Drug Pricing - Cutting Out the Middleman

[somarco]

I wonder if our resident PBM guru can noodle this out and cut through the mumbo jumbo. Does Health Warehouse have a PBM or are they affiliated with a PBM?

 

[StephanieCJ]

At the risk of sounding like an ***...what is a PBM?

 

[XpressInsurance]

At the risk of sounding like an ***...what is a PBM?

Pharmacy Benefit Manager

 

[kgmom219]

I am 99% sure the answer is no.

And since they are trying to remove the middleman, it would seem like they wouldn't be, anyway.

 

[goillini52]

During a speech Friday, the president promised that his administration's actions would reduce what consumers pay at the pharmacy and would end the abuse in the system that leads to high drug prices. He blasted drug makers, health insurers, pharmacy benefit managers and others for profiting off American patients.


"We are going to take on the tangled web of special interests ... the drug lobby is making an absolute fortune at the expense of American patients," Trump said.

 

[Justin Bilyj]

Big Changes coming to PBM's!

Considering fiduciary status for Pharmacy Benefit Managers (PBMs)

Here Is Trump's Blueprint For Lowering Drug Prices

And some more details from the Plan:

Increased Competition:

• Immediate Actions
  • Steps to prevent manufacturer gaming of regulatory processes such as Risk Evaluation and Management Strategies (REMS)
  • Measures to promote innovation and competition for biologics
  • Developing proposals to stop Medicaid and Affordable Care Act programs from raising prices in the private market
• Further Opportunities
  • Considering how to encourage sharing of samples needed for generic drug development
  • Additional efforts to promote the use of biosimilars

Better Negotiation

• Immediate Actions
  • Experimenting with value-based purchasing in federal programs
  • Allowing more substitution in Medicare Part D to address price increases for singlesource generics
  • Reforming Medicare Part D to give plan sponsors significantly more power when negotiating with manufacturers
  • Sending a report to the President on whether lower prices on some Medicare Part B drugs could be negotiated for by Part D plans
  • Leveraging the Competitive Acquisition Program in Part B.
  • Working across the Administration to assess the problem of foreign free-riding
• Further Opportunities
  • Considering further use of value-based purchasing in federal programs, including indication-based pricing and long-term financing
  • Removing government impediments to value-based purchasing by private payers
  • Requiring site neutrality in payment
  • Evaluating the accuracy and usefulness of current national drug spending data
  • Investigating tools to address foreign government threats of compulsory licensing or IP theft that may be harming innovation and development, driving up U.S. drug prices

Incentives for Lower List Prices

• Immediate Actions
  • FDA evaluation of requiring manufacturers to include list prices in advertising
  • Updating Medicare’s drug-pricing dashboard to make price increases and generic competition more transparent
• Further Opportunities
  • Measures to restrict the use of rebates, including revisiting the safe harbor under the Anti-Kickback statute for drug rebates
  • Additional reforms to the rebating system
  • Using incentives to discourage manufacturer price increases for drugs used in Part B and Part D
  • Considering fiduciary status for Pharmacy Benefit Managers (PBMs)
  • Reforms to the Medicaid Drug Rebate Program
  • Reforms to the 340B Drug Discount Program
  • Considering changes to HHS regulations regarding drug copay discount cards

Lowering Out-of-Pocket Costs

• Immediate Actions
  • Prohibiting Part D contracts from preventing pharmacists’ telling patients when they could pay less out-of-pocket
  • by not using insurance
  • Improving the usefulness of the Part D Explanation of Benefits statement by including information about drug price increases and lower cost alternatives
• Further Opportunities
  • More measures to inform Medicare Part B and D beneficiaries about lower-cost alternatives
  • Providing better annual, or more frequent, information on costs to Part D beneficiaries

 

[somarco]

I am 99% sure the answer is no.

And since they are trying to remove the middleman, it would seem like they wouldn't be, anyway.

That's what I thought, but then not sure if that was "kosher" to go direct to the pill makers and cut out the PBM

As for the Trumponian plan to reduce Rx costs, I am all for it. Other countries with lower Rx costs (to consumers) do that via govt subsidies plus more relaxed rules for approving drugs, especially generics.

 

[gregj]

As for the Trumponian plan to reduce Rx costs, I am all for it.

too bad it's more press release than plan

 

[somarco]

too bad it's more press release than plan

Of course it is.

I would love to see SOME help on select med's, in particular insulin. However many of the "live saving" cancer drugs are not life saving but life extending . . . an average of 2 to 3 months.

 

[kgmom219]

Azar went off this morning in a speech about drug costs. And he actually seems like he has a clue of how bad the issues are and that its a complicated debacle.

I still don't get how they are going to have Medicare negotiate the drug costs. They can use the standard formula from the PBM's, but we are still dealing with the acquisition cost at the pharmacies, which varies widely.

Standard Formula: 85% of AWP (Average Wholesale Price) plus dispensing fee.

Personally, I think the first thing that needs to be fixed is drug reps. Make it illegal for drug reps to meet with doctors. Spend some tax dollars at the FDA for provider education on drugs.

Second, AMERICANS need to take more responsibility for their drug costs. Stop taking the latest and greatest. Use something old and cheap before going up the ladder. However, most people have their doctors on pedestals and never question them. (This is the reasoning behind step therapy prior auth's, which I have NO problem with.)