GoodRx’s Post

Explore 2025 trends in patient access and medication affordability, including the rise of cash pay and its impact on the prescription drug landscape. Read the full article on Drug Channels: https://lnkd.in/er8pnkP5.

The federal #340B program, which makes prescription drugs more accessible to low-income patients, was the focus of a discussion in a public health committee meeting today about possibly allowing Arkansas hospitals to hold retail pharmacy permits. See our 340B explainer here. #arleg #arpx

📢 Key Insights From the HHS Prescription Drug Cost Report The HHS’ latest report highlights critical data on prescription drug spending, pricing trends, and their impact on premiums. Key findings include: 💊 Rising Prices: Over 4,200 drug products saw list price increases from 2022 to 2023, averaging 15.2%, with 46% exceeding inflation. 📉 Rebates: Rebates accounted for 20%-22% of gross drug spending in private plans and 53% in Medicaid. 📊 Coverage: 143M Americans had private prescription drug coverage in 2020. The Prescription Drug Data Collection (RxDC) initiative under the CAA enhances transparency in this critical sector. As we navigate these trends, collaboration between policymakers, insurers, and consumers is vital for meaningful reform. #HealthcareTransparency #PrescriptionDrugPricing #HealthPolicy #DataAnalytics

I highly recommend watching this discussion in its entirety. This congressional debate delves into one of the most complex industries in the world—the role of pharmacy benefit managers (PBMs) in the United States' pharmaceutical supply chain. The discussion covers key aspects such as distribution and network access, incentivization structures, pharma contracting, and the reimbursement framework that underpin the U.S. healthcare system. It offers valuable insights into how PBMs influence drug pricing, access, and overall healthcare costs. The congressional hearing featured executive leadership from the three largest PBMs: Express Scripts by Evernorth, OptumRx (Optum), and CVS Caremark. 🔸 𝐄𝐱𝐩𝐫𝐞𝐬𝐬 𝐒𝐜𝐫𝐢𝐩𝐭𝐬 is a subsidiary of Cigna Healthcare, a major health services company with approximately 70,000 employees. As a PBM, Express Scripts manages prescription drug benefits for health plans, aiming to negotiate drug prices, control costs, and improve patient access to necessary medications. 🔸 𝐎𝐩𝐭𝐮𝐦𝐑𝐱 is part of UnitedHealth Group, a leading diversified healthcare company with around 400,000 employees. OptumRx provides pharmacy care services that are integrated with UnitedHealth Group's broader healthcare offerings, focusing on managing medication benefits, enhancing clinical outcomes, and ensuring cost efficiency. 🔸 𝐂𝐕𝐒 𝐂𝐚𝐫𝐞𝐦𝐚𝐫𝐤 operates under CVS Health, a healthcare innovation company with approximately 300,000 employees. CVS Caremark administers prescription drug plans for various health insurance plans, working to optimize the value and effectiveness of pharmacy benefits while supporting patient health. These PBMs play crucial roles in the U.S. healthcare system, impacting drug pricing, availability, and the overall management of pharmacy benefits. 𝐓𝐡𝐞𝐬𝐞 𝐭𝐡𝐫𝐞𝐞 𝐏𝐁𝐌𝐬 𝐚𝐜𝐜𝐨𝐮𝐧𝐭 𝐟𝐨𝐫 𝟖𝟎% 𝐨𝐟 𝐭𝐡𝐞 𝐩𝐫𝐞𝐬𝐜𝐫𝐢𝐩𝐭𝐢𝐨𝐧𝐬 𝐝𝐢𝐬𝐩𝐞𝐧𝐬𝐞𝐝 𝐢𝐧 𝐭𝐡𝐞 𝐔𝐒. 🔗 𝐖𝐚𝐭𝐜𝐡 𝐭𝐡𝐞 𝐝𝐢𝐬𝐜𝐮𝐬𝐬𝐢𝐨𝐧 𝐡𝐞𝐫𝐞: https://lnkd.in/gc-Xefg5 #PharmaceuticalIndustry #PharmaSupplyChain #HealthcareReimbursement

Couldn't have said it better! Hopefully Jae and others can get more employers to start paying attention to what is happening and why these PBM's moved into the work comp market. Employers do have a choice and they need to start speaking up about how their pharmacy dollars are being spent. As Jae stated, the problem we see most often is that employers think (or are being told) they DO NOT have a choice to selecting their own pharmacy provider due to bundled Insurance Carrier/TPA programs. We work with both bundled and unbundled program providers. There is nothing wrong with a bundled program if it is a transparent model for the employer that is truly going to help reduce their pharmacy cost. As we like to tell prospective employers, "It is your money and you do have a choice when it comes to how it is being spent on medications". Some employers feel they need to be with one of the Big Three to get the best deal. Unfortunately, that is rarely the case when managing a pharmacy program. We all utilize the same retail pharmacies nationwide to manage your program. CPS does go one step further than most of our competitors by providing our long-term medications using our in-house mail order with a true cost-plus model. This also means we have an idea of what the retail pharmacies are paying for the drugs they are dispensing and what a fair reimbursement rate should be. As we have been saying since the early 2000's before all of today's work comp paper PBM's started popping up, "Don’t get caught up in the Smoke and Mirrors?" If this is you, don’t feel alone. Please contact us if we can ever be of assistance in educating you and/or your clients that are looking to reduce their overall pharmacy spend. Performing a cost comparison takes very little effort on the part of the employer and usually results in huge savings. Thanks again for sharing Jae.

Pharmacy benefits managers (PBMs)- third party administrators of prescription drug programs- have gained scrutiny in the US over the years. Independant pharmacies raised the alarm about "unfair" tactics used by PBMs to monopolize the industry, such as underpaying for prescriptions that are filled and claw-backs to reimbursements which threaten to put them out of business. The FTC announced plans this week to sue three of the largest PBMs over practices that they allege contribute to inflated drug prices. The PBMs targeted controlled 79% of US pharmacy benefit management in 2022 (according to the data platform Statista) when the initial investigation began : -Caremark (CVS Health) - 33% -Express Scripts (Cigna) - 24% -Optum RX (United Healthcare Group) - 22% The call for more transparency into their operations comes as PBMs blame manufacturers for higher drug prices and drug manufacturers justify increases blaming their higher list prices on rebating and fees collected by the PBMs.

This is how CVS Caremark and GoodRx are robbing patients and pharmacies. Patient copay: $45.83 Drug cost: $23.86 CVS/GoodRx Fee: $38.50 Profit: (-$16.03) That's right, the PBM and GoodRx are charging the patient 192% of drug cost while charging the pharmacy 162% of the drug cost. The pharmacy keeps 30% of drug cost, a 70% loss and the patient pays an inflated fee. CVS Caremark is bouncing down these claims to GoodRx, without patient or pharmacy permission, and then the pharmacy is being charged outrageous fees. Pharmacies are forced to run these claims as cash to not take a huge loss, leaving the patient without money going toward their deductible. CVS Caremark wins if they get to charge the fee and Aetna wins if the patient doesn't have this count toward their deductible. The patient and the pharmacy lose. Price fixing and vertical integration at their finest. A marriage of greed despotism. And this for a schedule II medication that brings along with it more costs and risks than normal for the pharmacy. There is no incentive to even exist. Oh, and GoodRx is selling the patient's healthcare information on top of everything. Let's not forget that part. Pharmacies have an ethical obligation to try to limit these claims in the name of patient privacy. #Pharmacy #PBM

More info on GoodRx being embedded inside regular PBM insurance processing. Joey Dizenhouse, FSA, MAAA Joey Mattingly Adam Fein Antonio Ciaccia Sophia Herbert Thanks for sharing my YouTube video, here is more related info.

SAVE THE DATE // Pharmacy Benefits Managers and Their Role in Prescription Drug Spending   📆 October 10, 2024 ⏰ 2 - 4 p.m. 🏢 Turner Industries (8687 Turner Industries, Baton Rouge) Healthcare costs continue to escalate year over year, which creates a significant burden on employers. Pharmacy Benefit Managers have a major behind-the-scenes impact in determining drug costs and patients’ access to medications. Soaring drug expenses are a key factor in the overall rise in healthcare costs. This session will provide an overview of: ➡️ The role PBMs play in how much we spend on prescription drugs ➡️ The role PBMs play in providing services and the flow of funds for prescription drugs ➡️ The impact PBMs have on independent pharmacies. Make plans to join us & register today!