The COVID-19 crisis has provided policymakers with an opportunity to examine public policy and make recommendations for the future. One of the hot spots of discussion in the last legislative session was over whether to add more regulations to pharmacy benefit managers. In the process of that discussion, many in the legislative arena tried to make them out to be the bad guys.
Nothing could be farther from the truth, and what we believe the COVID crisis will show is just how much they do for both consumers and taxpayers in guaranteeing affordable access to quality healthcare.
Over 200 million Americans have their medicine benefits managed through a pharmacy benefit manager, saving us approximately 25 percent on the cost of prescription drugs. They are one of the only entities in the drug supply chain dedicated to lowering the cost and increasing access to quality medicines.
The skyrocketing list price of prescription drugs has challenged patients’ access to these medications, but government had their way in the last legislative session, intervention with PBMs would only have limited choices and increased patient costs with unnecessary rules and duplicative regulations.
COVID-19 has delivered a punch in the gut to our economy and to our tax revenue collections. As lawmakers strive to find ways to make up shortfalls and continue to guarantee health services for all, they will find that pharmacy benefit managers are a strong ally in bringing better health outcomes to all Floridians.
Regina Brown is the Director and Founder of Transforming Florida, a coalition of believers committed to transforming our culture through, prayer, biblical truth & community involvement.
What about the impact that PBM Fees and DIR Fees are having on independent pharmacies? For example, DIR fees have increased 45,000% since 2010. The way these fees are assessed makes it hard to see why a legislature wouldn’t make the PBMs out to be bad guys. For example the DIR fees are based on a drug’s list price, not the actual price and PBMs have a vested interest in the highest list price in extracting rebates. Keep an eye on the Prescription Drug Pricing Reduction Act (S. 2543), which contains a provision that would require plans to include the value of pharmacy DIR fees in the negotiated price.
Regina Brown has been brainwashed if she thinks that PBMs deliver REAL cost savings. We don’t know if Florida consumers are even getting the cost savings they’re entitled to without appropriate audits of the book of business for each PBM. As Rep. Randy Fine succinctly said during the legislative session, it doesn’t make sense to allow PBMs to negotiate drug discounts with pharmaceutical companies, dictate what the price will be, and also own, at the same time, the retail pharmacy store. That gives way too much pricing power to the PBMs. If she thinks that PBMs should be held harmless, why do PBMs also own insurance companies or insurance companies own PBMs. This consolidation allows for vertical integration which again does no favor to consumers on either the price or accessibility.
Mrs. Brown what you have failed to discover or mention in your article is that PBMs during the Covid crisis have done nothing to help those millions of lives you say they help. They do not make drugs, do the research on drugs and their effectiveness against the virus, do not dispense the medications or anything beneficial. This crisis has exposed that they are non-essential and non-beneficial when Floridians lives were most vulnerable. As a matter of fact during this time and drug supply issues the Medicaid system has failed recipients due to PBMs closed and narrow networks. So many areas of Florida have seen where only an independent or small chain pharmacy had the life saving medication needed but were not in the PBMs network. This has left lives at risk and exposed how dangerous they have become in the healthcare realm
Wake up people. Before you write article on PBM, one must first educate themselves on what PBM is and how they operate.
PBM is intermediary, collecting money from insurance payor and transferring those money to Pharmacies.
However, problem is that they collect 100$ from insurance payor and only transfer 40$ to pharmacy. Rest of the 60$ goes vanished. That’s how big 3 PBM of this country; OptumRx, CVS, and ESI have became fortune 25 companies within last 10 years without selling a penny worth of goods.
It is so obvious that Regina Brown has no clue what she’s talking about. After owning retail pharmacies for decades, PBM’s are absolute criminals who rob and steal from all parties involved in the healthcare environment.
Here’s one example of this non-truth. A lady needs a drug for COPD – in a class thats heavily “rebated”. There is a generic to one Brand (Advair) and Advair (Brand) and Breo (another brand) are covered with a $45 copay. The generic is NOT covered (without a Prior auth) and they told her she could ask for the Prior Auth to be approved but that would BUMP her copay to the next (higher cost tier). How are PBMs saving us all money? The brands make her go through the donut hole also quicker – so tax payers are on the hook for the catastrophic phase.
A few questions – how many PBM workers, execs are risking lives every day on the front line of healthcare (hint: zero). So its becoming CRYSTAL clear as to who is providing value to the system and who is looking at this system as nothing more than a money grab. One of largest PBMs now is paying CEO $36.5mil a year. The managed care companies that Medicaid contracts with (who use these PBMs) are also paying their CEOs in the TENS OF MILLIONS of dollars. Record breaking profits on wall street.
Latest whistleblower case with CVS and Aenta (before they merged), lady said CVS wasn’t giving them the best deal for Part D. CVS’s answer (you can’t make this up): just because we negotiate “on your behalf” doesn’t mean YOU get that benefit. We do!