RX BENEFITS GROUP LAYS PRICING BLAME AT DRUGMAKERS’ FEET
http://www.bna.com/rx-benefits-group-b57982082329/
This is – to me – AMAZING… it has been reported that these PBM’s and insurance companies … DEMAND up to 70% rebates/kickbacks from the Pharmas… in order to keep their particular medications on the PBM’s approved formulary. They also control what the pharmacy is paid when they fill prescriptions… basically controlling the gross/net profit of pharmacies. Because they are technically “licensed as an insurance company… they are EXEMPT from the Sherman Anti trust Act so they can do many things that are ILLEGAL for every other business – like prices fixing and they can even collude without any legal consequences.
When the PBM industry came into being… prescription costs were abt 6% of total medical expenses… today they are about 12% of all medical expenses and PBM’s – like Express Scripts – is showing a 2 + BILLION NET PROFIT… and basically the only service that they provide is not much more than the services provided by entities like Master Card, VISA, Discover and American Express charge cards. So wonder why Congress does not repeal the McCarren- Ferguson Act that provides for the Sherman Antitrust Act exemption to the insurance industry… maybe it has something to do with the fact that the Insurance industry has one of the largest $$$ political paks and employ a very large number of lobbyists ?
Pharmaceutical companies may be blaming others for high drug prices, but they’re the ones who set the prices, the head of a pharmacy benefit manager group told me Oct. 27.
“We understand that the drug industry is in a desperate situation right now and is lashing out at a lot of different groups in order to deflect attention,” said Mark Merritt, president and chief executive officer of the Pharmaceutical Care Management Association (PCMA). “But ultimately, the drug manufacturer sets the price, and I think you have to start there.”
Drugmakers are under heavy scrutiny by lawmakers, consumers, medical professionals and presidential candidates for their pricing practices. Most recently, generic drugmaker Mylan Inc. came under attack for increasing the cost of its EpiPen allergy injection by 400 percent in nine years.
Meanwhile, Matt Gorman, the strategic campaign communications director at the Biotechnology Innovation Organization (BIO), told me Oct. 31 “the list price is not what the manufacturer generally makes on the drug,” and “at the end of the day, the insurer really determines what a person actually pays for a drug.”
Gorman said, “There’s been a lot of shouting about price, and I think it really started to amp up when insurance companies were looking for a scapegoat, essentially after premiums had to skyrocket for them under the” Affordable Care Act.
Insurers “needed to find a scapegoat and even their own data, which they’re required to disclose under that same law, show that drug prices are clearly not the reason for increased premiums,” Gorman said. “They’re a very small portion of that.”
Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.
Filed under: General Problems
They are all making huge profits while consumers pay the price.
During the debates of the Affordable Care Act, one statistic stuck in my mind: about 1/3 of every health care dollar goes to collection cost. That’s insurance company rake-offs by any other name. About the only solution I see for this condition is to eliminate insurance companies altogether in the payment cycle and go to a single-payer system. But the companies themselves pour hundreds of millions into Congressional campaigns with loud condemnation of “socialized” medicine. And Voters let them get away with this crap!
As Pogo once famously said, “We have met the enemy and he is us!”