Winner, Winner – PBM Dinner?

Sorry for the delay since the last post, but it has been VERY BUSY around here lately, with continued games from the insurances.  

We had a patient just call to complain about a prescription being sent to another pharmacy, who hadn’t filled it for her despite texting to come pick it up.  They were ordering the medication in, and told the patient the copay was over $900 copayment from her insurance.  We offered to transfer it to us and work on options.

Doing so, we found the doctor had sent 3 month’s worth of her inhaler, when she only gets it monthly due to cost.  However due to the first-of-the-year deductible, the patient has a $590+ copay for even just 1 month.  The worst part, when finding what the insurance pays (only $64+ toward the total of the cost of the drug), the pharmacy still loses more than $41 off the average cost of the inhaler to get in. 

The short version: patient is paying over 90% of the cost of the inhaler, all in one setting, and the pharmacy is losing 6% of the cost of the medication – without any overhead costs involved!  The pharmacy has zero ability to negotiate this deficiency in payment to the pharmacy, and the patient has to come up with almost $600 to make the payment for this life-altering medication, all after having to pay property & real estate taxes this past month, as well…

The only winner in this: the Pharmacy Benefit Manager.  They recoup the costs paid plus administrative fees to the insurance sponsor (Medicare in this case), turn around to the manufacturer of the inhaler for a drug rebate, and have received a premium from the patient (and possibly Medicare plans) for the insurance policy.  They are making money left and right, ensuring to cover their costs, at the expense to the patient and pharmacy.  

This is the exact reason these groups need to be addressed, immediately!  These companies are raking in the profits of a government estimate of 30% or higher, with a net profit of anywhere from 3% to 8% of their net gain.  Many patients and pharmacies are not able to keep anywhere near those percentages of any funds gained, and largely due to the ever-increasing costs of healthcare being affected by the PBM practices…

Make your voice count, showing that it should be illegal for any company to dictate another business sell a product for less than it can be purchased.  Work to ensure patients aren’t being stuck with 90% of the total reimbursement of a positively life-altering medication.

Sign the petition by clicking the yellow button at the top of this page.  Then, share the link to everybody in your email contacts, on facebook, at work, at church — anywhere you are going — to get this information out and take back control of our nation’s healthcare!