By In Around the Web, Prescription Drugs

How PBMs Work, or, Why Being an Active Health Care Consumer Is Both Hard and Necessary

I was sitting down to write something and then saw this thread on Twitter and decided, to hell with it, this is a brilliant dissection of how pharmacy benefit managers (PBM’s) work and why and how they’re contributing to high prices in health care.

There are several ways to read this thread. Certainly PBM’s are not practicing fairly and with consumers in mind. But their dance partner, insurance companies, are to blame as well for turning the other cheek to the “kickbacks” that the DJ, pharmaceutical companies, are paying the PBMs for promoting certain brand-named drugs over available (and much cheaper) generics.

This scenario is not an uncommon abstraction. In fact, I’m dealing with two similar scenarios right now:

1) a drug I’ve taken for 15 years isn’t covered through my pharmacy of choice, Walgreens, because my PBM is CVS Caremark.

Price to buy through CVS: $12
Price to buy through Walgreens: $421

2) A drug prescribed for my son that is not yet available in generic form costs $309 after the GoodRx discount. I don’t have any option other than to go without or take my chances on a different drug with different/more side effects.

I wrote about a similar type of phenomenon on my LinkedIn profile last week, with a link to the definition of a “Mexican standoff.” For the uninitiated, that’s when two or more people have guns pointed at each other and the only way out is mutually assured destruction…or working together. It’s a favorite movie trope of Quentin Tarantino, and it usually doesn’t end in cooperation.

Until the lords of health care figure out how to work together, it’s on us to look out for our own interests.

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