Health insurance companies are notorious for exploiting prior authorization schemes to avoid paying for care and have denied claims at alarming rates in recent years.

However, corporate consolidation of industry “middlemen” that experts say are partially to blame for the prescription drug affordability crisis has received less scrutiny from the general public,
despite efforts by lawmakers and the Federal Trade Commission (FTC) to shine light on the notoriously opaque and confusing corporate bureaucracy that determines the cost of medicine.

We often hear about Big Pharma selling drugs at high prices
and insurance companies dragging their feet when it comes time to pay the bill,
but the prices patients pay out of pocket for pharmaceuticals is largely shaped by the connective tissue between insurers and drug manufacturers: #pharmacy #benefit #managers, or PBMs.

PBMs have been around for decades, but the largest PBMs have merged with major insurance companies to form conglomerates,
including UnitedHealth Group’s #OptumRx.

In theory, PBMs negotiate discounts and rebates paid by drug makers that are passed onto insurance companies and their patients,
but the lack of transparency in that process has long frustrated lawmakers and regulators attempting to contain the skyrocketing cost of medicine.

The PBMs say their secret negotiations with drug companies make prescriptions more affordable for consumers,
but this system has not shown to protect patients from sticker shock at the pharmacy counter.

Nearly 30 percent of Americans say they haven’t taken prescribed medication due to cost,
and an estimated 1.1 million Medicare patients alone could die over the next decade because they cannot afford the drugs prescribed by their doctors,
according to the American Hospital Association.

The FTC reports that in 2023, the U.S. spent more than $722 billion on prescription drugs,
nearly as much as the rest of the world combined.

Clearly the system is not working for patients or public health,
and policy makers in both parties have increasingly focused on the PBMs
and their recent mergers with major insurance companies.

According to a two-year FTC investigation on health care conglomerates released in July,
PBMs are “powerful middlemen inflating drug costs and squeezing Main Street pharmacies.”

“We’ve heard accounts of how the business practices of PBMs may deprive patients of access to the most affordable medicines
and how doctors find themselves having to subordinate their independent medical judgment to PBMs’ decision-making at the expense of patient health,”
FTC Chair Lina Khan said in a statement at the time.
https://truthout.org/articles/its-not-just-denied-claims-insurance-firms-are-hiring-middlemen-to-deny-meds/

W przyszły piątek Aborcyjny Dream Team zaprasza na wydarzenie AboTak w wersji Drag - Benefit na powstanie pierwszej Aborcyjnej Przychodni w Polsce!

Tego jeszcze nie było!

Aborcyjny Dream Team i społeczność drag queens łączą siły, by stworzyć niezapomnianą imprezę, gdzie zabawa i aktywizm idą w parze. Wspólnie zbieramy fundusze na pierwszą w Polsce przychodnię aborcyjną – bo czas wziąć sprawy w swoje ręce!

Kiedy: [25 października/piątek]
Gdzie: Warszawa, Galeria Club, Plac Mirowski 1
Start: 20:00
Dress Code: Aborcyjny Halloween – odważnie, kreatywnie, pełna fantazja!

Co w planie wieczoru?
Karaoke – Śpiewaj, krzycz i baw się z nami!
Aborcyjne Bingo – W wersji pro-choice,
Tarot dla Aborcji – Zobacz, co przyszłość przyniesie dzięki aborcyjnym kartom!
a na deser Drag Show i burleska.
Kiki Surprise
Bom Belle
Killer Pickles
Valerie
Martwa
Lucy d’Arc
Valerio Signet

Wstęp: 30 pln (połowa na przychodnię ABOTAK) Każda złotówka przybliża nas do otwarcia pierwszej przychodni aborcyjnej w Polsce!

Dodatkowo: Na miejscu będziecie mogły kupić nasze unikatowe koszulki, kurtki, bluzy, a także wlepy, przypinki i przepiękne plakaty Oli Jasionowskiej – a to wszystko na rzecz lepszego dostępu do aborcji w Polsce.

To będzie najbardziej aborcyjna noc roku – pełna mocy, przebieranek i wspaniałej energii. Każdy bilet, każda koszulka i każdy grosz przybliża nas do otwarcia pierwszej przychodni aborcyjnej w Polsce!

To nie tylko impreza – to manifest wsparcia i solidarności! Bo nie jesteś sama.

A tu możesz wesprzeć otwarcie Przychodni online
https://cause.lundadonate.org/aborcyjnydreamteam/abotak

strona wydarzenia na facebooku: https://www.facebook.com/events/2523458694525168

Americans are paying too much for #prescription #drugs.

It is a common, longstanding complaint. And the culprits seem obvious: Drug companies. Insurers. A dysfunctional federal government.

But there is another collection of powerful forces that often escape attention, because they operate in the bowels of the health care system and cloak themselves in such opacity and complexity that many people don’t even realize they exist.

They are called #pharmacy #benefit #managers.
And they are driving up drug costs for millions of people, employers and the government.

The three largest pharmacy benefit managers, or P.B.M.s, act as middlemen overseeing prescriptions for more than 200 million Americans.

They are owned by huge health care conglomerates
— CVS Health, Cigna and UnitedHealth Group
— and are hired by employers and governments.

️The job of the P.B.M.s is to reduce drug costs. ️
Instead, they frequently do the opposite.
They steer patients toward pricier drugs,
charge steep markups on what would otherwise be inexpensive medicines and
extract billions of dollars in hidden fees, a New York Times investigation found.

Most Americans get their health insurance through a government program like #Medicare or through an #employer, which pay for two different types of insurance for each person.

One type covers visits to doctors and hospitals, and it is handled by an insurance company.

The other pays for prescriptions. That is overseen by a P.B.M.

The P.B.M. negotiates with drug companies, pays pharmacies and helps decide which drugs patients can get at what price.
The theory goes, everyone should save money.

the largest P.B.M.s often act in their own financial interests, at the expense of their clients and patients. Among the findings:

P.B.M.s sometimes push patients toward drugs with higher out-of-pocket costs, shunning cheaper alternatives.

They often charge employers and government programs like Medicare multiple times the wholesale price of a drug, keeping most of the difference for themselves.
That overcharging goes far beyond the markups that pharmacies, like other retailers, typically tack on when they sell products.

The largest P.B.M.s recently established subsidiaries that harvest billions of dollars in fees from drug companies, money that flows straight to their bottom line and does nothing to reduce health care costs.

The P.B.M.s, which are responsible for paying pharmacies on behalf of employers, are driving independent drugstores out of business by not paying them enough to cover their costs.
Small pharmacies have little choice but to accept these lowball rates because the largest P.B.M.s control an overwhelming majority of prescriptions.
The disappearance of local pharmacies limits health care access for poorer communities but ultimately enriches the P.B.M.s’ parent companies, which own drugstores or mail-order pharmacies.

P.B.M.s sometimes delay or even prevent patients from getting their prescriptions.
In the worst cases, patients suffer serious health consequences.


https://www.nytimes.com/2024/06/21/business/prescription-drug-costs-pbm.html?smid=nytcore-ios-share&referringSource=articleShare