It’s time to regulate PBM’s

  • PBMs often portray themselves as fighting the “good fight” on behalf of employers and employees.
  • In reality, they are highly profitable intermediaries that typically do not take possession of the drug, bear little to no risk, and minimally innovate.
  • PBM profit margins are much higher than other players in the supply chain who bear much of the public’s anger over rising drug prices.
  • Express Scripts for example, one of the largest PBMs, reported gross profits of $8.76 billion in 2017.

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Prescription drug pricing is out of control

  • The cost of insulin more than tripled — from $231 to $736 a year per patient — between 2002 and 2013.
  • A new marijuana-based epilepsy treatment is going to cost $32,500 a year.
  • “The goal is to keep the price of the drug on par with other epilepsy medications”.
  • PBM’s are driving hard bargains with the manufacturer and they are increasingly finding ways to expand their profitability at the expense of employers and patients.

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The hypocrisy of Express Scripts

  • Express Scripts said “despite promises to limit price increases, drugmakers are trying to game the market by delaying generic competition, blocking access to safe and effective biosimilars, and coyly deferring – not cancelling – list-price increases. This is why our work to expand access and maximize value is more important now than ever”.
  • In 2015, Express Scripts, the largest PBM-only company in the U.S., reported a profit of more than $660 million, from sales exceeding $25 billion.
  • In 2017, pharmacy benefits giant Express Scripts saw its net income skyrocket by 33% year-over-year to $4.51 billion.

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Medicare for all will not save millions of dollars

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Freeze on drug price increases won’t effect patients

  • Several pharmaceutical companies have recently said they’ll delay some of their price increases, under pressure from the Trump administration. But hospitals have made no such concessions, even though they make up a much larger share of total health care spending.
  • Pfizer, Novartis, Merck and other drug makers have said they will delay, freeze or roll back price increases on some of their medicines. Experts largely dismissed those pledges as political bandages with little real effect on patients’ pocketbooks.
  • Drug pricing is the political controversy of the moment, but hospitals cost the health care system far more.  Retail drug spending represents 10% of U.S. health care spending, while hospital and doctor services consume about half of spending.

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The biggest threats to your health care

  • The biggest threats to our health care is not the cost of prescription drugs.
  • The health insurance industry is tracking your race, education level, TV habits, marital status, net worth. They’re collecting what you post on social media, whether you’re behind on your bills, what you order online. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.
  • Medical experts say that digital health can’t do much for users that are already sick, or at high risk of a serious medical condition. Many of these companies won’t diagnose disease for regulatory reasons, even if they’re picking up strong signals through sensors and algorithms, so instead they’ll suggest that a user see their doctor.

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Let’s blame drug companies for OUR poor health

  • Physical inactivity is a primary cause of most chronic diseases.
  • Population levels of physical activity, inadequate to meet current guidelines can place a health burden on the U.S. population that results in higher health care expenditures.
  • Regular physical activity is associated with important health benefits, including reduced risk for premature death, cardiovas­cular disease, ischemic stroke, type 2 diabetes, colon and breast cancers, and depression.
  • A study of one million people has found that physical inactivity costs the global economy $67.5 billion a year in healthcare and productivity losses, but an hour a day of exercise could eliminate most of that.
  • Just 23% of US adults get enough exercise, CDC reports

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