Jeffrey Pfeffer’s Post

GoodRx is facing at least three separate class-action lawsuits from independent pharmacies accusing it of “conspiring” with pharmacy benefit managers to fix reimbursement rates in a way that boosts the PBMs’ profits Two of the suits also name CVS Caremark and Express Scripts by Evernorth, two of the top 3 PBMs in the country, as well as smaller PBMs MedImpact Healthcare Systems, Inc. and Navitus Health Solutions. The lawsuits come as PBMs face increasing scrutiny, with the Federal Trade Commission bringing a lawsuit against the country’s top three PBMs in September for allegedly boosting profits by inflating the price of insulin. Read more: #PBMs #pharmacybenefitmanager #GoodRx

Major development: The FTC has filed a lawsuit against the largest pharmacy benefit managers (PBMs) for inflating insulin prices. Millions of Americans with diabetes are facing unreasonably high insulin costs, and the FTC is now targeting Optum Rx, Caremark, and Express Scripts for prioritizing profits over patients. The lawsuit claims these PBMs have manipulated the system to drive up insulin prices, impacting countless lives. At OCAP, we advocate for transparency and accountability in drug pricing. This action by the FTC marks a critical step toward reforming a broken system and ensuring affordable access to life-saving medications. https://lnkd.in/gusFUNUA #AffordablePrescriptions #PBMReform #PrescriptionDrugCosts #PharmacyBenefitManagers #OCAP

Legacy PBMs are inflating your prescription drug costs. It's time to fight back. 💪 Everything you need to decode confusing contracts, spot hidden fees, ensure transparency, and align PBM goals with yours is right here! Our in-depth blog will equip you with the proper knowledge to evaluate your PBM accurately. Click here for insider tips on choosing a PBM that truly serves your needs: https://lnkd.in/ggvtAYPf #healthcare #prescriptiondrugs #employeebenefits #PBM #smithrx

Americans pay nearly three times what those in other countries do for prescriptions. And according to a new study, patients' prescription costs have risen twice as much as payers'. This structure is counter-productive. Patients who can't afford their medication may go without or try to ration doses. This can lead to costly complications and even death. Let's stop treating pharmacy like a volume business based on the number of prescriptions we fill. Let's make patients the priority and cut costs for both your plan and your members. With this approach, and thanks to Group Synchronization, our covered patients maintain a PDC (percentage days covered) greater than 80% – the industry's standard measure for excellent prescription adherence (and the point at which a patient is getting the maximum benefit from their medications). Can we help your plan members? #pharmacy #prescriptioncosts #prescriptionprices #prescriptions #healthcare #selffunded #healthcoverage

There’s been a lot of attention on Pharmacy Benefit Managers, and for good reason. If you’ve ever wondered why prescription drug prices feel unpredictable or why there aren't any independent pharmacies anymore, PBMs are to blame. PBMs were originally created to help manage prescription drug plans – think of them as middlemen between insurers, pharmacies, and manufacturers. But over the years prescription data has been monopolized, their influence has expanded, and so have the hidden costs tied to their practices. In Wayne County, NY, Dobbins Drugs is the LAST independent pharmacy standing. They've weathered the challenges so far, but the weight of PBM practices is something my Dad feels every day. The recent FTC lawsuit against OptumRx, Caremark, and Express Scripts shows how PBMs have driven up insulin prices through rebate schemes that prioritize profits over patients. And with new bipartisan legislation calling for the separation of PBMs from pharmacy ownership, we might finally see real reform. Here’s why the big 3 suck: -Anti-competitive practices – PBMs own their own pharmacies (retail, mail-order, and specialty) while reimbursing independent pharmacies below cost – creating a system where they profit while competitors struggle to survive. -Vertical integration – PBMs don’t just manage drug benefits – they’re now integrated with insurers and pharmacy chains (like CVS/Aetna, Cigna/Express Scripts), controlling multiple layers of the supply chain. -Horizontal consolidation – Over the last decade, PBMs have merged, leaving just three companies controlling 76% of prescription drug benefits for over 266 million Americans. This reduces competition and leaves little room for small pharmacies to compete. -Coercive contracting – PBMs offer “take it or leave it” contracts to pharmacies. Refusing these contracts often means losing access to as much as half of your patients, forcing pharmacies to accept terms that cut into profits or risk closing altogether. -Fraud, waste, and abuse – PBMs profit through spread pricing (charging insurers more than they reimburse pharmacies) and rebates from manufacturers in exchange for favorable formulary placement. Transparency? think again. I can’t help but wonder: are we on the verge of real change, or just another shuffling of the cards? #PBMReform #IndependentPharmacy #IDontKnowHowToDoThis #ButImLearning

Middlemen drive up out-of-pocket costs for patients, profiting off of fees and rebates tied to drug prices while denying coverage of lower-cost medicines. They receive billions in rebates and discounts that reduce the cost of brand name drugs, but still force patients to pay the full price. I believe PBMs should be required to share these negotiated discounts directly with patients to lower out-of-pocket costs. As I’ve said time and time again, we need policymakers to prioritize PBM reform now to relieve patients and small pharmacy owners of the headaches that insurers and their middlemen cause. https://lnkd.in/e3NzJvzn

The high cost of prescription drugs is one of the major drivers of healthcare expenses in the U.S. I'm encouraged to see our government and innovative entrepreneurs stepping up to bring positive disruption in this area. When GLP-1 drugs were removed from the formulary for obesity at a previous employer, a pharmacy leader remarked, 'You only get the drug once you have diabetes.' What a response! This highlights the importance of bringing clinically and economically sound solutions, both in the short and long term, to the forefront—essential for success in the healthcare industry. Right? 💊 #valuebasedcare #healthcare #leadership #pharmacy https://lnkd.in/dQGh8ycH https://lnkd.in/dGWJEvsB

The FTC just released an interim report on how PBMs drive up costs for medicines and drive out independent pharmacies. This report builds on additional efforts from Congress and federal and state agencies – including FTC, DOJ, HHS and state attorneys general – looking at harmful PBM practices.    The three largest PBMs controlled 80% of the prescriptions dispensed in 2023 and are vertically integrated with large insurers, providers, and pharmacies. As the WSJ reports, we are seeing how PBMs anti-competitive practices are now pushing patients to use PBM-owned specialty pharmacies to fill prescriptions. These middlemen are using opaque practices to control where you get your medicine and what you will pay at the pharmacy, all while pushing out independent pharmacies and marking up costs for patients.   https://lnkd.in/eCFYKYis

It is so very wrong, many say criminal, that we allow people who are in need of important, so often life sustaining medicines like insulin that we allow PBMs to “set/control” the price of these drugs here in the US at 6 to 10 times more than all of western Europe, Scandinavia, Canada, Australia, New Zealand, Japan, etc. It is important to understand that 20% to 25% of the 9M+ people that use insulin in our United States cannot afford these inflated prices and have to ration their insulin which sadly brings on ill health when they do not take the proper insulin dose allowing the development of far more serious, disabling, and costly complications of diabetes. These excessive profits made only here in the U.S. are not justified. Insurance companies and insulin manufacturers throughout the world make a profit in all of these countries listed above. PBMS do not exist anywhere else in the world other than the United States. In our awesome country, we allow these 3 groups led by the PBMS to have a rebate system that gives them even more profits when they set the price of these medicines at criminally high levels. There is no other business in the United States that is allowed to work with partners to set the price (is this price fixing?) and then receive the cash rebates. All other businesses that offer rebates have the rebates go back to the consumers. Our political leaders who care and honestly serve us and not these big companies must demand full transparency of all costs and revenues and ensure that the price of medicines are not hyperinflated.

One of the reasons I care so deeply about PBM reform is because of the positive impact it would have on patients. As of right now, PBMs may actually end up limiting certain medications that patients in some areas have access to. According to a recent survey, 51% of independent pharmacists "say they are strongly considering not stocking the drugs because of the potential underwater reimbursements from pharmacy benefit managers," reports Jeff Lagasse. Underwater reimbursement refers to a pharmacy being paid less than the cost of acquiring a certain drug. Because independent pharmacies may not be able to afford certain medications, this will cut back on affordable medications for patients. PBM reform is key for improving patient care. #IndependentPharmacy #PharmaNews #PBMReform