Posts Tagged ‘pharmacy benefit managers’

Who Benefits from Pharmacy Benefit Managers?

November 15, 2023 — A trip into the world of pharmacy benefit managers (PBMs) is enough to make our heads spin. It leads us to wonder: exactly who benefits from pharmacy benefit managers? The answer is not clear, but it seems obvious that patients in need of affordable medicine do not. In Search of a Fair Deal The biggest […]

Do PBMs Drive Drug Costs Up or Down? Can They Do Better?

November 6, 2023 — It is frustrating. The list price of Mounjaro (tirzepatide) is more than a thousand dollars per month. Pharmacy Benefit Managers (PBMs) negotiate costs for this drug that brings the average cost down to an estimated $215,  but many folks get stuck paying the full list price, forgoing treatment, or paying a copay that might exceed […]

The GLP-1 Windfall for Pharmacy Benefit Managers

October 24, 2023 — We have grown tired of the mindless repetition of a $1,350 monthly list price for Wegovy in endless news reports about the great expense of this very important new drug for obesity. Not because the drug isn’t expensive. But because that list price is not an accurate representation of what the drug really costs. So […]

Obesity Medicines Price Shocks Hitting Employers

August 3, 2023 — Message to University of Texas Employees: Continuing to pay for obesity medicines is unsustainable. Message from Novo Nordisk: No comment. Price shocks for advanced obesity medicines are hitting employers. Things are starting to get messy in the marketplace and you can be pretty sure that they will only get messier as makers of obesity medicines […]

Enforcing Second Class Status for Obesity

May 26, 2023 — Some health insurance plans seem to be panicking. For years, the order of things was simple. People with obesity had only themselves to blame and besides, nothing could be done about their condition. So health insurers routinely denied coverage for medical care of obesity. “Regardless of any potential medical benefit” was the language written into […]

Biosimilars and PBMs: The Joke’s on Us

April 12, 2023 — Two innovations in health systems and health policy – PBMs and biosimilars – are supposed to save us money on drugs. But so far, it looks like the joke is on us. PBMs (pharmacy benefit managers) can actually drive prices higher. Their stated purpose is just the opposite – to drive drug costs down. Adding […]

Is Health or Greed Driving Health Systems?

January 15, 2023 — Workers at the largest health system in the U.S., HCA, this week accused the system of putting profits ahead of patient care and health. We regularly hear from obesity care providers about insurers using lame excuses to deny coverage for obesity meds or surgery for lame reasons. This happens even when the health plan covers […]

Putting the Best Meds Within Reach for Everyone

September 9, 2022 — Be careful what you wish for, says the wisdom of the ages. It’s all about unintended consequences. Right now, policymakers all over the political spectrum are wishing to solve the problem of drug pricing in the U.S. The simple fact is that drug pricing in the U.S. puts the best, most innovative drugs out of […]

The Dark Art of Pharmacy Benefit Managers

May 24, 2022 — Drug pricing has been getting a lot of attention for some time now, so it’s no surprise that the prices of obesity medicines would get attention, too. New medicines are coming, competition will be increasing, and one factor in that competition will be prices. The only way to get good value is to consider both […]

Unaffordable Drugs: Simple Greed or a Complex Market?

March 17, 2019 — Prescription drug prices are under the microscope again and the intense scrutiny is unlikely to fade anytime soon. That’s because those prices are hurting people who need the drugs. The prime example of unaffordable drugs is insulin. In the short time between 2012 and 2016 alone, costs of insulin almost doubled. Some patients who need […]