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.
I suppose I should add that the ACA at least tried to address this, though not with any success. And since that point, we have had a Congress devoid of compassion and understanding on matters involving the basic issues of humanity of the citizens of this country.
Thank you for bringing this horrible decision that has been with us way too long back into the light for discussion.
I have looked at your profile. Am I right that you are a physcian associate with an interest in cardiology and that you are in law school? If that is correct you are uniquely qualified to lead the fight to better health at lower cost in this country. Thanks for your comment. There are over 1000 professional subscribers to this content and this is the kind of interchange that I hope to stimulate.
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?
Thanks Khanh. Readers should know that you are a PharmD and a leader in your state. You manage hundreds of patients with diabetes and I have seen your outcomes. They are fantastic. I really appreciate your explanation. I have never been able to figure it out and my guess is most healthcare professionals don't know how it works. Our government allowed the vendors to design the program. It is completely opaque. No one knows who is winning and losing except the vendors. One thing is sure, it does not serve "we the people" well at all. Leaders in our system would have you believe they provide patient-centered care. That is the last thing it is. It is centered around the interests of businessmen, vendors, institutions, and providers. That is why so many consumers are frustrated. The European system works much better.
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.
Your comment makes complete sense
I suppose I should add that the ACA at least tried to address this, though not with any success. And since that point, we have had a Congress devoid of compassion and understanding on matters involving the basic issues of humanity of the citizens of this country.
Thank you for bringing this horrible decision that has been with us way too long back into the light for discussion.
I have looked at your profile. Am I right that you are a physcian associate with an interest in cardiology and that you are in law school? If that is correct you are uniquely qualified to lead the fight to better health at lower cost in this country. Thanks for your comment. There are over 1000 professional subscribers to this content and this is the kind of interchange that I hope to stimulate.
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
Thanks Khanh. Readers should know that you are a PharmD and a leader in your state. You manage hundreds of patients with diabetes and I have seen your outcomes. They are fantastic. I really appreciate your explanation. I have never been able to figure it out and my guess is most healthcare professionals don't know how it works. Our government allowed the vendors to design the program. It is completely opaque. No one knows who is winning and losing except the vendors. One thing is sure, it does not serve "we the people" well at all. Leaders in our system would have you believe they provide patient-centered care. That is the last thing it is. It is centered around the interests of businessmen, vendors, institutions, and providers. That is why so many consumers are frustrated. The European system works much better.