Pharmacy Benefit Managers commonly referred to as pbm's
Pharmacy Benefit Managers were created in the 1960'S as a way to assist insurers and employers in processing prescription drug claims for insurance companies and health plan sponsors. Today, they act as middlemen managing prescription drug benefit programs as third- party administrators.
Here's the problem. Pbs are costing Californians and making it harder for people to access the life-saving medicines. They rely on how PBS have an enormous and lucrative advantage when it comes to influencing prescription drug programs that includes negotiating drug prices with manufacturers, demanding rebates for specified prescription drugs that insurance companies will pay for, and direct contracting with health plans and pharmacies.
PBS use this power as leverage to control what prescription medications are on the market, requiring patients to use their corporate owned pharmacies which limits consumer choice. They even interfere in the patient physician relationship by overriding their medical judgment on your prescriptions.
They do all this to benefit their bottom line even if it costs the patient.
Second PBS have evolved into massive, complex corporations largely operating in the shadows of our healthcare system. The three largest PBM CVS. Care Mark expressed scripts and Optima Rx cover 100 and 80 million patients, or 76 percent of the market. Despite this enormous market influence. PBS largely escaped the scrutiny of government regulation
Third PBS make money from patients paying more than the actual cost of their prescriptions. In a recent study, patients paid 100 and 35 million dollars over the cost of the medicine and the PBS pocket this money for their own profit. This happens when the cop-ayya from patients are greater than the actual cost of the drug. In 2013 alone, this evolved nearly a quarter of pharmacy prescriptions. Bottom line. PBS have become massive, unregulated monsters that control the prescription drug market at the expense of patients.
There IS A Better Way