There is more and more issues coming to light of how the PBM industry is extracting a “boat load’ of excessive profits from just about any entity/person within our medication distribution system from Medicare/Medicaid/Insurance, pharma, wholesaler, pt. It is possible that there could be HUNDREDS OF MILLIONS OF DOLLARS INVOLVED in overcharging by the PBM industry. The largest 4-5 PBM – now all owned by insurance companies – control some 85-90% of all prescriptions.
Perhaps this is how CVS Health is fighting back against what it appears to be some cost controls coming down on this Industry. CVS Health owns 10,000 community pharmacies, specialty & mail order pharmacies, Aetna Insurance, Caremark PBM, Silver Scripts Part D.
According to this, it would appear that CVS Health makes so much money on filling prescriptions from kickbacks/discounts/rebates from the Pharmas and “spread pricing” paying the pharmacy filling the pt’s Rxs a fraction of what they charge the final payer (Medicare/Medicaid/Insurance)… that they will “settle” with just collecting the insurance premium and forcing the pt to pay for the ENTIRE COST OF THEIR MEDICATIONS. Just because you use a “cash Rx discount card”, doesn’t mean that a PBM won’t get a kickback/rebate/discount from a Pharma and/or collect you and your Rx information and sell all that data to some entity willing to pay for it.
Filed under: General Problems
Yup. That is me. 10$ copay for Eliquis outside w/card. $300 at Express scripts same amount. So. Why the difference and how can they do that?