Richard Staynings’ Post

Actually, there is a fairly straightforward reason why Americans are paying more for drugs in general — and Ozempic in particular — compared to other countries. The problem is the Pharmacy Benefit Manager, commonly known as a PBM. Novo Nordisk currently charges Americans with Type 2 diabetes $969 a month for Ozempic, while this same exact drug can be purchased for just $155 in Canada and just $59 in Germany. The amount of money that must be paid to the PBMs through what is essentially a shakedown process — if the pharmaceutical company does not pay the rebate, the PBM will not allow the drug to be sold in the pharmacy — has made PBMs profit centers of astonishing proportions. What percentage of the $969 Novo Nordisk charges for a months’ supply of Ozempic in the U.S. constitutes rebates to PMBs? Some estimates place it at around 70 percent, which more than explains why the price of Ozempic is so high in the United States, where PBMs are allowed to operate, as compared to the rest of the world, where PBMs do not exist. https://lnkd.in/eWWtRixf

Interesting read for those hoping greater transparency and efficiencies can improve the US prescription procurement and delivery process from costing multiples of other nations! "The report finds that PBMs wield enormous power over patients’ ability to access and afford their prescription drugs, allowing PBMs to significantly influence what drugs are available and at what price."

Do you ever wonder what is driving up healthcare costs? Prescription drugs continue to be the biggest driver of overall costs due to many factors. Some carriers offer solutions for your high-cost drugs which can dramatically reduce your overall benefit costs. If your broker is not showing you these alternatives, you are missing out on potential significant savings. There are also plan design strategies that can drive down overall costs while maintaining benefits or enhancing them. #benefitsolutions #RxSavings #healthcareinnovation #healthcarecosts

Actually, there is a fairly straightforward reason why Americans are paying more for drugs in general — and Ozempic in particular — compared to other countries. The problem is the Pharmacy Benefit Manager, commonly known as a PBM. Novo Nordisk currently charges Americans with Type 2 diabetes $969 a month for Ozempic, while this same exact drug can be purchased for just $155 in Canada and just $59 in Germany. The amount of money that must be paid to the PBMs through what is essentially a shakedown process — if the pharmaceutical company does not pay the rebate, the PBM will not allow the drug to be sold in the pharmacy — has made PBMs profit centers of astonishing proportions. What percentage of the $969 Novo Nordisk charges for a months’ supply of Ozempic in the U.S. constitutes rebates to PMBs? Some estimates place it at around 70 percent, which more than explains why the price of Ozempic is so high in the United States, where PBMs are allowed to operate, as compared to the rest of the world, where PBMs do not exist. https://lnkd.in/eEZ4BwaY

CMS issued initial guidance on the Medicare Prescription Drug Inflation Rebate Program in February 2023 and voluntarily sought public comments on key topics. The agency received and analyzed more than 90 comments on the initial guidance from consumer and patient groups, drug companies, and other interested parties. CMS gathered feedback on how best to address challenges drug companies are facing due to likely or actual drug shortages and severe supply chain disruptions, particularly for events outside of their control, and provides for appropriate reduced rebate amounts consistent with the Inflation Reduction Act. The revised guidance also includes guardrails to minimize incentives for drug companies to remain on a shortage list, delay resolving a severe supply chain disruption, or maintain a situation in which a generic drug would be at risk of shortage in order to avoid paying an inflation rebate. While the inflation rebates do not apply to multi-source generic drugs, which are the drugs most likely to be in shortage, the revised guidance provides a greater rebate reduction for Part D sole-source generic drugs as well as Part B and Part D plasma-derived products in shortage. Today’s guidance strikes a balance between discouraging large price increases by drug companies and providing appropriate relief to drug companies experiencing shortages or severe supply chain disruptions. The goal at CMS is to make sure drugs are more affordable and accessible, which includes helping to safeguard and ensure that the pharmaceutical supply chain can deliver critical medicines to providers and patients. https://lnkd.in/emENM_6X #rafaelgonzalezesq #cattiegonzalezpllc #medicare #medicaid #secondarypayer #ahigherstandard #mspcompliance

The Federal Trade Commission is investigating the role of drug wholesalers and healthcare purchasing entities in the shortage of generic drugs, impacting vital medications across the U.S. The Biden administration is targeting middlemen like group purchasing organizations and drug wholesalers to understand the root causes of these shortages. The FTC and U.S. Department of Health and Human Services (HHS) are seeking public input on market practices and concentration. Key players, including Vizient, Inc, Premier Inc., HealthTrust, Cencora, Cardinal Health, and McKesson, are under scrutiny. #DrugShortages #Healthcare #FTC #BidenAdministration #GenericDrugs #MarketTransparency #drugs #pharma #pharmacybenefitsmanagement https://lnkd.in/eeyrQmh7

In the complex debate over inflated prescription drug prices, both Big Pharma and Pharmacy Benefit Managers (PBMs) are shifting blame onto each other. The Federal Trade Commission's recent investigation highlights unethical PBM practices that inflate drug costs, while pharmaceutical companies argue that PBM tactics contribute to high prices. However, both sides bear responsibility. To address this, government actions like the FTC’s legal efforts and proposed legislative reforms are essential to ensure affordability and transparency in the drug pricing ecosystem. MedMind is the solution we need! Providing affordable healthcare for all. Follow us for more as we continue to innovate and provide care for people in need. #MedMind #Pharma #HealthcareReform #DrugPricing For further details, check out the full article on BioSpace: https://lnkd.in/gtnJ-akm

Regardless of how you feel about Cuban or CVS, the average, everyday consumer desires more transparency and more simplicity (and more reasonable pricing) when it comes to prescription drugs. I believe this example demonstrates a good shift... Thoughts? https://lnkd.in/g7CrTmHU

A primer on brand-name prescription drug reimbursement in the US >>> lqventures.com #strategy #competitiveintelligence #marketing #pharma #pharmaceutical #healthcare #biotech #productmarketing

CVS is the latest leader in healthcare to make major moves, that should change the way prescription drugs are priced for the better. The announcement of their CVS CostVantage solution features greater transparency on Rx pricing and a simplification of the traditional PBM formulations. While a positive move, some will view the announcement as a reaction to Mark Cuban's Cost Plus Drug Company and Express Script's announcement last month regarding a similar program. Either way, a seismic shift appears on the horizon in the RX drug world and more specifically how PBMs operate within it. Maintaining a pulse on these moves as well as understanding how your employer clients may respond to them will be key in 2024 as these programs materialize. #WinLoss #Fletcher #PBM #healthinsurance https://lnkd.in/guqZ-mdw