Raymon Estrada’s Post

A must-read for all benefits leaders. Today's Federal Trade Commission's report reveals the enormous power traditional PBMs wield over the cost of prescription drugs. See how they're inflating drug costs and overcharging patients. #pbm #pharmacybenefits #rightway #prescriptions #healthcare

📊 FTC Interim Report Highlights Impact of Pharmacy Benefit Managers (PBMs) on Prescription Drug Costs 🏥 The FTC's interim report reveals significant concerns regarding PBMs' influence on prescription drug accessibility and affordability in the U.S. market. Key findings include: 1️⃣ **Market Dominance**: The six largest PBMs control nearly 95% of all prescriptions filled, wielding substantial power over drug availability and pricing. 2️⃣ **Patient Impact**: High concentration allows PBMs to potentially hike drug costs and restrict access to essential medications, with many Americans reporting skipping doses due to affordability issues. 3️⃣ **Impact on Independent Pharmacies**: Unfair contractual terms imposed by PBMs pose challenges to independent pharmacies, affecting their ability to compete and serve communities effectively. 4️⃣ **Regulatory Response**: The FTC emphasizes its commitment to scrutinize these practices and ensure transparency, urging compliance from PBM entities to fulfill reporting obligations. The report underscores ongoing efforts to address these issues and protect consumer interests in healthcare access and affordability. #HealthcarePolicy #PharmacyBenefitManagers #FTCReport #HealthcareAccess #AffordableMedicine #rightwayPBM

"As a result of this high degree of consolidation and vertical integration, the leading PBMs now exercise significant power over Americans’ ability to access and afford their prescription drugs." Pharmacy benefit managers, or "PBMs," are coming under increased scrutiny by the FTC and in legal proceedings. If you aren't familiar with these middleman organizations that exert control over drug prices, you should definitely study up. This interim preliminary report by the FTC is an excellent primer on how these often unknown entities have amassed enormous power to define pricing and access to life-saving medicine. https://lnkd.in/ezEzMagN

🏥 The Federal Trade Commission (FTC) has criticized the business practices of pharmacy benefit managers (PBMs) and highlighted their role in inflating prescription drug prices. However, #drugmakers are also at fault for the high costs of medications. 💡 Insight - PBMs like Express Scripts, Caremark, and Optum Rx control 80% of U.S. prescriptions, using tactics that raise drug prices. Meanwhile, drugmakers set high prices and increase them over time, forcing patients to pay more or abandon treatment. Both sides blame each other, but the sanctimonious finger-pointing hasn't resolved the affordability issue. ❓ Key questions - How can regulatory measures like the #DRUGAct and the #MedicareDrugPriceNegotiationProgram effectively address these issues? What additional reforms are needed to ensure fair pricing and access to medications? #Pharma #PBMs #DrugPricing #HealthcareReform #FTC #PatientAccess

One of the things we at Innovative Rx Strategies often do is give our clients a crash course on the world of pharmacy benefits. With our team's years of experience in this space, I wouldn't call it a primer as much as a graduate level course! Our clients walk away understanding the basics and the complexity of this space! However, if you are looking to get started, AMCP recently put out a new primer on brand-name prescription drug reimbursement https://lnkd.in/gK7ETpRc. If you want to move on to the next course in the series of complexity, reach out! #pharmacybenefits #Pharmacists #PBM #AlwaysLearning #complexity

Today, we brought action against the three largest prescription drug benefit managers (PBMs)—Caremark Rx, Express Scripts (ESI), and OptumRx—and their affiliated group purchasing organizations (GPOs) for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’ access to lower list price products, and shifted the cost of high insulin list prices to vulnerable patients. Caremark, ESI, and Optum and their respective GPOs engaged in unfair methods of competition and unfair acts or practices under Section 5 of the FTC Act by incentivizing manufacturers to inflate insulin list prices and other drugs, restricting patients’ access to more affordable drugs on drug formularies, and shifting the cost of high list price of drugs to vulnerable patient populations, the FTC’s complaint alleges We want to thank the brilliant team at the Health Care Division in the Bureau of Competition for developing and now prosecuting this enforcement action. https://lnkd.in/eNZNZWG7

This CBO Report dives into the important topic of prescription drug prices and various approaches to lower them. The report highlights strategies such as capping prices, limiting their growth, promoting price competition, and influencing information dissemination. Stay informed on the latest developments in healthcare pricing by checking out the full report. #Healthcare #PrescriptionDrugs #CBOReport

Really great share by Sana's PBM, SmithRx, highlighting the importance of transparency and reform in the Rx space. How do you know if you are truly using a completely transparent PBM? - Disclosure of rebates and "discounts" - Clear pricing strategy - Accessible information and plan data - Disclosure of independent audits - Contract transparency Leveraging a transparent pharmacy strategy is no longer a commodity for large self funded health plans. It is a necessary lever in healthcare that otherwise costs your clients tens of thousands, if not hundreds, in annual Rx spending. #benefits #healthcare #innovation #pharmacy #pbm

"The Federal Trade Commission today published an interim report on the prescription drug middleman industry that underscores the impact pharmacy benefit managers (PBMs) have on the accessibility and affordability of prescription drugs. The interim staff report, which is part of an ongoing inquiry launched in 2022 by the FTC, details how increasing vertical integration and concentration has enabled the six largest PBMs to manage nearly 95 percent of all prescriptions filled in the United States." Learn more reading "FTC Releases Interim Staff Report on Prescription Drug Middlemen" #drugmiddleman #drugs #middleman #prescriptions #pharmacybenefitmanagers #pharmacy #yourhealthmatters #buylocal #shoplocal #yousaveonmeds

In a recent lawsuit, Johnson & Johnson's (J&J) prescription drug pricing practices were brought into question, revealing the pitfalls of discount-focused PBM strategies. Turns out they were overpaying for prescription drugs by margins of over 805%. 💥 This isn't just a problem for J&J; it's a widespread issue among companies that contract with discount-driven PBMs like the Big Three. With a cost-focused PBM partner like SmithRx, we prioritize lowering overall costs rather than chasing discounts and rebates. 🤝 Learn more about how a cost-based approach can benefit your organization: https://lnkd.in/gkRXCTwT #johnsonandjohnson #pbms #employeebenefits #transparency #smithrx