Currently, 90% of the PBMs in the US are under investigation by the Federal Trade commission. Seems notable.
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For the acronym adverse people like me, Pharmacy Benefit Managers, I assume.
https://www.ftc.gov/news-events/news/press-releases/2022/06/ftc-launches-inquiry-prescription-drug-middlemen-industry https://www.ftc.gov/news-events/news/press-releases/2022/06/ftc-launches-inquiry-prescription-drug-middlemen-industry
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Yes I found that out when I started my new job and the PBM/pharmacy plan only covered brand name insulin and if I went with generic at a 1/4 of the price and paid for it outside of the plan it wouldn’t go towards my deductible. It’s all a joke/scam. Companies making millions off of us!
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I discovered that the Pharmacy Benefit Manager for my Medicare Advantage plan was either stupid or incompetent. They wouldn’t cover my Insulin because they said it wasn’t on their formulary. After many, many phone calls I found out that the electronic prescription system converted my Novolog prescription to one for Insulin Aspart, the generic name for Novolog. I told the PBM that Novolog and Insulin Aspart are one and the same (and that Humalog and Insulin Lispro are the same). They said “Huh?” and I said just Google Insulin Aspart, and then they said “Oh, Duh.”
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Luckily I was able to get connected with a diabetes clinic associated with a large hospital system that has some special program for major conditions that require expensive meds like diabetes, HIV, etc. And without my insurance I am able to get my 3 months of Novolog (not generic) for $15.
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