boutons_deux
08-06-2015, 01:40 PM
The Secret Industry That Meddles With Your Medications
Adam Pierno, a 40-year-old ad exec in Scottsdale, Arizona, was heading to his local CVS not so long ago, intending to refill a prescription. Quick errand, or so he thought. Upon arrival, he heard his insurance was suspended. But wait! When he called his insurer, Blue Cross Blue Shield, they said there wasn’t a problem and they’d put the scrip through if he wanted — but first, wouldn’t he like to hear how he could save money by switching to a mail-order pharmacy run by Express Scripts?
they make a business of inserting themselves between you and the medications your doctor prescribes. (The Federal Trade Commission estimates that PBMs handle 95 percent of U.S. prescriptions.)
Drug companies, for instance, don’t sell their meds to doctors or patients — they just spend enormous sums convincing doctors (http://www.ozy.com/immodest-proposal/should-doctors-be-required-to-be-healthy/39948) to prescribe the pills that insurance companies will ultimately pay for. Insurance companies hate that and fight back with coverage restrictions and other bureaucracy. Under such circumstances, the capitalist magic of business competition can’t do much to improve service and lower costs. Instead, the warring sides wage costly but inconclusive trench warfare, occasionally creating new weapons like PBMs in hopes of breaking the stalemate.
Lindsay Kearns, a 24-year-old food and nutrition marketer in Denver, found her recent attempt to pick up a migraine (http://www.ozy.com/fast-forward/fast-fast-fast-relief/1478) prescription hijacked by her insurance company, UnitedHealth Group. But Kearns didn’t get a soft sell; she says the insurer told her she could either switch to a mail-order pharmacy run by UnitedHealth’s in-house PBM, OptumRx, or pay the full — i.e., uninsured — price. UnitedHealth referred queries to OptumRx, which responded with a boilerplate statement touting its “92 percent customer satisfaction score” and the benefits of home delivery. Blue Cross Blue Shield and Express Scripts said they couldn’t comment on the specifics of Adam Pierno’s case, although Express Scripts noted that, in general, insurers sometimes require home delivery of certain prescriptions “for added convenience, safety and cost savings.” (Both Pierno and Kearns ultimately switched to home delivery, saying they couldn’t afford to pass up the lower prices.)
PBMs “They go to the [drug] manufacturer and say, ‘If you give us the lowest price, we will structure our [benefits] to steer patients towards your drug,’” Danzon says.
PBMs soon hit on the notion of running their own mail-order operations to cut local and chain pharmacies out of the picture.
Express Scripts, generally considered the largest independent PBM, reported a $2 billion profit last year, up 9 percent from the previous year, even though its overall revenue declined. These companies are also getting bigger. UnitedHealth just paid almost $13 billion for a PBM called Catamaran, which it intends to merge with OptumRx to create the third-largest PBM in the world. According to research from Trefis, UnitedHealth will eventually manage more than 1 billion prescriptions when this deal goes through.
http://www.ozy.com/fast-forward/the-secret-industry-that-meddles-with-your-medications/60182?utm_source=dd&utm_medium=email&utm_campaign=08062015
Americans and America are fucked and unfuckable, their wealth drain over their lifetime by BigHealthCare, among others.
Adam Pierno, a 40-year-old ad exec in Scottsdale, Arizona, was heading to his local CVS not so long ago, intending to refill a prescription. Quick errand, or so he thought. Upon arrival, he heard his insurance was suspended. But wait! When he called his insurer, Blue Cross Blue Shield, they said there wasn’t a problem and they’d put the scrip through if he wanted — but first, wouldn’t he like to hear how he could save money by switching to a mail-order pharmacy run by Express Scripts?
they make a business of inserting themselves between you and the medications your doctor prescribes. (The Federal Trade Commission estimates that PBMs handle 95 percent of U.S. prescriptions.)
Drug companies, for instance, don’t sell their meds to doctors or patients — they just spend enormous sums convincing doctors (http://www.ozy.com/immodest-proposal/should-doctors-be-required-to-be-healthy/39948) to prescribe the pills that insurance companies will ultimately pay for. Insurance companies hate that and fight back with coverage restrictions and other bureaucracy. Under such circumstances, the capitalist magic of business competition can’t do much to improve service and lower costs. Instead, the warring sides wage costly but inconclusive trench warfare, occasionally creating new weapons like PBMs in hopes of breaking the stalemate.
Lindsay Kearns, a 24-year-old food and nutrition marketer in Denver, found her recent attempt to pick up a migraine (http://www.ozy.com/fast-forward/fast-fast-fast-relief/1478) prescription hijacked by her insurance company, UnitedHealth Group. But Kearns didn’t get a soft sell; she says the insurer told her she could either switch to a mail-order pharmacy run by UnitedHealth’s in-house PBM, OptumRx, or pay the full — i.e., uninsured — price. UnitedHealth referred queries to OptumRx, which responded with a boilerplate statement touting its “92 percent customer satisfaction score” and the benefits of home delivery. Blue Cross Blue Shield and Express Scripts said they couldn’t comment on the specifics of Adam Pierno’s case, although Express Scripts noted that, in general, insurers sometimes require home delivery of certain prescriptions “for added convenience, safety and cost savings.” (Both Pierno and Kearns ultimately switched to home delivery, saying they couldn’t afford to pass up the lower prices.)
PBMs “They go to the [drug] manufacturer and say, ‘If you give us the lowest price, we will structure our [benefits] to steer patients towards your drug,’” Danzon says.
PBMs soon hit on the notion of running their own mail-order operations to cut local and chain pharmacies out of the picture.
Express Scripts, generally considered the largest independent PBM, reported a $2 billion profit last year, up 9 percent from the previous year, even though its overall revenue declined. These companies are also getting bigger. UnitedHealth just paid almost $13 billion for a PBM called Catamaran, which it intends to merge with OptumRx to create the third-largest PBM in the world. According to research from Trefis, UnitedHealth will eventually manage more than 1 billion prescriptions when this deal goes through.
http://www.ozy.com/fast-forward/the-secret-industry-that-meddles-with-your-medications/60182?utm_source=dd&utm_medium=email&utm_campaign=08062015
Americans and America are fucked and unfuckable, their wealth drain over their lifetime by BigHealthCare, among others.