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The one paying should have a say in the decision. Why do you disagree?
ie... the patient?
No. The $50 copay of the patient does not constitute "paying" for the $3000 humira prescription. If they were paying full price, they could choose their pharmacy.
It's smoke and mirrors though, the PBM isn't really paying $3000 either. Sure they'll tell the employer groups, Medicare, and Medicaid that, but we all know they're getting kickbacks from the manufacturers. Having their own pharmacy just sweetens the deal even more.
Okay, so it's $1500. Same point.
Nono, my point was the retail pharmacy pays a little under $3000 for the drug, the cash paying patient would pay a little over $3000 with dispensing cost... but the PBM wouldn't. Sure they'd reimburse the pharmacy the $3000 for dispensing, but the manufacturer gives them a kickback for it, so they've actually spent maybe $2000. They can tell the patient "we paid $3000 worth of drug cost for you!" and they tell the employers "we paid $3000 worth of drug cost for your employee!" and they tell Medicare "we paid $3000 worth of drug cost for that member!" but they got a kickback and did not really spend $3000.
