This is the bill that provides drug coverage for Medicare beneficiaries, but prohibits price negotiation by our government. We provided coverage, but prohibited price negotiation which makes our brand-name drugs over three times more expensive than in other countries. Can anyone defend this law?
There is absolutely no defense. It flies in the face of common sense and reasonableness and against basic contract negotiation! Why would anyone in Congress/CMS NOT want the ability to negotiate price? Hmmm...you know, Bill, that this has to get political. It clearly demonstrates the undue influence that big pharma has on the regulatory and legislative process in this country. And also that the "free market" Republicans are willilng to sacrifice integrity for $$$. What other explanation could there possibly be? And with the fiasco in the Senate subject to the Filibuster Rule, it isn't likely to change, for the good anyway, any time soon.
The rules were made in favor of the Pharmacy Benefit Managers (PBM). The Modernization Act Prohibit Drug Price Negotiation directly with big Pharma, it requires the middleman, PBM, to negotiate with Pharma in the form of rebates. Pharma must pay rebate to the government thru PBM, and brand name drugs that made it to the "approved formulary" usually 3 times more expensive. Pay to Play or should I say Monopoly at its best when it comes to drug prices.
If price negotiation was truly the answer, why is it PBM only cover specific products?
Why does government insurance plans require brand name products when generics exist at a fraction of the cost and cannot be substituted unless the hidden rebate scheme is a viable part of their program. The price hikes are created by PBM, and patients are on the hook to pay full price. For example, Lantus insulin for uninsured patient is $99.00 per box of 5 pens, but thru PBM negotiated price for medicare patient is from $ 400 to $ 500 per box. The rebated prices are not passed on to medicare patients because Pharma already paid rebates to the government thru PBM.
Brand name Metformin is non existent in the market today where because of the generic but look at Nexium and the generic and or Ventolin/Proventil inhaler vs the generic at half the cost.
When the PBM owns everything what could go wrong? Optum owns United Health Care for example. They have the doctors to prescribe, the PBM to negotiate the cost of the drug along with contact reimbursements to their competitors. Why does Walgreens refuse to accept certain insurances?
CVS Caremark not only a pharmacy but a PBM, clinic and bought Aetna in 2018 and look at these articles. Optum or should I say UHC is trying to buy/merge Change Health is this analytics or competitive data? Change Health is one of two processors for all the scripts adjudicated in the United States, what could go wrong?
There is absolutely no defense. It flies in the face of common sense and reasonableness and against basic contract negotiation! Why would anyone in Congress/CMS NOT want the ability to negotiate price? Hmmm...you know, Bill, that this has to get political. It clearly demonstrates the undue influence that big pharma has on the regulatory and legislative process in this country. And also that the "free market" Republicans are willilng to sacrifice integrity for $$$. What other explanation could there possibly be? And with the fiasco in the Senate subject to the Filibuster Rule, it isn't likely to change, for the good anyway, any time soon.
The rules were made in favor of the Pharmacy Benefit Managers (PBM). The Modernization Act Prohibit Drug Price Negotiation directly with big Pharma, it requires the middleman, PBM, to negotiate with Pharma in the form of rebates. Pharma must pay rebate to the government thru PBM, and brand name drugs that made it to the "approved formulary" usually 3 times more expensive. Pay to Play or should I say Monopoly at its best when it comes to drug prices.
If price negotiation was truly the answer, why is it PBM only cover specific products?
Why does government insurance plans require brand name products when generics exist at a fraction of the cost and cannot be substituted unless the hidden rebate scheme is a viable part of their program. The price hikes are created by PBM, and patients are on the hook to pay full price. For example, Lantus insulin for uninsured patient is $99.00 per box of 5 pens, but thru PBM negotiated price for medicare patient is from $ 400 to $ 500 per box. The rebated prices are not passed on to medicare patients because Pharma already paid rebates to the government thru PBM.
Brand name Metformin is non existent in the market today where because of the generic but look at Nexium and the generic and or Ventolin/Proventil inhaler vs the generic at half the cost.
When the PBM owns everything what could go wrong? Optum owns United Health Care for example. They have the doctors to prescribe, the PBM to negotiate the cost of the drug along with contact reimbursements to their competitors. Why does Walgreens refuse to accept certain insurances?
CVS Caremark not only a pharmacy but a PBM, clinic and bought Aetna in 2018 and look at these articles. Optum or should I say UHC is trying to buy/merge Change Health is this analytics or competitive data? Change Health is one of two processors for all the scripts adjudicated in the United States, what could go wrong?
https://www.healthcarefinancenews.com/news/unitedhealth-group-and-change-healthcare-amend-merger-timeline
Merger CVS and Aetna
https://www.cnbc.com/2018/11/28/cvs-creates-new-health-care-giant-as-69-billion-aetna-merger-closes.html
Now in 2020 Aetna requires use of CVS Specialty pharmacy only
https://www.cmadocs.org/newsroom/news/view/ArticleId/48943/Anthem-to-require-use-of-CVS-Specialty-for-HMO-specialty-medications
The Purple Pill
https://www.3axisadvisors.com/projects/2019/12/10/purple-haze-how-a-little-purple-pill-called-nexium-exposes-big-problems-in-the-us-drug-supply-chain