Posts Tagged ‘pharmacy benefit managers’

Americans are only barely aware of the role that pharmacy benefit managers play in health insurance. But what they do know is not good. To the extent that most people know anything about these shadowy players in health insurance, they know PBMs control which drugs they can get, how much hassle it is to get […]

“It’s absolutely insane to try to keep up with it all,” says obesity medicine physician Laura Davisson. She is talking about the impossible maze of requirements that so-called health insurance plans set up to prevent people from securing coverage for medicines to treat obesity. It leads us to ask: Are health plans insuring profits more […]

Maybe you’ve noticed this is an election year. This might explain some of the heat on pricing that both obesity drug makers and pharmacy benefit managers (PBMs) are feeling. Both of the U.S. candidates for president are making promises to bring down drug prices. Senator Bernie Sanders and his Senate health committee is turning up […]

For many of us, it’s just too painful to think about. But a rerun of the 2020 presidential election is coming and drug pricing is likely to be a big talking point for both of the major candidates. President Biden is talking about corporate greed while former President Trump is talking about reviving an executive […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]