Imperium Health’s Post

"Among members of the Oversight Committee, there was broad support for finalizing comprehensive PBM reforms – and much skepticism about the excuses, and at times downright lies, the PBM executives were attempting to feed them about the roles of their organizations in increasing prescription costs and decreasing patient access to health care," said NCPA CEO Douglas Hoey, after the hearing concluded. "Patient steering, self-dealing formularies, spread pricing, take-it-or-leave-it contracts, the fee-for-nothing scam … legislators have seen enough that the PBM-insurers can no longer obfuscate these important issues." Read Hoey's full reaction here: https://lnkd.in/eybeMZTp ____ Today at 10 a.m. ET, mega-PBM executives — Adam Kautzner, PharmD, president, Evernorth Care Management and Express Scripts; David Joyner, executive vice president, CVS Health, and president, CVS Caremark; and Patrick Conway, MD, chief executive officer, OptumRx — will be testifying before the House Oversight and Accountability Committee on their organizations’ role in rising health care costs. Here's where you can tune in: https://lnkd.in/eZWRT4_D

🚨 𝐁𝐑𝐄𝐀𝐊𝐈𝐍𝐆 𝐍𝐄𝐖𝐒: 𝐀𝐂𝐂𝐎𝐔𝐍𝐓𝐀𝐁𝐈𝐋𝐈𝐓𝐘 𝐈𝐍 𝐏𝐁𝐌 𝐈𝐍𝐃𝐔𝐒𝐓𝐑𝐘🚨 The recent hearing announced by Chairman Comer sheds light on the significant role that Pharmacy Benefit Managers (PBMs) play in the escalating costs of healthcare. As highlighted, the lack of transparency and the complex business practices of traditional PBMs contribute to higher drug prices and limited access to affordable medications for patients. 𝐓𝐮𝐧𝐞 𝐢𝐧 𝐭𝐨 𝐰𝐚𝐭𝐜𝐡 𝐭𝐡𝐞 𝐜𝐨𝐧𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐚𝐧𝐝 𝐥𝐞𝐚𝐫𝐧 𝐦𝐨𝐫𝐞 𝐚𝐛𝐨𝐮𝐭 𝐡𝐨𝐰 𝐭𝐡𝐞𝐬𝐞 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞𝐬 𝐚𝐫𝐞 𝐢𝐦𝐩𝐚𝐜𝐭𝐢𝐧𝐠 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞 𝐜𝐨𝐬𝐭𝐬! At AffirmedRx, we were founded on the principle of breaking away from these traditional, opaque practices. We believe in full transparency in our pricing and business model, ensuring that our clients and members always know exactly what they are paying for. Our commitment is to provide clear, honest, and straightforward pharmacy benefits management, focused on public good rather than profit margins. We are dedicated to combating the corruption and lack of transparency seen in the industry. Our approach is different – we prioritize our clients’ needs, ensuring they receive the most cost-effective and efficient solutions without hidden fees or misleading practices. Join us in our mission to transform the PBM industry and make healthcare more affordable for everyone. 𝐑𝐞𝐚𝐜𝐡 𝐨𝐮𝐭 𝐭𝐨 𝐀𝐟𝐟𝐢𝐫𝐦𝐞𝐝𝐑𝐱 𝐭𝐨𝐝𝐚𝐲 𝐭𝐨 𝐟𝐢𝐧𝐝 𝐨𝐮𝐭 𝐡𝐨𝐰 𝐰𝐞 𝐝𝐨 𝐭𝐡𝐢𝐧𝐠𝐬 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐭𝐥𝐲 𝐚𝐧𝐝 𝐡𝐨𝐰 𝐰𝐞 𝐜𝐚𝐧 𝐡𝐞𝐥𝐩 𝐲𝐨𝐮 𝐚𝐜𝐡𝐢𝐞𝐯𝐞 𝐛𝐞𝐭𝐭𝐞𝐫, 𝐦𝐨𝐫𝐞 𝐚𝐟𝐟𝐨𝐫𝐝𝐚𝐛𝐥𝐞 𝐡𝐞𝐚𝐥𝐭𝐡𝐜𝐚𝐫𝐞. #HealthcareTransparency #PBM #PharmacyBenefits #AffirmedRx #Accountability https://lnkd.in/eK-EKN7a

Caught in a dilemma? Imagine a world where every prescription decision could save a life or break the bank. Welcome to the Pharmacy Benefit Management Dilemma. Balancing scales seldom seen, Pharmacy Benefit Managers (PBMs) stand at the crossroads of healthcare and commerce. Their role? To negotiate drug prices and manage pharmacy benefits. But herein lies the conundrum - is the focus on profit overshadowing patient care? Consider this - while PBMs were created to streamline drug pricing and expand access, critics argue their opaque pricing models and rebates might actually inflate the cost of medications for consumers. The question then arises: Are we compromising patient care for financial gain? Digging deeper, the impact of PBMs on independent pharmacies is profound. Small businesses often find themselves at a disadvantage, struggling to compete with the pricing structures dictated by large PBMs. This not only affects the pharmacies' survivability but also limits patient access to personalized care. Yet, it's not all gloom. Innovative models and regulatory changes are emerging, aiming to realign the industry's focus towards patient well-being while ensuring sustainability. Transparency, fair play, and patient-centric approaches are becoming more than just buzzwords. The debate is complex, but one thing is clear - the path forward requires a delicate balance. It's time to rethink and remodel the role of PBMs in our healthcare ecosystem. What's your take on the PBM dilemma? Share your thoughts or experiences below. Let's ignite a conversation for change.

Join us, Thursday, July 18, at the Conway Center for Family Business Roundtable to learn how to reduce healthcare costs for your family business. At C&A Benefits Group, we prioritize educating employers on misaligned health plan incentives and the impact of overspending on prescriptions. Discover how fixing this component can lead to savings of up to 50% on prescriptions. Stay informed with insights from the latest news: WSJ and FTC are taking action against PBMs over drug pricing tactics. Get wiser, take control, and save on healthcare costs with us. #HealthcareCosts #FamilyBusiness #OhioEmployersHealthPlan.

A bipartisan legislative proposal has been introduced in the House and Senate that could significantly reshape the U.S. healthcare landscape by targeting the role and structure of Pharmacy Benefit Managers (PBMs). As Howard Crawford and Patrick Firth write, "The Patients Before Monopolies Act aims to dismantle the vertically integrated structures of PBMs and their affiliated pharmacies. If enacted, the legislation would represent one of the most comprehensive overhauls of PBM practices to date."

Great perspective about the complex system we find ourselves in today.

While other PBMs are profiting at the expense of patients and pharmacies, AffirmedRx does things completely differently... better! 💡 AffirmedRx empowers its clients and members to become heroes of their own health care stories. In the complex landscape of pharmacy benefit management, AffirmedRx stands as a steadfast guide, offering the tools, knowledge and support necessary for members to make informed, confident health care decisions. https://lnkd.in/euxPTvbT

I’ve written a piece in AMCP’s Journal of Managed Care & Specialty Pharmacy that speaks to how the industry should approach PBMs and hope you’ll give it a read. All important health care practices, including those of PBMs, deserve scrutiny. Yet, the current rhetoric, which often blames them solely for high drug prices, is unproductive and lacks a balanced approach. The problem of high drug prices is a complex web of players and cannot be attributed to a single entity. While PBM reform efforts are well-intentioned, overly broad measures could backfire by reducing PBMs' ability to negotiate lower drug prices effectively, thus raising overall healthcare costs. The complexity of PBMs' functions and the varied evidence behind critiques of their practices call for a more nuanced, evidence-based discussion. Policymakers and stakeholders must engage in a more constructive and scientifically rigorous debate about PBMs and their role in the health care system. At the center of this collaboration the focus should always remain on the patient and improving access and affordability for all. Read here: https://bit.ly/3Z5QujS

The Hidden Middlemen Driving Up Healthcare Costs: A Closer Look at Pharmacy Benefit Managers (PBMs) - Part 2 Recent Federal Trade Commission (FTC) action has shed light on a critical issue in healthcare: the complex and often opaque world of PBMs. These intermediaries are dramatically impacting drug pricing and accessibility in ways most people don't realize. How do PBMs make money? Their revenue streams are both creative and controversial: • Spread Pricing: Charging health plans more than they pay pharmacies, pocketing the difference • Manufacturer Rebates: Negotiating "kickbacks" that often incentivize higher-priced drugs • Pharmacy Fees: Collecting network participation and retroactive fees • Vertical Integration: Owning pharmacies to capture additional dispensing profits To put this into perspective, Optum Rx (owned by UnitedHealth Group) generated $116.09 billion of revenue in 2023 - 16.4% more than the previous year. The FTC's recent lawsuit against the big 3 PBMs (Express Scripts, Caremark, and OptumRx) reveals shocking practices. They've been accused of creating a system that artificially inflates drug prices, particularly for critical medications like insulin. For instance, Eli Lilly's Humalog insulin price skyrocketed from $21 in 1999 to $274 in 2017. The human cost is real: patients are forced to ration life-saving medications due to these pricing mechanisms. Legislative efforts like the Pharmacy Benefit Manager Transparency Act are now pushing to prohibit these deceptive practices and protect consumers. This isn't just a corporate issue - it's about healthcare accessibility and affordability for millions of Americans.

A recent report from the U.S. Department of Health and Human Services states that specialty medications account for 51% of total pharmacy expenditures in the US—despite only serving 2% of the population. This striking disparity highlights an urgent need for greater transparency and efficiency in managing healthcare costs. Intelligent Health Markets offer a new gateway into transparency within drug pricing and rebate structures, while also aligning with broader goals of equitability and efficiency in healthcare. Read our new blog article to discover the role of advanced platforms like MacroHealth's Intelligent Exchange™ (MiX) platform:  https://lnkd.in/e-y3PsAT