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(Some Guy)   Pharmacy Benefits Manager companies are making a shiat-ton of money, but no one seems to know where all those kickbacks are coming from   (beckershospitalreview.com) divider line
    More: Obvious, Prescription drug prices in the United States, Pharmacy Benefit Management, Pricing, pharmacy benefit managers' gross profit, PBM retention of manufacturer rebates, Pharmacology, sources of these profits, Marketing  
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861 clicks; posted to Business » on 03 Dec 2021 at 2:50 AM (6 weeks ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook



28 Comments     (+0 »)
View Voting Results: Smartest and Funniest
 
2021-12-03 1:38:10 AM  
I didn't even know 'Pharmacy Benefits Manager' was even a job, much less a whole company... or companies... I guess it's a whole industry... I sold weed in high school, can I get in on this?
 
2021-12-03 3:10:24 AM  
Bitcoin
 
2021-12-03 3:53:33 AM  
I'm in the wrong line of work
 
2021-12-03 4:06:12 AM  
Man the only bribes and kickbacks I get at work are food.
 
2021-12-03 6:37:20 AM  
https://eu.dispatch.com/story/news/20​2​1/12/02/us-drug-prices-remain-excessiv​e-part-due-failure-rein-pbms-health-ca​re-prescriptions-rebates/8819629002/

They are also the ones screaming loudest about the Prescription Drug Price Transparency Act. Revealing pricing would hurt their negotiations (facepalm)
 
2021-12-03 7:03:20 AM  
If this is in the USA, then I am not surprised at all.  We have a massive system that employs hundreds of thousands of people to move documents from one computer or another, at different brick and mortar physical locations all around the country.  The system has no transparency on pricing or the millions of overlapping contracts.  It's a pyramid scheme operator and money launderers wet dream.

There are no less than six layers of red tape between me and my PC, and the US has more than one million different health insurance "plans".
But single payer would be no different than a Soviet bureaucracy right?
/Oh well, another 10%+ increase in health care costs.
 
2021-12-03 7:31:22 AM  
Ooh ooh I know!! Insurance companies. You and me. It comes out of our f*cking pockets!

The "rebate" goes to the PBM, like the one owned by CVS... WHICH also sells you the drugs.

It's a f*cking pure mob racket.

I think it was Elijah Cummings (god rest his soul) who was taking aim at them to destroy them. When he died no one else seems to have taken up that fight because they bribe everyone.

It's a criminal enterprise and should be destroyed. But, you know, yay Capitalism.
 
2021-12-03 7:52:49 AM  
I take that back, looks like that's what they are trying to pass, as mentioned by others above... Sorry, been tuning in and out of this stuff because everything is so crazy these days.

Elijah E. Cummings Lower Drug Costs Now Act: The Long and Winding Road to Drug Pricing Reform (sheppardhealthlaw.com)
 
2021-12-03 8:09:42 AM  
There are layers and layers of inefficient bureaucracy in the health care system, each taking a cut and raising prices, under the guise of trying to lower costs. Remember how much we hated HMOs back in the day? Now I wish my employer would offer one instead of the high deductible HSA bullshiat.

Single payer/universal health care would wipe out tons of jobs, but they provide no benefit to society and I would not shed a tear for them.
 
2021-12-03 8:31:43 AM  
The US pharmaceutical industry is highly complex by design.  If no one can understand how it works, no one can regulate it.  The way the money moves around is quite bizarre.
 
2021-12-03 8:35:28 AM  

desertfool: There are layers and layers of inefficient bureaucracy in the health care system


It's a battle over money, and the combatants are highly efficient.  There are also parasites lurking throughout the medical system, and they're pretty efficient too.  The whole thing extracts unbelievable amounts of money from the public every year.
 
2021-12-03 9:15:15 AM  

desertfool: There are layers and layers of inefficient bureaucracy in the health care system, each taking a cut and raising prices, under the guise of trying to lower costs. Remember how much we hated HMOs back in the day? Now I wish my employer would offer one instead of the high deductible HSA bullshiat.

Single payer/universal health care would wipe out tons of jobs, but they provide no benefit to society and I would not shed a tear for them.


Ross Perot started to digitize medicine back in the 1960s.  He was told to stop because too many jerbs would be lost.  We now have both inefficient digital records (which are being sold to silicon valley types), and absurd paper bureaucracy.  Behind it are literally millions of contracts and agreements which are hidden, with 99.999% of patients who don't have a right to see their own contract (presumably VPs of HR do).  Instead it's hidden behind four layers: your HR, your Benefits Consultant, your Benefits coordination company, and finally your multiple benefits providers like health insurance, brokerage, and financial tech corporations.
But single payer would be too expensive!
 
2021-12-03 9:52:25 AM  

groppet: Man the only bribes and kickbacks I get at work are food.


"B-but there are lots of people...not a lot of cake. The ratio of cake to people is too big!"
 
2021-12-03 10:23:27 AM  
These are the guys setting the drug prices, btw.
 
2021-12-03 11:53:54 AM  

Monty_Zoncolan: I didn't even know 'Pharmacy Benefits Manager' was even a job, much less a whole company... or companies... I guess it's a whole industry... I sold weed in high school, can I get in on this?


They are as big of a scam as PSAO (pharmacy service administration organizations). A PSAO is a middle-man between a pharmacy and an insurance company and skim as much as they can off the top from the insurance companies before giving small portions to the pharmacies.
 
2021-12-03 12:01:41 PM  
PBMs are a bullshiat. That profit is fees.

/Used to work for a healthcare non-profit and bought meds for uninsured patients. The entire pharmaceutical industry is maddening.
 
2021-12-03 2:05:28 PM  
People in the industry know where they come from. Part of my business is analyzing and optimizing all of this for pharma companies in order to maximize patient access to meds.

You want to add outrage, check out how PBMs are now setting up mega PBMs (GPOs) as another layer of rebate skimmers, often offshore to avoid US legislation. Link
 
2021-12-03 2:41:35 PM  
we should be allowed to get our medicine from other countries.  they have a monopoly on the US market.  that means high prices and crappy customer service.
 
2021-12-03 4:38:13 PM  
The amazing thing to me is that Pharmaceutical Companies have been so successfully demonized as "Big Pharma," by both Left and Right, but no one says peep about the PBMs and the insurance companies (aka, the middlemen) who are at least as responsible for the high prices of prescription meds.

To say nothing of the fact that prescription drugs are just a small part of the high cost of health care in America.  Have you looked at the cost of hospitalization or any in-patient procedures?  Astronomical, and have risen faster than the cost of prescription drugs.  People are much more likely to be bankrupted by a hospital bill than a prescription drug co-pay.  But no one demonizes "Big Hospital."  Oh no, people hold fundraisers for their local hospitals.

It's a remarkable illustration of the power of PR.  And Pharma has some of the worst PR.  It's an industry that invents and develops cutting-edge new life-saving and quality-of-life improving medicines every year, but its public image is down there with tobacco companies and gun manufacturers.

And I'm not saying that all pharma companies have no responsibility for rising health care costs, or that they have all acted completely ethically (that's obviously not true of companies in any industry).  But it is remarkable how they are singled out as boogeymen, while letting others like PBMs and insurers (which invent nothing and innovate nothing) skate.
 
2021-12-03 5:14:18 PM  
SOMEBODY knows where the money is coming from.
 
2021-12-03 6:18:25 PM  
We need more middlemen in our healthcare $ystem. That is the only way we can improve healthcare.
 
2021-12-03 8:09:48 PM  

Doc Daneeka: The amazing thing to me is that Pharmaceutical Companies have been so successfully demonized as "Big Pharma," by both Left and Right, but no one says peep about the PBMs and the insurance companies (aka, the middlemen) who are at least as responsible for the high prices of prescription meds.

To say nothing of the fact that prescription drugs are just a small part of the high cost of health care in America.  Have you looked at the cost of hospitalization or any in-patient procedures?  Astronomical, and have risen faster than the cost of prescription drugs.  People are much more likely to be bankrupted by a hospital bill than a prescription drug co-pay.  But no one demonizes "Big Hospital."  Oh no, people hold fundraisers for their local hospitals.

It's a remarkable illustration of the power of PR.  And Pharma has some of the worst PR.  It's an industry that invents and develops cutting-edge new life-saving and quality-of-life improving medicines every year, but its public image is down there with tobacco companies and gun manufacturers.

And I'm not saying that all pharma companies have no responsibility for rising health care costs, or that they have all acted completely ethically (that's obviously not true of companies in any industry).  But it is remarkable how they are singled out as boogeymen, while letting others like PBMs and insurers (which invent nothing and innovate nothing) skate.


They make toxic chemicals
 
2021-12-03 9:37:28 PM  

NewportBarGuy: Ooh ooh I know!! Insurance companies. You and me. It comes out of our f*cking pockets!

The "rebate" goes to the PBM, like the one owned by CVS... WHICH also sells you the drugs.

It's a f*cking pure mob racket.

I think it was Elijah Cummings (god rest his soul) who was taking aim at them to destroy them. When he died no one else seems to have taken up that fight because they bribe everyone.

It's a criminal enterprise and should be destroyed. But, you know, yay Capitalism.


And CSV uses their vertical integration of pharmacy benefits management with pharmacy sales to undercut competitors - a clear violation of antitrust legislation.

Biden appointed the first FTC chair in 40 years who will actively prosecute antitrust legislation. (Sorry Obama and Clinton, but you were both big business shills.) Hopefully this will be an inflection point for the better for our economy.
 
2021-12-03 10:45:28 PM  

Northern: If this is in the USA, then I am not surprised at all.  We have a massive system that employs hundreds of thousands of people to move documents from one computer or another, at different brick and mortar physical locations all around the country.  The system has no transparency on pricing or the millions of overlapping contracts.  It's a pyramid scheme operator and money launderers wet dream.

There are no less than six layers of red tape between me and my PC, and the US has more than one million different health insurance "plans".
But single payer would be no different than a Soviet bureaucracy right?
/Oh well, another 10%+ increase in health care costs.


I just started in the accounting dept at the corporate office for a group that owns 50 skilled nursing facilities.
Had a presentation yesterday on Medicaid reimbursement rates.
Long story short, after an incredibly complex formula is applied, it turns out we don't earn the full reimbursement rate (which differs state to state) because we are very good at cutting overhead admin costs.
Yup, if we had a higher rate of admin costs, we'd get closer to the full reimbursement.
 
2021-12-03 10:48:16 PM  

desertfool: There are layers and layers of inefficient bureaucracy in the health care system, each taking a cut and raising prices, under the guise of trying to lower costs. Remember how much we hated HMOs back in the day? Now I wish my employer would offer one instead of the high deductible HSA bullshiat.

Single payer/universal health care would wipe out tons of jobs, but they provide no benefit to society and I would not shed a tear for them.


Well, since apparently, no one wants to work now, this is the time to do it.
 
2021-12-04 4:43:42 AM  

Tiga: desertfool: There are layers and layers of inefficient bureaucracy in the health care system, each taking a cut and raising prices, under the guise of trying to lower costs. Remember how much we hated HMOs back in the day? Now I wish my employer would offer one instead of the high deductible HSA bullshiat.

Single payer/universal health care would wipe out tons of jobs, but they provide no benefit to society and I would not shed a tear for them.

Well, since apparently, no one wants to work now, this is the time to do it.


I hear the home eldercare business is absolutely booming; wiping wrinkly butts for sub-minimum wage seems like a great opportunity for these folks!
 
2021-12-04 10:28:33 AM  
They make doctors pay for the privilege of prescribing for their own patients, they make pharmacies pay up to a quarter for transmitting and receiving insurance claims, they charge you and your employer out the wazoo for premiums and copays, they screw independents on audits nine ways to Sunday, they delay treatment with formularies and prior authorizations, they force artificially higher cash prices in pharmacies to make up for their ridiculous reimbursement rates. They are a cancer.
 
2021-12-04 12:42:49 PM  
This is straight from a (now former) health care administrator at one of our large local hospitals.

A procedure costs $16K.

We bill the patient $144K.

The patient's insurance "negotiates" a new final cost of 28K. In reality this is all pre-arranged with the insurer.

The patient pays a 2K copay; the insurance pays the 26K balance.

The patient is happy that a 144K procedure cost them only 2K.
The insurance company is happy because they can claim that they "fought for the patient" and negotiated the price way down.
The hospital is happy because they made 12K in actual profit, but have a paper loss of 116K that they can use elsewhere to their advantage. Hollywood accounting and health care accounting play by the same book.

The USA has possibly the best health care in the world. Alas it is coupled with one of the lousiest health care systems in the world. A lot of reform, particularly on the accounting side, is needed. And I am fairly certain that government-owned single payer will make it worse, not better.
 
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