Wednesday, April 10, 2019

Rx for Big Pharma?

One of the subtexts of the healthcare transparency movement is something called Pharmacy Benefit Managers (PBM's):

"PBM's are (allegedly) a cost-efficient way for carriers to offload the administrative functions of filling prescriptions ... The stated reason for this business model is that it helps carriers to rein in the cost of medications, which make up a disproportionate percentage of claims."

Of course, intentions ≠ results.

While the concept seems innocuous enough, it's apparently become a major source of tension in the health care community, and is frequently cited as a major driver of increasing health care costs.

So when I got this link from FoIB Holly R, I just had to pass it along:

Perhaps coincidentally, I also recently received an email from local insurer CareSource about their new efforts to bring about more transparency, and to rein in the power of PBM's:

"CareSource, a leading nonprofit multi-state health plan serving government sponsored programs, announced its intent to implement a new, integrated approach to administering pharmacy benefits and services."

The new push will focus on:
* Full price transparency validated by an independent third-party

* Custom pharmacy network to provide the same access members have today while protecting independent pharmacies
And several other worthy endeavors.

Although I'm generally skeptical about "feel good" insurance company campaigns, this one at least seems focused on something real, not just lofty.


Case in point: A client who takes synthroid recently refilled her 90 day scrip. Through her insurance (and thus, PBM), the cost would have been about $100. Uncharacteristically, GoodRx was almost $120. As usual, though, BlueSky clocked in at about $30. Heh.
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