Transparency-Rx

Mark Cuban takes his PBM fight to employers https://lnkd.in/dHEUftbr

Thank you to all the fantastic groups, advocates and leaders in Kansas for hosting a discussion on PBM reform and changes that need to be made to help lower costs and improve access to care. Joseph M. Shields, Esq. had a great discussion with Senator Marshall about the negative impacts the Big PBMs have on patients in Kansas. We all appreciate his leadership and insight in this important conversation.

Yesterday the House Committee on Oversight and Government Reform grilled the CEOs of the Big 3 PBMs on specialty steering, mark-ups, and more. Specialty drugs are used by less than 2% of the population but account for 50% of the drug spend, because the PBMs are using a non-clinically indicated designation to mark up the drugs taken by the sickest patients. Here's CVS Caremark's own data on percent mark-ups over NADAC from an employer in Massachusetts: Multiple sclerosis Rx – 38,352% Leukemia Rx – 13,591% Prostate cancer Rx – 6,375% Chronic kidney disease Rx – 5,037% HIV Rx – 4,124% Heart failure Rx – 161% CVS Caremark & the other PBMs claim that the Federal Trade Commission, the Centers for Medicare & Medicaid Services, 3 Axis Advisors, The New York Times and The Wall Street Journal are all wrong about their nefarious practices. But their own data proves otherwise.

Life comes at you fast. During congressional testimony this week, CVS Caremark president David Joyner told lawmakers that they pass 99% of drugmaker rebates and fees to plan sponsors. Hours later, it was announced that they coughed up $45 million to settle allegations in Illinois that the company was not passing through promised rebates to the state. https://lnkd.in/gCrRT8UP

BIG 3 PBM CEOS APPARENTLY MISLED CONGRESS TO HIDE PROFITS OVERSEAS   On Tuesday, executives from the “Big Three” pharmacy benefit managers (PBMs), CVS Health, Express Scripts, and OptumRx, testified in front of the Committee on Oversight and Accountability in a hearing aimed to examine the role of big PBMs in the prescription drug market. During the hearing, the executives needed to be reminded numerous times that they were under oath, as they continuously proffered prepared testimony that conflicted with countless independent reports, data points, and case studies on the nature of the big PBM, and their demonstrable impact raising the cost of medicines.     Specifically, the executives failed to answer repeated questions regarding the “offshoring” of American healthcare dollars to foreign-based so-called U.S. rebate aggregators or group purchasing organizations. (GPOs), which have become a profit-centers for PBMs based in well-known tax-havens.   Big PBM executives including CVS’s CEO repeatedly assured committee members that 100% of all manufacturer revenues are shared with employer clients or “passed” through, to help meet safe-harbor provisions under U.S. laws afforded to actual GPOs.     Lawmakers raised concerns about PBM’s GPO profits and the reach of U.S. laws on privacy, health regulations, and consumers protection in relation to these offshore accounts.   In the wake of the hearing, this morning, it was uncovered CVS Caremark, announced a breath-taking settlement to pay at least $45 million to the state of Illinois for rebates that were not passed through during a recent four-year period. At issue, according to media reports and settlement documents, was the relationship between the PBM and several related entities — particularly a so-called group purchasing organization — that allegedly obscured rebates paid by drug manufacturers but that should have been sent on to the state. This arrangement was noted in a contract that began in 2015 with the Illinois Department of Central Management Services.   In addition, the Federal Trade Commission determined, according to whistleblowers, “The intention of the G.P.O. is to create a fee structure that can be retained and not passed on to a client. A P.B.M. has to keep some level of income for them to grow and satisfy stockholders.”    “Based on what was answered and not answered today, it appears incredulous that big 3 PBMs share 100% of their rebates and fees with employers as opposed to lining their own pockets through offshore accounts,” stated Joe Shields, Founder and CEO of Transparency-Rx. Congress should pursue all available means to determine the truthfulness of these executives’ testimony and whether they lied under oath.”   Transparency-Rx applauds the House Oversight Committee attention to necessary reforms to the PBM market, delinking middleman profits from critical medicines, bringing transparency and relief to the American people and local employers through throughout the nation. 

Comer: Pharmacy Benefit Managers Must be Held Accountable for Role in Rising Drug Prices Chairman Comer detailed how the House Oversight Committee has obtained over 140,000 pages of documents and communications exposing Pharmacy Benefit Managers’ (PBMs) anticompetitive policies and their role in rising drug prices. The information, outlined in an Oversight Committee report released today, shows how the three largest PBMs—CVS Caremark, Express Scripts, and OptumRx—have prioritized deliberate pricing tactics to line their own pockets, which have increased prescription drug costs, hurt independent pharmacies, and harmed patient care. https://lnkd.in/epiF-8M5

Today, the Big Three PBM CEOs went out of their way to justify their massive profits, which come at the expense of American businesses, their employees, and most importantly, patients. Unlike transparent PBMs, who offer their services for a simple, clear fee, the big PBMs manipulate users and disguise their prices with confusing gimmicks and hidden fees. We continue to support Chairman Comer’s work on the House Oversight Committee to bring necessary reforms to the PBM market. It is time we delink Big Three PBMs’ profits from prescription drug costs and bring transparency and relief to the American people.

Tomorrow (7.23.24) at 10 a.m. EST—there will be an investigative hearing on #PBMs by House Committee on Oversight and Government Reform. More visibility is needed into the overall industry practices, and this is a crucial step towards that. What we do as a coalition should be an industry standard, not an exception! https://lnkd.in/eZWRT4_D

What does Bikini Bottom have to do with #PBMs? Apparently lots of things, according to Adam Fein. Dr. Fein tackles why patients still are paying high prices when these middlemen are "negotiating" better prices. This is an Alaskan Bull Worm of a problem that shouldn't exist in an industry meant to serve patients. Without the problem of delinking being addressed, this will only continue. Don't tear up your town or lose your tail from the damage. Instead, choose a pharmacy benefit partner that let's you Live like Larry and values good business principles. https://lnkd.in/eiD8K5nM

F.T.C. Slams Middlemen for High Drug Prices, Reversing Hands-Off Approach In a report, the regulator sharply criticized pharmacy benefit managers, a turnaround from its longstanding tolerance of their practices. https://lnkd.in/dB67WRqk