Posted on 06/17/2017 4:53:46 AM PDT by Kaslin
When it comes to the nation’s healthcare system, most citizens recognize the need to counter rising healthcare costs and control fixed costs such as spending on insurance premiums and prescription drugs. By reducing these burdens on consumers and taxpayers, the U.S. can lower costs for entitlement programs and reinvest or return money to taxpayers where it’s needed most.
In an effort to identify areas for additional cost savings across the healthcare delivery network, the Senate Health, Education, Labor and Pensions Committee recently held a hearing on how drug delivery systems affect consumer prices.
Though only covering one aspect of the larger healthcare system, this is an important step in understanding the numerous players that operate in the opaque ecosystem between drug manufacturers and consumers. Organizations that influence pricing for pharmacies hold enormous sway over the healthcare market and face very little scrutiny or regulation.
The largest of these players are Pharmacy Benefit Managers (PBMs), companies which function as third party administrators of prescription drug programs. PBMs develop a list of approved medications they will cover, negotiate with manufacturers for list prices and accompanying rebates on behalf of pharmacies, and then contract these lists and prices to pharmacies.
The size and power of these companies means that manufacturers must negotiate with them to distribute their products, while pharmacies must contract to them to fill prescriptions for patients.
In fact, just three PBMs (Express Scripts, CVS Caremark, and OptumRX) control 75-85 percent of the market and have more than $250 billion in estimated revenues. It should be of no surprise that many of these companies are some of the largest in the U.S. – CVS Health, which owns CVS Caremark, is the seventh largest company in the country and Express Scripts is the 22nd largest.
This has led to numerous instances of abuse and outright criminal behavior as PBMs pocket savings intended for consumers and operate a business model that privileges profits over patients. Recently, Anthem decided to part ways with its PBM, Express Scripts, over an ongoing suit the insurer filed claiming Express Scripts withheld billions in savings. These are savings that ultimately are not being passed onto the taxpayer.
From rebates from manufacturers to processing fees for pharmacies, PBMs pocket profits at every step and, due to their market power and size, can even increase costs to consumers while reducing choice and competition.
PBMs author and update formulary lists, a master list of prescriptions that are approved by the PBM for issuance. Exclusion from these lists can result in non-coverage for patients or higher prices for comparable technologies. All while the company profits.
Without a full understanding of the players in this space, it remains unclear how much of the savings PBMs negotiate from drug manufacturers are passed onto U.S. taxpayers in the form of lower out of pocket costs, lower premiums or lower copays.
It is vital to the health of our nation that we identify inefficiencies that are driving up health care prices and resulting in more out of pocket costs for American taxpayers.
By taking a holistic view of the market and scrutinizing all players equally, we can make real progress towards improving our nation’s health and saving American families money.
We need ANOTHER guberment agency to watch over the costs (sarc)
It’s not just inefficiencies driving up costs. It’s also government regulations and subsidies. Don’t see anyone addressing those.
It wouldn’t surprise me to find out that the government requires dealing with these companies.
“The System” if one wants to call it that is all about big entities working together to get what they want including big health care companies getting profits, big government getting control of people etc. etc.
That’s how “The System” works in banking or anything else out there like health care.
Nigel Farage has spoken about “Corporatism” which is the coming together of big business, big banks and big government that shuts the little people and small business out of markets, opportunities etc.
The only the cost are so high is because of government interference .
exactly
before gov’t intervention: health care was 5% of GDP
after gov’t intervention: health care is 19% of GDP
eliminate all gov’t regulation of health care and costs will plummet.
unregulated areas of medicine ( primarily plastic surgery and eye care ) have seen costs drop every year and quality increase
Military healthcare for retirees requires prescription medicine be obtained from Express Scripts or a military pharmacy. It’s a pain if you need a new script fast for an ailment, especially if the military pharmacy doesn’t have it.
35 years in healthcare, both as a provider of services and hands-on medical care, as I see the problem; the 3 primary causes are:
1. Government price fixing and regulations
2. MBAs who have turned healthcare into a cash cow
3. Trial lawyers who sue for frivolous reasons before dumb jurors.
I will do my part. If I get cancer I have already decided I would not take chemo because it didn’t work for my wife or anyone I know....just gave them a year of pain and misery at great expense to Medicare.
I know that hydrogen peroxide taken intravenously or orally will do more good to kill cancer cells than chemo therapy and will not harm the good cells. I tried to convince my wife to go that route but she could not get used to the taste and it gave her nausea. Problem is she waited too long and took the chemo as the first course of action. I presently take hydrogen peroxide orally and have for over 5 years and have never been sick a day, not even a cold and I am willing to bet that I will never get cancer.
All three points are true and factual, and no one can deny them
CEO pay is out of control. As is their ability to just jack up prices for no reason. Epi Pen and Diabetes meds and testing strips. Why should a bottle of cardboard test strips cost $85 through ins. When Wal-Mart or Kroger’s sell them for their meters $22 for 100. Said meters can be up to 30% OFF calibration and it’s OK with the FDA.
Why are docs getting kick backs for pushing the newest high dollar drugs when older generic ones work just as well or better with less side effects. Crestor became the #1 cholesterol drug due to a multi-million $$ ad campaign, not that it worked better than Provachal a older cheaper one. In fact has more SIDE EFFECTS than Provachal. Ditto for Lipitor #2.
This HEP C treatment is upwards to $100K. Notice they are really pushing it on TV to get tested for SENIORS. http://www.everydayhealth.com/news/how-pay-costly-hepatitis-c-drugs/
It is a illegal drug transmitted virus, sharing dirty needles. Promiscuous sex, blood transfusions from people who have it but doesn’t show in the RC’s testing. Same as HIV.
http://hepc.liverfoundation.org/diagnosis/how-hep-c-is-spread/
Routine blood screening for Seniors would pick up liver issues just as they do PSA or Kidney.
Both my husband and I are in Tricare for life and we get our prescriptions from one of the pharmacy locations at Fort Campbell. As a matter of fact I have to pick a refill for my husband and and one for myself this morning. (I am not out of the medication (Metformin) and my husband is not out of his (Spiriva inhaler, he has COPT). We just don’t have an refills left
(Hi Gail!)
My son saw these commercials and said to me, "Mom! You're in that group, why don't you get tested?"
Because, while I might be in that group by age, I didn't engage in the risky behaviors like using injectable illicit drugs. I don't know how I would contract HepC. I've been vaccinated for HepA and HepB because I have used human cells and tissues in research, which puts me in a high risk group for those diseases.
All those reasons are correct on the supply side. On the demand side, the biggest consumers are insulated form the fort aspect, and so have to reasons to make efficient decisions.
That fits me I didn’t engage in those activities either, nor have I ever had a blood transfusion. Had a friend who got Hep C from one and he died.
Reminds you of Arthur Ash getting HIV from a blood transfusion, the drugs they use drive the disease down so low blood screening test no longer pick it up that the RC runs. And they run all Blood Bank TESTING for donations, and there is NO more direct transfusions. It’s a month long process now. So bank you own blood if you need surgery that might need a transfusion.
Another thing Saline is a very cheap product to make yet the hospitals are charging over $300 a IV Unit.
Got that right, as of June 28, you will have to get Nexium from ES if you can’t take the 3 subs. So I had to get a letter of exemption from my Gastro. ES just shoves your EXPENSIVE meds in your mailbox NO ID SIGN FOR. 2 of the 3 meds our small Navy base does not carry comes from ES and 2 are near $3K retail. It will require a act of Congress to change this Stupidity. And they will OVER RIDE a DAW script for a cheap generic. I have 1 that is manufacture specific that I have to get from my former private family owned Pharmacy.
Other factor is Base is closed Weekends, holidays, and for change of duty or training. Takes up to 3 hrs for a script fill, don’t turn 1 in after 3 pm. As you will need to go back the next day. Since Commissary is closed on Monday’s every one goes Tue or Fri. Parking lot is NOT HANDICAP friendly, to many parking slots for Brass, not enough for handicapped. Nor is the Pharmacy which is tiny, it was designed for Active Duty walk in’s. When the remodeled the Exchange, for a roof leak, they didn’t touch the Pharmacy, which has lines out to the front door on Tue and Fri. You call Pensacola for refills takes 5 days, ES takes 2 weeks for scripts and refills. Highly inefficient. You filled the script at the base, you should be able to refill there.
Thank God nobody is talking about enforcing long standing Federal Laws prohibiting the very model health care is built upon. I read about 10 pages of out anti-trust laws, it is basically a detailed description of our current health care system.
The Sherman Act outlaws “every contract, combination, or conspiracy in restraint of trade,” and any “monopolization, attempted monopolization, or conspiracy or combination to monopolize.” Long ago, the Supreme Court decided that the Sherman Act does not prohibit every restraint of trade, only those that are unreasonable. For instance, in some sense, an agreement between two individuals to form a partnership restrains trade, but may not do so unreasonably, and thus may be lawful under the antitrust laws. On the other hand, certain acts are considered so harmful to competition that they are almost always illegal. These include plain arrangements among competing individuals or businesses to fix prices, divide markets, or rig bids. These acts are “per se” violations of the Sherman Act; in other words, no defense or justification is allowed.
https://www.ftc.gov/tips-advice/competition-guidance/guide-antitrust-laws/antitrust-laws
Health cost drivers made simple: 1) Frivolous lawsuits. 2) Endless bureaucracy 3) Pharmaceutical companies charging ridiculous prices as compared to the rest of the world. 4) Facilities escalating the cost to offset loss due to non paying patients or government agencies. 5) Greed
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