WASHINGTON — Congress’ Medicare advisers are chiding lawmakers for a controversial change they made to the Medicare prescription drug program’s so-called donut hole last year.
The group, known as MedPAC, argued in its annual report Friday that the change — which puts drug makers, rather than insurers, on the hook for a higher percentage of the cost of some Medicare drugs — disincentivizes insurance companies from managing high drug costs.
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This donut hole problem is another perfect example of how the PBM’s are to blame. Medicare part D patients are charged AWP. By doing this the patient goes into the donut hole so much quicker.Once the patient is in the donut hole they pay 100% of the cost until they get out of the donut hole. The problem is that the patient never spends enough on drugs to get out of the hole. The PBM would never let the pharmacy keep that AWP money(they know what the drug cost) . So a month later the PBM claws back the difference between AWP and what the drug costs. These claw backs are called D.I.R fees. A Harvard law professor would never be able to figure out how these PBM’s came up with this bunch of crap method of stealing .This donut hole problem is another way the PBM’s are making billions of dollars,and not allowing the mom & pop pharmacy to survive .
Does anyone else see a problem with the PBM’s ? or is it just me ?