When I started working in a pharmacy after my 2nd year of pharmacy school…  the average Rx price was $4-$5… 90%+ was for BRAND NAME MEDS, there was NO PBM’s, and there was no DEA.  Insulin was about $2.50 for a 10 ml vial of a equivalent to today’s 100 u insulin, Birth Control pills was $1.33, Pharmacies typically had a minimum price of a Rx of $1.50.  The PBM industry didn’t start until the winter of 1969-1970 and they were just a centralized uniform billing system for pharmacies and pts.  DEA didn’t come around to abt 1973.  The Brand name pharmas was the only way that the Research and Development of new drugs were paid for by the profits from all the medications that they sold.

Today, the PBM industry now controls what meds will be paid for and how much the pharmacy will get paid for filling the Rxs for the pt and the PBM now controls about 90%+ of all Rxs that are filled.  All those “discount drug cards” like GOOD RX and others are owned by or the Rxs are processed thru those same PBM’s.  Those PBM’s have created a system that they DEMAND rebates/kickbacks/discounts upward of 75% of the wholesale price of the meds from the pharmas or the pharma’s meds require a prior authorization for the PBM to pay for them.  The average price of Rxs today is pushing $70… even though about 90%+ of Rx dispensed are generics.

Here is a chart that outlines/demonstrates where the $$ that a pt pays at the register goes. Bureaucrats/politicians are starting to pay attention to these types of gross overcharges by these PBM’s and some individual states are starting to pass new laws that will curtail these gross overcharges, but I expect it will take years for things to corrected.  These PBM’s are will funded and have no problem with spending untold $$$ on Lobbying Congress and state legislature to defend what they are doing.

Of course, with 90%+ generic and the companies that produce them, do no research and development… so all R&D has to be funded by the brand name pharmas and thus we see new meds coming out with VERY HIGH COSTS, because they are only providing abt 10% of all Rxs.

Costly new Alzheimer’s drug could force Medicare to restrict access

https://www.foxbusiness.com/healthcare/costly-alzheimers-drug-medicare-restrict-access

The federal health insurance program may limit who can get the drug, which Biogen priced at $56,000 a year, to limit the financial impact

The recent approval of a high-price Alzheimer’s drug is raising questions about who will have access to a treatment that could cost Medicare billions of dollars in coming years.

Biogen Inc. priced the drug Aduhelm at $56,000 a year. Wall Street analysts estimate it could eventually surpass $5 billion in yearly sales, mostly paid by Medicare, while some health economists warn the bill would be multiples higher.

Medicare normally pays unconditionally for approved medicines. To limit the financial hit from Aduhelm, however, Medicare could restrict access, former U.S. health officials and health-policy experts said.

“Medicare can’t afford to treat this as business as usual,” said Andy Slavitt, a former Medicare acting administrator and Biden administration senior adviser.

HOW WILL INSURERS COVER BIOGEN’S NEW ALZHEIMER’S DRUG? 

The Centers for Medicare and Medicaid Services, the agency overseeing Medicare, is reviewing Aduhelm’s approval and will have more information soon about its coverage, a spokesman said.

“Whether or not that drug will be covered by Medicare and Medicaid is an outstanding question, something HHS will have to deal with,” Department of Health and Human Services Secretary Xavier Becerra said during an interview live streamed on YouTube on Thursday.

“We’re going to be making some pretty heady decisions about how it’s treated, if it will be reimbursed, how much, and so forth,” he added.

Meanwhile, Biogen said it wants to limit who gets Aduhelm to Alzheimer’s patients in the early stage of the disease with mild symptoms.

The federal government and the company may need to move quickly. “I’m not quite certain how we’re going to accommodate all the patients who want it,” said Richard Isaacson, director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian hospital.

Filed under: General Problems