PBMs is the wrong argument. Yea - they profit - BUT the systemic flaw is TIERED coverage - which we've tied (as an accident of history) to employment. These rates are accurate - and destined to do one thing. Always go higher. Why? Because commercial rates for HC delivery are uncapped.
Inflation is why it goes up. But you didn't answer my question. Why do PBMs need to exist when our government has already negotiated The Price, for the VA? Why not make the VA price, The Price? There can't be that much in profit in ripping off the uninsured.
Why is The Price for Flomax $20 for The Insured, when Cuban sells it for $6? Why not make The Price $6?
Mark's CPD is great at EXPOSING highly variable pricing - but it's not a solution b/c the variable pricing applies to every aspect of healthcare not just Rx - and the cost of one surgery w/ a 3-day hospital stay can easily eclipse $100K. Billionaires can afford to self-fund that - can you?
I'm not trying to fix the whole problem, I'm just trying to fix this specific one. Still don't understand why PBMs need to exist when the VA (e.g. the federal government) has already negotiated The Price. Generic Flomax starts at $20, and goes down to as low as $6.32 from there. Why?
PBMs are a reflection of the whole problem. Tiered coverage to support tiered pricing. For commercial Rx coverage - PBMs do that. BUT. Generics = high volume/low margin. Branded+Specialty Rx is the real elephant in the Rx room and direct pay can't solve patent protected pricing.
Right, but since The Floor has already been negotiated, why not do bottom up, by % instead of top down/roll the dice? About 90% are covered by some kind of drug plan, it should be easy. We could cut the PBMs out immediately. And if you're uninsured, you should get the VA price by default 😀
Lobbying. Pharma doesn't want that - anymore than the rest of the system wants single-pricing. The profits are ginormous - and those would be severely curtailed (not eliminated). We do this today for utilities - and it's time we thought about extending monopsony (one buyer) pricing to healthcare
I think you're right about the lobbying, but I don't think you're right about the pharma companies. They can't be making that much money off the 8% uninsured. Everybody else is paying the PBM negotiated price. Look at Lilly Direct with their GLP. The price is $500.
If you ELIMINATED PBMs - you wouldn't eliminate tiered pricing - which for Branded/Specialty Rx is uncapped (AND often patent protected). PBMs know this - and why they're shifting their biz model. Generics are high volume but low margin. Branded/Specialty is where the BIG margins are. #Medsky
Footnote: If you eliminated PBMs - the effect on pricing would be nominal. Mark's solution generates a LOT of publicity - but it's NOT a total solution. For one thing - many generics are so low price - his 15% margin + $5 shipping is higher than 20 locations I can source locally. #Medsky
"Campaign finance reform isn't the biggest problem facing the country - but it's the first." @lessig.bsky.social We can't keep trying to navigate AROUND these issues. That's what solutions like CostPlusDrugs is doing. It works - BUT - it has consequences AND it doesn't solve the systemic issue.
Generic Rx = subset of a subset and we need to stop carving out slices of HC to force into a cash/consumer model b/c it has a consequence on coverage rates - and you can't ELIMINATE pooled risk. We've already done that with dental, vision - now we're aiming to do that w/ Primary Care & Rx. Dumb.
Specifically addressing the price of prescriptions. Healthcare - the physician and hospital are an entirely different kettle of worms. Last 5 years of life need to be addressed...specific example: Why TF did a physician try to order a colonoscopy for my 88 year old dad?
I agree - b/c we've designed a "for-profit" system w/ uncapped commercial pricing - and the system is working as designed. We need to change the design. UHC is that system design change. But this is also an 80yr battle going back to the Truman administration. The HC INDUSTRY keeps winning ;-(
... why not VA4ALL? That's UHC - which I absolutely support/lobby for. Pricing would need to be debated (VA and Medicare pricing are too low), but we should have THAT debate. Not who's covered. We don't need single-payer healthcare - but we absolutely need single-pricing. hc4.us/oneprice