Hi all! Posting this in a few places because it’s really important! For anyone who uses coupons from pharmaceutical companies to help with out of pocket costs, the Diabetes Patient Advocacy Coalition wants to hear from you! DPAC has filed a lawsuit against the Department of Health and Human Services because patients are not getting the full value from their insurance plan, which translates to higher costs. Please email Jacob Jansen (jjansen@diabetespac.org) if you can share your story and help out!
But what does HHS have to do with this? HHS administrates Medicare and Medicaid which is governed by a federal law against kickbacks when using these programs. I guess I am very confused.
1 Like
Fundamentally the coupons are a way for big pharma to maintain high list prices and keep actual production costs hidden. Most importantly today, they are a way for big pharma to avoid pressure from congress and regulatory agencies to be transparent or reduce list prices.
This article on diaTribe seems to be a fuller explanation: diaTribe Joins Coalition to Improve Access to Affordable Medications | diaTribe Change
So I read the statement from diatribe and I agree mostly. However suing HHS still seems odd to me. But perhaps I misunderstand the legal underlinning of the rebate system.
I do somewhat understand the employer point of view but - before I side with the employees totally we have to acknowledge that employers contract with PBM’s so in theory, they operate in tandem in almost all cases. If the employer is upset with a PBM, they fire it and get a better arrangement. Employees, by contrast, are stuck with who the employer selects. The power relationship favorite the employer
Now the reverse side of that argument is powerful to me. Employers do rely on rebates to lower plan cost. The smaller the employer the bigger the deal. So yes an automaker likely is not seeing enough to make a big difference overall. However a 30-person place and one big claim can wipe out a plan and potentially a business.
So in this regard I’m afraid I have to disagree with the petition. To make a blanket statement that this would impact premiums by less than 1/2 percent is terribly self-serving. We actually have no idea the impact because at present PBMs are sucking up so much of the rebate that the system is distortited. So yes patents are paying more - but so are health plans.
Instead of attacking employers we need to attack pbms and educate employers. Not sweep them into a fight.
So this is different from the rebate conversation but I can give you some info on that too!
Here is an explanation of the HHS suit, which is procedural, but would have positive impact:
Hope that helps!