This time, the blame is being put on the Pharmacy Benefits Managers (middlemen) enjoying the revenue from insulin prices. Made me curious as to why health plans even use PBM’s to negotiate with pharma. Do all health plans use these guys? It would seem (from what the WSJ article implied) that any savings from negotiating prices and setting the favored drug s for formularies aren’t really benefitting the health plans. Anybody here who works for health plans and PBMs that can answer this for me?
Bingo! You hit on one of the biggest problems with our system. How can it be that my medical supplier charges $1200 for one Dexcom G4 transmitter, but my health insurer only allows $600, so the supplier accepts that and the other supposed $600 in charges simply disappears? It drives me crazy every single time I get an EOB for pump and Dex supplies. False prices so some middleman can “negotiate” a better price and pocket some of the savings.
And I too would love it if someone in the now could explain how this all came about, but I fear there is no clear answer.
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I got a chance to meet T.R.Reid (author of “The Healing of America, A Global Quest for Better, Cheaper and Fairer Health Care” A must read for anyone who is a patient, an HCP and a policy maker. One of the things that US healothcare does that no other nation does is have “networks” - and PBM’s. I think I will [ay my dues to PHNP this evening!