Tell Us Your Story:

You can make a difference that can lower your pharmaceutical costs. We need your stories to share with the news media and/or elected officials so that our voices can be heard. 

Have you been denied medication prescribed by your doctor? Did you even know there is a pharmacy benefit manager making decisions about your medicine? Maybe your doctor prescribed a less expensive generic but your health plan/pharmacy benefit manager insists on a more expensive brand name. Whatever your experience, you’re invited to share it on this page; post your comments at the bottom of the page.

Comments

[Tom Hall]

I am a broker for several PBMs. When you consider that Rx drug cost is the fastest growing segment of healthcare costs, I am amazed about the void of knowledge about this industry and the ways it makes money.

Even insurance brokers, employee benefit managers and TPAs have little if any working knowledge about the PBM industry and how to help their clients reduce their drug costs.

The reason that large, publicly owned PBMs are fighting a transparency models is they cannot afford to take the financial hit to their bottom line. The stock analysts would crucify them and within a short number of months they would be bankrupt.

Traditional PBMs are in the same boat that the traditional, previously subsidized major airlines were in when the no-frills airlines like Southwest, AirTrans, Jet Blue, etc. came into existence. Both industries are in a box!

Only PBMs that initially began as a transparent PBM are excited to have corporate executives and legislators ask the tough questions. PBMs are notorious for non-disclosure of their revenue sources...mark-ups on drugs, drug manufacturer rebate income the significant mark-up on generic drugs.

Anyway, I am a proponent of transparency model PBMs. One caveat though, traditional PBMs use the term "transparency" but do not fully disclose some or all of the hidden revenue streams that they have. They might tell you what those revenue areas are...but not how much revenue they are generating.

A true "transparent model" will and should only charge the client a "flat transaction fee" and have that be their only source of income. All other sources of revenue like drug manufacturer rebates and wholesale drug pricing spreads...that is the margin between what the PBM pays for the drug and what it prices it for to the client...should be returned to the client to provide the lowest possible Rx drug cost to that client.

In summary...think of PBM as a "Magician". You know you're being had...you're just not sure how!!!

If anyone is interested in locating a true "transparent model" company, sned me an e-mail and I will assist you in making that connection. The potential savings are significant.

-tom.hall@hallmarkrx.com

[Valerie Horne]

My son, 9, had an ear infection last week end (he hasn`t had on for a few years) after the necessary doctor visit we went to get the antibiotic. He was prescribed one he had in the past but this was the first time I had to pay almost $70.00 for a medicine I just had to pay $15.00 in the past. How more outrageous could that become?

[Dennis Song, R.Ph.]

I am an independent community pharmacist in Flower Mound, Texas. The latest in the "HMO/PBM" arena is that Caremark is now requiring that all their contracted pharmacies print their "usual and customary" price (the retail cash price) on the label next to the Caremark "co-pay."

This will not only cause confusion to our patients, but cause a misperception of the truth. Pharmacies have no other choice but to comply with Caremark's contractual demands or loose the contract.

[Melissa McLaughlin]

"Is it possible that a STAGE FOUR, 29 year old breast cancer patient would have their medication delayed because of the greedy bastards not wanting to give up that cash cow of a rx? I hate to think it."
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One thing that you could possibly help me with. Do the mail order companies try to "Hang on" to the super expensive Rx's and do everything in their power NOT to transfer to a retail pharmacy?

I needed my chemotherapy pills in whe worst way (I was 4days behind my scheduled start) and Medco continually tells me theres a week long "processing" time (???!!!) (I used to use caremark and they always had it to me next day) But time after time, would NOT release it for transfer to a retail pharmacy so that I could pick it up right away.

It wasnt till after all was said and done that I wondered if it had something to do with not wanting to give up a prescription that, in the end, after all three refills, woudl have been about $6000....

Is it possible that a STAGE FOUR, 29 year old breast cancer patient would have their medication delayed because of the greedy bastards not wanting to give up that cash cow of a rx? I hate to think it.

>>>FROM BLOGMASTER:
Melissa, pharmacy benefit managers (PBMs) often have their own pharmacy through which they fill prescriptions by mail order. This is quite profitable for the PBM. PBM contracts permit the PBM to charge more for drugs purchased at local retail pharmacies than those purchased through the mail order pharmacy.

Sadly, the answer to your last question is "yes."

Click on the icon for "What You Can Do" to make your voice heard by elected officials. Also, if your insurance is through an employer, discuss the situation with the benefits manager and ask for assistance. Also, direct them to this Website for information they may not have about pharmacy benefit managers.