From what I heard from our state board is that Pharmacist Benefit Management needs to be regulated. A lot of these companies are mail order and do not counsel patients. The formularies they create are not patient centered but profit centered. What do you think?
Are PBM's the Devil?
- Thread starter Fatpharm
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The PBMs are the devil. There should be some restrictions on certain unproven drugs but a lot of their decisions are profit driven. They change their formulary constantly, depending on the rebates they get from the drug manufacturers. They make physicians fill prior authorization and they expect pharmacists to be the bad guy and enforce their policies, while sometimes not paying pharmacists above the cost of the drug. They don't pay for preventive therapy. They do all of these for one reason: maximize the bottom line. They only provide a service, not a product like pfizer, but yet, they make billions in profit a year.
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I'm not sure how I feel about them since I haven't scrutinized the issue that much, but one of my professors thinks they're the devil. One of the questions he's asked us is "Who are they working for, big pharma or the insurance companies?" It has to do with where their money comes from, rebates from manufacturers for their drugs being placed on formularies, or from insurers for using low cost drugs. PBMs are basically a carve out service and may or may not act specifically for the benefit of the patient. State run PBMs I believe are illegal b/c of Medicare Part D wording and possibly that came about b/c of the Maine Rx issue. I wish I understood it fully, but I place more focus on pharmaceutical sciences compared to social and economic issues.
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I think the whole idea of prescription insurance is "bunk". I've seen people walk out with hundreds or thousands of dollars worth of prescription medications and then gripe about their $20 copay.
I only get a few scripts filled every now and then, but my allergy medicine carries a copay of $40 bucks. I might use $500 worth of medications a year, but an obese diabetic patient, who diligently buys large bags of M&Ms on Tuesdays and Thursdays, can drain $1,000+ dollars per month for medicine from the pool of funds. That's bull!
My plan doesn't even cover OC drugs, but my provider covers the costs associated with labor and delivery. On top of that, there's an additional member of the family, a newborn infant, that will need funds for medications too.
It just doesn't pay to be conservative with benefits. It's like you have to play the game to benefit from the system.
By the way, I'm tired 😴. It's starting to look like I'm typing on two computer screens, yikes!
I only get a few scripts filled every now and then, but my allergy medicine carries a copay of $40 bucks. I might use $500 worth of medications a year, but an obese diabetic patient, who diligently buys large bags of M&Ms on Tuesdays and Thursdays, can drain $1,000+ dollars per month for medicine from the pool of funds. That's bull!
My plan doesn't even cover OC drugs, but my provider covers the costs associated with labor and delivery. On top of that, there's an additional member of the family, a newborn infant, that will need funds for medications too.
It just doesn't pay to be conservative with benefits. It's like you have to play the game to benefit from the system.
By the way, I'm tired 😴. It's starting to look like I'm typing on two computer screens, yikes!
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Some are worse than others... but they are all incredibly profitable. ExpressScripts charges $63,000 to release a person's prescription records (when others charge less than $100)... Caremark just settled a multimillion dollar lawsuit for switching patients to drugs that were more expensive to them, but brought bigger rebates to Caremark (which they didn't share, of course). California is investigating their insurance providers like crazy...
