WASHINGTON — Health and Human Services Secretary Alex Azar called on Congress Friday to upend the way drugs are paid for by “immediately” passing a law banning rebates that drug makers pay to insurers.
His push comes the morning after after HHS announced a policy proposal that would eliminate rebates in the Medicare program, which the department claims will lower the amount of money seniors spend on prescription drugs at the pharmacy. Though HHS estimates it will raise premiums in the program, it believes patients will ultimately save money.
These PBM’s still have a few tricks up their sleeve . There’s the price spread, DIR fees, Waiting a week to update their computers prices when drugs do go up in price . Then there are all the commercial accounts where none of this comes into play and they can still charge their extortion …. I mean drug rebate fee to be on formulary. Have no fear , PBM’s will always be the MAFIA of the pharma industry !!!!
They are an organization underground. But here is why.
These large PBMs 20 years ago were adjudicators, clinical guidance, and offered direction on financials. In that past twenty years they absorbed the specialty distribution channels handling the massive growth of biological and they took over all contracting for 90% of the nations insurers. The market place basically allowed multiple conflict of interests in healthcare become melded into one huge machine. The relationships that exist in this model are solid as granite and the good old boys will fight hard to not allow it to broken down. Transparency, routine audits, and reform watch dogs is a must. You don’t know where you can help the healthcare cost issue until you break down the silos that are thick in walls. Separation of these multiple functions inside the current PBM model is a must. Them once separate they should be monitored and evaluated separately.
So the PBMs will sue. Do they realize the can of worms they open when their business practices get laid bare in court (i.e., what % they pocketed vs. passing on to the patient)? That would not end well for them.
Elimination it shall be.