pbms

Watchdog: Insurance Groups Buy Drug “Middle Men”; Transparency Calls Grow

Spectrum News 13 July 23, 2019 PBMs: have you heard of them? If not, you’re not alone, but they do factor into your prescription drug costs. They’re essentially a “middle man” between drug makers, health care plans, and patients, negotiating the prices most of us pay for prescription drugs. n the last two years, health insurance companies, which set deductibles and co-pays, have bought up the three main PBMs: Express Scripts, CVS Caremark, and Optum RX. A number of independent pharmacies have told Spectrum News they are now losing business and revenue because of PBMs, including Five Points Pharmacy in Cocoa, a pharmacy that has been welcoming customers since 1958. Louella McCormick Edwards started coming to 5 Points Pharmacy with her mother. But now, Edwards says most of her family can no longer get their medication filled at 5 Points after their health plans dropped the pharmacy from their networks.  Continue Reading

Independent pharmacies being driven out of business by ‘predatory middlemen’ | Opinion

South Florida Sun Sentinel October 21, 2019 Lately, everywhere you look there are people worried about keeping drug prices affordable, especially for Florida’s aging seniors. People are voicing their concerns, but many are ignoring one of the biggest factors contributing to reduced access and increased costs — and sometimes driving people like me out of business. Pharmacy Benefit Managers, or PBMs, have been abusing their power for years, remaining undetected as they drive independent pharmacies into the ground. These predatory middlemen no longer serve their original purpose of negotiating medication savings for patients. Instead, they use their corporate clout to force patients to certain pharmacy chains. This drives up costs for everyone while the PBMs pocket profits. This national issue is affecting millions across the country. Though the problem is widespread, its roots are felt locally. By serving as go-betweens, PBMs determine which medicines will be covered by insurance plans …

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The Secret Drug Pricing System Middlemen Use to Rake in Millions

Bloomberg September 11, 2018 For years, Frahm’s South Side Drug bought pills from distributors, and dispensed prescriptions to the Wapello County jail. In turn, the pharmacy got reimbursed for the drugs by CVS Health Corp., which managed the county’s drug benefits plan. As he compared the newspaper notice with his own records, and then with the county’s, Frahm saw that for a bottle of generic antipsychotic pills, CVS had billed Wapello County $198.22. But South Side Drug was reimbursed just $5.73. So why was CVS charging almost $200 for a bottle of pills that it told the pharmacy was worth less than $6? And what was the company doing with the other $192.49? Frahm had stumbled across what’s known as spread pricing, where companies like CVS mark up—sometimes dramatically—the difference between the amount they reimburse pharmacies for a drug and the amount they charge their clients. It’s where pharmacy benefit …

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