Ann Lewandowski’s Post

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Founder | Patient Advocate of the Year 2024 | Health Plan Risk Management | Anti-Bias AI | Helping Plans, Solutions, and Decision-Makers Understand the Complex Patient Journey

I’m not very excited about the PBM hearing on Tuesday. Why? Well, when things are as complicated as they’ve become in healthcare policy solutions become a wack a mole game. Personally, I’m delighted that my lawsuit has forced difficult conversations. However, let’s consider the state of things. The photo below is from Drug Channels Institute, an HMP Global Company and SmithRx. Do policy makers fully appreciate its about how the ecosystem interacts? 1. Two of the rebate aggregators used by dark money PBMs are now ex-US companies. Legislating for them will be difficult. 2. Focusing exclusively on PBMs misses that it’s the twisted and complex relationship between pharmaceutical companies and PBMs. Focusing on one or the other will not drive the changes we actually need. 3. We aren’t talking about how damaging rebates are for plans and patients. Consider, if you are an employer, you could get a patient on the right drug immediately using precision medicine. Guess what? You can’t because rebates will be withheld because it’s beyond the label. Essentially, you are forced to experiment on your employees to get more reasonable pricing on drugs. Patients then experience negative consequences and the plan spends money on uncontrolled diseases. Typically that’s about $25,000 in additional costs. I hope the conversation continues. PBM practices against #independent #pharmacies are disgusting and hurt communities. I hope there are a lot of questions on how to keep #independent #pharmacies going.

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Pramod John

CEO at VIVIO, A Public Benefit Corporation

3mo

Ann Lewandowski on point #3, that is widely held misconception as we've proven the point in the market that you can take an approach of trading lower rebates for more flexibility in drug choice and the result is significantly lower net costs. That approach fundamentally breaks the PBM model which is why the industry keeps telling the lie that there isn't an alternative. You can get to personalized therapies today. All you have to do is choose to.

Mike Garcia, Pharm.D 🪙

Helping Pharmacists Crush Credit Card Debt and Break the Cycle of Paycheck to Paycheck

3mo

They will fight hard to keep the status quo. Change will be slow and grueling.

Sarah Sorum, PharmD, CAE

Executive Vice President & CEO at Pharmacy Society of Wisconsin

3mo

The gaslighting from some of the “moles” adds to the complexity and frustration of the policy conversations too!

point #2 is the key to reform

Jake Auchincloss

Congressman from the Massachusetts Fourth

3mo

What questions do you hope lawmakers ask? I will be at the hearing.

Jeremy Counts

The voice of war in a profession of peace. Get into the fight against PBMs by joining PUTT!

3mo

You cannot align incentives for a vertically integrated oligopoly that has been given a market advantage via a kickback exemption. Allowing a market advantage like rebates to exist requires incredibly strong oversight and cannot exist in a vertically integrated conglomerate. The PBMs whine about "competition", but this is no market. They are using the rebates and the opaqueness they help create around drug practicing as cover to move margin to areas of their company that they can mandate their patients to use and make unbundling the service seem very cost ineffective through exaggerated savings while they hide fees in their off shore GPOs. PBMs only exist to hide money. Take away their kickback exemption and plan sponsors would leap at the opportunity in-house their benefits cheaply. It is a racket. A shell game. A profanity to decency. And it must end. Pay attention to some hammers dropping next week before and after the hearing next week. I think you would really enjoy the PUTT summit on Wednesday. I am taking this topic head on.

Wesley Sukdao

CEO @ Proteotype | Dad | On a Mission

3mo

Is there a diagram that includes the role of the hospital?

Peter Cranstone

CEO@3PMobile l Reimagining Digital Engagement l Low-cost Growth Engine for Web-based Businesses l Harnessing the Power of Digital Ecosystems through Consumer Choice.

3mo

Here's the gem... Do policy makers fully appreciate it's about how the ecosystem interacts? Nope, Nope, and Nope. The system is so broken that it can't be fixed. The money will simply flow somewhere else. You will have to convince all of the following: • Politicians • Lobbyists • Employers • Insurance Companies • Hospitals & Health Systems • MBAs and JDs And if you managed to convince them all what it be replaced with? Healthcare in the US is suffering from a design flaw. It can't be fixed. The only thing is to start over - I used to think that was possible, but I'm not sure now, especially when I look at the list above. I support everyone who wants to try, but it's like trying to plug a dam with your finger. Probably the best thing to do is let it collapse on its own. It will eventually when the money runs out and it always does. Thanks for a great post though and I love the diagram.

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