Generics going up?

[Ron Van D]

The PBM's look to be the bad guys here.

Seniors pay more for generics, Avalere study finds

An Avalere analysis finds Part D prescription drug plans continue to increase patient copays for generics by moving them to higher tiers.

drugstorenews.com

 

[somarco]

PBM's are responsible for much of the consumer level copay increases. Perhaps they served a purpose initially and delivered lower cost medications to mom & pop pharmacies.

But large chains have grown, driving many smaller pharmacies out of business in large and smaller cities.

Maybe @kgmom219 has a different take but I fail to see anything positive from PBM's and any benefit to the consumer is non-existent.

Most of my clients use GoodRx and SingleCare vs their PDP unless the PDP has a $0 copay for their meds.

 

[GoPokes]

I agree with somarco. The PBM's have been behind the scenes causing a lot of the issues. I am close friends with a rural pharmacy owner, they won't even take humana because they cannot make any money. All the express scripts are less favorable, especially with 90 day supply. Caremark and Optum are really the only decent players, from my understanding. But they all require strong negotiations each year.

When doing a PDP plan comparison, you can actually see how the PBM drives traffic to the chain pharmacies, away from the small rural independently owned. The PBM even gives the mail order option an unfair advantage.

I am under the impression that some of the decision makers at the MA organizations are not fully aware of it. A wellcare rep told me they changed from Caremark to express scripts, in an effort to capture more rural marketshare. However, the rural pharmacy is actually worse off with express. Smaller communities have stronger loyalty to their local business, which shouldn't be ignored when designing plans.

[EXTERNAL LINK] - CMS asks health plans, PBMs to ease up on independent pharmacies

 

[kgmom219]

PBM's are responsible for much of the consumer level copay increases. Perhaps they served a purpose initially and delivered lower cost medications to mom & pop pharmacies.

But large chains have grown, driving many smaller pharmacies out of business in large and smaller cities.

Maybe @kgmom219 has a different take but I fail to see anything positive from PBM's and any benefit to the consumer is non-existent.

Most of my clients use GoodRx and SingleCare vs their PDP unless the PDP has a $0 copay for their meds.

First, I don’t agree on going without Part D unless level 4 or 5 on IRMAA.

One of the very few benefits of PBMs is drug interactions. Especially for people who use multiple pharmacies.

True story: new client was on some brand new drug for migraines. Around $1K a month, plus step therapy. Hit the deductible and calls me with “I can’t afford this, it use to be $40”. So I ask what other drugs she had tried.

“None. This started about 6 months ago and this is what he gave me”.

She’s on no other meds. Drug Rep probably had great legs. So client gets hammered instead of trying the $5 drug first.

Step therapy is a hassle but it actually does contain costs.

 

[JamesRobinson]

Yes, you are right, I agree with you.