If PBM's are indirectly funding these panel members is their obligation to disclose. Is there a code of conduct that members of the committee sign that states the need to publicly disclose all conflicts and income from PBM's or contracts