Nayya’s Post

Important detailed reporting by The New York Times showing how prescription drug middlemen known as pharmacy benefit managers (PBMs) drive higher prices and increased patient costs. There is a better way, starting with full transparency, passing through rebates, discounts and other price concessions to patients and plan sponsors, and prohibiting PBMs from charging governments and employers higher prices than they reimburse pharmacists for the same medicine. In New Jersey, we were the first state to take on this broken system, with a sophisticated reverse auction to drive lower PBM costs that saves taxpayers $500 million each year.

Check out this insightful article from the NY Times shedding light on the complexities of traditional PBM's driving up prescription drug costs. It highlights the importance of transparency in the industry. Not all PBMs are the same - companies like #Rightway Healthcare Inc. prioritize fair practices and fee transparency, benefiting both insurers and members. In a world where skepticism is common, it's crucial to research and compare how transparent PBMs, like Rightway, operate compared to traditional PBMs. Read more here: [Link to the NY Times article] #PBMs #HealthcareTransparency

Last Friday, The New York Times reporters Rebecca Robbins and Reed Abelson published the first article in a series about “how pharmacy benefit managers prioritize their interests, often at the expense of patients, employers and taxpayers.” This piece, informed by hundreds of interviews, is a highlight reel for anyone familiar with the ongoing drug pricing debate. It points out several key issues: 💡 Perverse system incentives favor prescription medicines with higher list prices and larger rebates rather than lower-cost options. 💡 Consolidation in the health care system results in patients cycling between different divisions of three vertically-integrated companies for care and reimbursement. 💡 There is a steady increase in discounts, rebates, and fees paid by manufacturers, but there is no way to ensure those increases are used to help patients access and afford the medications they need in the form of lower copays or cost-sharing. At Sanofi, we see these dynamics first-hand and bring these concerns to light in our annual Pricing Principles report to advocate for a better, patient-focused system. In 2023, Sanofi had a 15% increase in fees – or service charges – paid on top of negotiated rebates to PBMs and health plans in Managed Care, Medicare Part D, and Managed Medicaid agreements. In total, we paid about $1.4 billion more in negotiated rebates and fees than in 2022 – almost an 18% increase year-over-year. Yet, too many patients still struggle to afford their medicines.  The issues discussed may not surprise those who study the disconnect between the rebates, discounts, and fees the industry pays to PBMs and the price patients pay at the pharmacy counter. However, there are millions of people who now have a better understanding of what a PBM is—and many of those readers experience firsthand the issues exposed in the article. Will this be the spark that pushes PBM reform over the finish line? I look forward to seeing what Rebecca and Reed publish next. https://lnkd.in/gyVs35x5

Pharmacy Benefit Managers (PBMs) are overcharging for prescriptions. "Americans are paying too much for prescription drugs. It is a common, longstanding complaint. And the culprits seem obvious: Drug companies. Insurers. A dysfunctional federal government. But there is another collection of powerful forces that often escape attention, because they operate in the bowels of the health care system and cloak themselves in such opacity and complexity that many people don’t even realize they exist. They are called pharmacy benefit managers. And they are driving up drug costs for millions of people, employers and the government... Read the full story: https://lnkd.in/gDR_d_9e

This primer delves deep into the reimbursement mechanics of brand-name drugs, elucidating the interplay between pharmacy and medical benefits within insurance policies. Emphasis is placed on understanding the stakeholders' roles and tracing the intricate flow of products and payments. However, it's essential to clarify that this primer does not encompass the nuances of drug acquisitions outside insurance frameworks or the variances in drug reimbursement structures between private and public insurers. #USHealthcare #PrescriptionDrugReimbursement #PharmaceuticalInsights

A recent The New York Times article brought attention to the ongoing issue of drug costs. (The article - https://hubs.ly/Q02D1gnj0) HCIQ receives weekly updates detailing the cost of every single FDA-approved drug in the US. Whatever the drug, we have access to the best price for that drug at any point in time. As a result, our clients continually monitor the best-case scenario price for drugs, ensuring they have access to optimal pricing options at all times. If your organization is grappling with the increasing burden of prescription drug expenses and is ready to address this issue with practical data and relevant insights, contact us to discuss your options! #transparency #PBM #selffunded #savings #employeebenefits #insurance #grouphealthinsurance #selfinsured #drugcosts #claims

"Americans are paying too much for prescription drugs. It is a common, long-standing complaint. And the culprits seem obvious: Drug companies. Insurers. A dysfunctional federal government. But there is another collection of powerful forces that often escape attention, because they operate in the bowels of the health care system and cloak themselves in such opacity and complexity that many people don’t even realize they exist." Continue to read "Opaque industry secretly inflates prices for prescription drugs" #Inflates #prices #prescriptions #Americans #benefitmanagers #yourhealthmatters #buylocal #shoplocal #yousaveonmeds

The New York Times recently published a detailed explanation of how PBMs drive drug costs up across the board. Pharmacy benefit managers (#PBMs) sometimes create significant barriers to the adoption of some innovative or even generic or biosimilar drugs, due to their incentives to keep patients on drugs that maximize their own profit. These middlemen, who manage prescriptions for over 200 million Americans, have merged and grown into major healthcare conglomerates. Instead of reducing drug costs, they often inflate them by pushing higher-cost medications, adding steep markups, and collecting hidden fees. We need to address the issue of economic incentives within the industry’s supply chain if we want to reduce drug costs and ensure affordable access to medications. I recently wrote about this issue in the context of Humira and its biosimilar alternatives, which you can find on my website. I highly recommend everyone to give the full article a read; it’s especially enlightening for those who are not in the industry and would like to learn more about drug pricing:  https://lnkd.in/g3D-bKC4

Thankfully a light is being shone on this issue, but we still have a long way to go: ➡ Prescription drug costs in the U.S. have been steadily rising, with patients often facing high out-of-pocket costs despite having insurance ➡ One of the main drivers of these high costs are pharmacy benefit managers (PBMs) - the middlemen that negotiate drug prices between drugmakers and insurers/employers ➡ PBMs are able to extract large rebates and fees from drugmakers, but these savings are not being fully passed on to consumers in the form of lower drug prices ➡ PBMs argue they help keep overall costs down, but critics say the industry lacks transparency and that PBMs are profiting excessively at the expense of patients ➡ There have been growing calls for reform and increased regulation of the PBM industry to ensure that the savings they negotiate are being shared with consumers ➡ Experts say addressing the role of PBMs will be crucial to tackling the problem of unaffordable prescription drug costs in the U.S https://lnkd.in/eipYB8Br

This is a great article to remind us there is plenty of medical spend waste in our system and with transparency, we will start to reduce this waste. Demand your PBM provides you rebate information by drug so you understand net pricing and what is the appropriate medication to put on your formulary. Michael Kody thanks for sharing this article! #employerhealthcare#pharmacy