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
Make The Price the VA Price. For everyone. Branded or generic. PBMs can still manage claims. They're mostly owned by insurance companies anyway. Now let's tackle another problem. How about we outlaw ads? For all heathcare, pharma, hospitals, everyone.
I've long supported single-pricing - for all of healthcare - but that would require legislation. That's the bottleneck. Not economic (or moral) logic. What's surprising is Mark's promotion of GOP logic - which is tilted to the status quo of "4 profit" healthcare. The evidence doesn't support it.
"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.
