VistaRx’s Post

Pharmacy Benefit Managers (PBMs) play a pivotal role in our healthcare system, acting as intermediaries between insurers, pharmacies, and manufacturers to manage prescription drug benefits. Their mission? To make medications more accessible and affordable for patients. With the complexity of drug pricing and reimbursement, PBMs have found themselves at the center of a heated debate. On one hand, they are seen as crucial players in negotiating discounts and rebates that can lower costs for insurers and consumers. On the other, questions arise about transparency, the impact on drug prices, and the overall effect on patient care. As we continue to navigate these challenges, it’s important to engage in open discussions about how PBMs can evolve to better serve all stakeholders. Collaboration, transparency, and patient-centric solutions must be at the forefront of this evolution. Together, we can work towards a healthcare system where every individual has access to the medications they need without the burden of excessive costs. 💡 How do you think PBMs can adapt to address the current challenges in healthcare? Share your thoughts! #Healthcare #PBM #PharmacyBenefitManagement #PatientCare #DrugPricing

Picture this: A world devoid of Pharmacy Benefit Managers (PBMs). At first glance, it sounds like a healthcare utopia, doesn't it? PBMs are often seen as the middlemen in the healthcare industry, negotiating drug prices between manufacturers and insurers. They're credited with keeping medication costs in check, yet criticized for the lack of transparency in their pricing models. But let's dive deeper. Without PBMs, the direct negotiation power shifts to insurers and pharmacies. Could this lead to a more transparent pricing model? Perhaps. Pharmacies might gain a stronger foothold in pricing negotiations, potentially passing savings directly to consumers. However, the absence of PBMs could also lead to chaos in prescription drug pricing. Without their large networks and bargaining power, smaller insurers and pharmacies might struggle to negotiate competitive prices, leading to a fragmented and potentially more expensive market. So, what's the verdict? Is a world without PBMs a step towards a more transparent and fair healthcare system, or would it unravel the delicate balance of prescription drug pricing, leading to higher costs and less access for patients? The answer isn't straightforward, and it challenges us to think critically about the structures we have in place. Let's discuss: How can we achieve the best of both worlds—a system that leverages the strengths of PBMs while ensuring transparency and fairness in drug pricing? Share your thoughts and let's explore the possibilities together.

U.S. pharmacy groups finally see results from their 15-year effort to raise awareness of the fact that the top three U.S. pharmacy benefits managers (who also own pharmacy chains, insurers and healthcare provider organizations) have deliberately inflated drug prices, limited patients’ access to medications and directly caused the closure of tens of thousands of community pharmacies. Says a Federal Trade Commission report: the PBMs “inflate prescription drug costs and interfere with patient care for their own financial benefit” and “have sought to use their position to artificially reduce reimbursement rates for competing pharmacies.” Read more here: https://lnkd.in/gyprmFtX

The Hidden Role of Pharmacy Benefit Managers: What You Need to Know! Ever wondered why your medication prices change or why some prescriptions aren't covered? Our latest blog post summarizes an article in The New York Times that uncovers the hidden role of Pharmacy Benefit Managers (PBMs) and their impact on your healthcare AND on your wallet. Learn about: - The hidden mechanisms behind medication pricing. - How PBMs influence drug coverage. - The effect of PBMs on independent pharmacies and patient care. Most importantly, discover ways that YOU personally can affect change – both in ensuring that YOUR prescription pricing is fair, as well as helping to advocate for PBM transparency and reform, which will ultimately benefit ALL of us! #Pharmacy #Healthcare #PBMs #IndependentPharmacy #PatientCare #MedicationCosts #NYTimes Stay informed & stay healthy! https://lnkd.in/gWrReARJ

Register today and learn how you can transform your pharmacy benefits plan with a pharmacy care partner that puts the pharmacist at the center of the PBM model.

I took on two different independent pharmacies as clients recently, both needing help to implement a 340B contract pharmacy relationship with a local covered identity. This relationship is not without risk for the contract pharmacy— The terms of the arrangement are important to get right. Properly implemented, these are synergistic relationships where an independent pharmacy is a true partner in caring for mutual patients. #340B #pharmacy #healthcare #340Bprogram #pharmacy #pharmacists https://lnkd.in/gQnR6imG

According to data gathered by Mercer, prescription drug costs saw a 31.3% surge in 2023 compared to 2022. Marking 2024 as a pivotal year in the battle against escalating pharmacy costs and building on our commitment to revolutionize the pharmacy landscape. How is SmithRx ensuring better medication affordability? Our innovative Connect 360 programs and strategic initiatives have resulted in substantial savings, surpassing $200 million last year alone– and that’s just the beginning! Our partnerships with Transparency-Rx, along with PBM reform introduced by Congress, will make healthcare more accessible and cost-effective for everyone. Learn more at www.smithrx.com #healthcare #pbms #prescriptiondrugs #smithrx

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.

Despite recent efforts to increase transparency and limit drug pricing, pharmacy spending continues to rise at an unprecedented rate, accelerated by utilization, drug prices, and emerging therapies. Employers looking to limit the impact of rising prescription costs on their premiums may consider “carving out” pharmacy benefits from their existing plan and contracting directly with a pharmacy benefits manager, or PBM. However, direct PBM contracts often do not provide the same value for a mid-sized employer as they do for larger organizations. Therefore, some businesses may consider pharmacy coalitions to be a cost-effective alternative. Even though these arrangements are designed to boost an individual employer’s negotiating power, they may not always result in actual savings. Much of it will depend on whether the coalition is owned by a brokerage or independently managed. Our latest article discusses several considerations to be aware of before engaging with a pharmacy coalition, and how USI helps employers evaluate cost-effective Rx strategies. Please contact me or your local USI benefits consultant to learn more, and read our latest #USIExecutiveSeries article: https://lnkd.in/ed_6qa5i