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Working in the Shadows
You have less control over your medication than you think
Rumors have been spoken in hushed whispers, of the figures lurking just beyond our reach, in the Pharmaceutical Industry. These figures are professionals at what they do, deceiving millions of Americans into thinking that they are in control of what they pay for their medication. These people are what pharmacists call “middlemen,” and they’re so good at what they do, you’ll never take notice until you pay your pharmacy bill.
What is a PBM?
These elusive figures are known as Pharmacy Benefit Managers, or PBMs. Originally, these managers had humble beginnings in the early 60s and 70s. The purpose of PBMs were to help consumers keep an easy “paperless trail” when they needed simpler access to medication. PBMs helped to keep those records in check and create an overall less stressful environment.
But unfortunately for patients and caretakers that rely heavily on modern medication, times have changed for the worse. These once helpful allies have now turned the other cheek towards consumers.
PBMs have influenced the extreme price hikes, and gradual disappearance of locally owned pharmacies. The supposed intention of PBMs today, is to help manage insurance plans that in turn, help to manage prescription drug costs. PBMs act as a middleman between drug manufacturers, insurance providers and the pharmacies themselves.
A sleeping giant
Pharmacy Benefit Managers will claim that the allegations brought against them are unwarranted, and that the current system is fair for both consumers and pharmacists.
PBMs and their affiliates are a large enterprise, and an influential force in the pharmaceutical industry. The healthcare industry, which accounts for approximately 12% of job positions in America, is slowly being swallowed up by PBMs. To give some perspective, UnitedHealth is only slightly smaller than Amazon. McKesson is a PBM company that’s bigger than both Boeing and Wells Fargo combined! As a result of their sheer size, PBMs have their fingerprints on just about everything that’s pharmaceutical.
A PBMs influence goes deeper than you realize
As healthcare costs in general have continued to soar in recent years, the truth about what PBMs have really been doing with your money has been revealed.
Most consumers who rely on medication don’t even know these middlemen exist, however if you have insurance, all your prescriptions could be funneled through a PBM of some kind. In fact, the biggest PBMs have positioned themselves to actualize trillions of dollars in revenue.
Some PBMs are hiding in plain sight as subsidiaries to larger pharmacy chains; The three biggest companies are: Express Scripts, CVS Caremark and Optum RX. They are 89% of the pharmaceutical market share, generating at least $300 billion dollars in 2017.
Simply put, a PBM pulls all the strings regarding what medication you get to take, how much it costs and if you are even allowed to obtain the prescribed medication. They control how much a pharmacy is reimbursed, for a medication, and how much of a co-pay their customers must give.
This process is not understood by most consumers, who believe it is insurance companies or manufactures setting the price. When it comes to what drug is covered by which insurance plan, PBMs have control over that as well. In order to ensure that a drug can be allowed on a plan, drug manufacturers will pay out royalties to PBM companies, called “rebates.” PBMs will control which drugs can be covered by insurance so they can make a rebate on it. Essentially, this control ends up driving the cost of what it takes to manufacture a prescribed drug. This ends up manipulating a system that is supposed to limit consumer cost.
There’s a better option in going local
Since 2013, nearly 1,200 local pharmacies have vanished from neighborhoods across the country. The influence of PBMs has created a competitive advantage for major pharmacy chains in our country. PBMs control the reimbursement a pharmacist gets on a drug, charging everyone more, while obtaining the largest share of revenue for themselves.
Local pharmacies have become a beacon of hope, in providing consumers the ability to obtain the medication they need for less. You can visit a local pharmacist in your neighborhood and get the same drug for a significantly lower out of pocket cost, rather than paying through your insurance at a chain like CVS.
Local pharmacies like Village Pharmacy of Hampstead, and Rocky Point Pavilion Pharmacy, are two such establishments working to fight for the right of the consumer to pay less. Or, to be more accurate, pay the actual cost of the drug and not an inflated price that only benefits the middleman.
So, which side would you rather do business with? Big businesses, or pharmacies owned by friends and neighbors who care about the well-being of you and your loved ones?
Visit Village Pharmacy of Hampstead and Rocky Point Pavilion Pharmacy to save on your prescription costs:
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