A pharmaceutical colossus
Prescribed medication has become a vital aspect of modern medicine. Patients all over America take medicinal drugs daily for any number of ailments. Xanax, Vicodin and Lipitor are just three of the top names that Americans have become accustomed to. According to a study done by the Mayo Clinic in recent years, 70% of Americans take least one prescription medication. 20% of consumers are taking five or more medications, with prescription drug use increasing over the last decade.
One of the negative side effects of the growth of big pharma is that Pharmacy Benefit Managers, or PBMs for short, are siphoning away your money without you even realizing it. They claim it’s to help regulate the system and help drive down co-pays, when the reality is the exact opposite.
Rebates and clawbacks
In the pharmaceutical industry, there is a lot of brokering behind closed doors over which medications will be covered with certain insurance plans. PBMs will often take advantage of a system that blatantly abuses taxpayer money by essentially lobbying for what medication will make them the most profit. Most of the dealings are centered around a type of pharmaceutical bonus known as “rebates.” Given that the definition of the word “rebate” is to pay back a sum of money spent on a product or service, a consumer might think: “How could such a concept be negative for what I’m paying for my prescriptions?” Rebates are money driven deals that are paid out to PBMs through pharmaceutical manufacturers. The negative impact of this transaction is that PBMs have complete control over what medications are covered by an insurance plan.
Rebates are claimed by PBMs to be highly beneficial to the consumer, advocating that they set aside a cut of those profits for insurance companies. This in turn is supposed to allow insurance agencies to lower the co-pays that consumers must provide up front. In such a murky world, pharmaceutical corporations and their PBM allies end up manipulating this system a little bit each time to make the co-payer increase their payments. Meanwhile the PBMs themselves make the biggest profit. This also places pharmacists in a precarious position, because their reimbursement is lowered for the drug that they are selling.
In the end, this sudden inflation occurs due to a drug manufacturer essentially being forced to hike the cost of production for a drug, just so they have enough money to provide PBMs with higher rebates. Rebates are usually placed on the most expensive drugs and medications, because the higher the cost of the drug, the larger the rebate that PBMs collect. In the end, the consumers who are hit the hardest are those who are medically dependent on prescriptions.
Clawing at your money
If you’re a patient or caretaker, the process of picking up medication is most likely very familiar; A pharmacist will retrieve your medication after receiving your name and birth date, and then a co-pay is charged to reimburse the pharmacy for part of the cost of the drug. What consumers and caretakers don’t realize is that PBMs are under control of what they pay, what pharmacists receive and what the PBM themselves make as middleman. This process involves microtransactions known to the pharmaceutical industry as “clawbacks.” Often, clawbacks might end up doubling what the actual cost of medication is.
With this system the pharmacies themselves make very little, and the PBM makes the most profit. For example, a medication might cost a pharmacy a dollar, charge you five dollars for a co-pay, and then make three dollars in reimbursement for the drug from the PBM. But a PBM’s influence over this system could force you to pay up to ten dollars on that same medication, leaving only a dollar for pharmacists and the rest for themselves.
Held captive by their own industry
Overall, the act of using clawbacks in today’s modern pharmaceutical industry has drastically affected the operations of many local and even chain pharmacies across the country. Many local shops have been forced to close their doors as a result. Many pharmacists have been desperately trying to shed light on the way this system works, and how it takes advantage of the consumer. Unfortunately, PBMs have that covered as well; pharmacies have been sworn to silence under what are known as “gag clauses.” These statements basically contract against informing clients they can get the same medication for less money if they don’t go through their insurance at a chain.
PBMs can’t handle the truth: there are ways to beat the system
PBMs and their financial partners do not want you to pay the true price of your prescribed medication. Instead, they want you to pay a price that lines their pockets. Over time, more consumers have begun to realize the truth of what is happening. In response to this, many PBMs defend themselves by stating that these accusations are without merit. They’ll claim that the current situation is fair to both consumers and pharmacists alike, and that their efforts help keep the pharmaceutical industry in a balanced state. Evidence brought up from multiple sources has proven otherwise. Fortunately, there is a way to fight for your right to purchase medication you depend on at a fair price. Local pharmacies like Village Pharmacy of Hampstead, and Rocky Point Pavilion Pharmacy are doing their in part to help communities pay less rather than being taken advantage of.
The helpful neighborhood experts at these locations know that your need to get the quality care you deserve, should not be placed to the side in favor of corporate clawbacks and rebates. Village Pharmacy of Hampstead and Rocky Point Pavilion Pharmacy are leading the charge for local pharmacies to treat their clients with honesty and integrity. They know the facts behind the underhanded deals and want to promote an atmosphere of transparency to all their customers.
You and your loved one’s well-being should come first over corporate profits. So, why do business with pharmacies that won’t be up front with you? Visit Village Pharmacy of Hampstead and Rocky Point Pavilion Pharmacy and start lowering the costs of your prescriptions.
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