Prescription drugs are expensive. Without insurance, consumers would pay even more for medicines that are essential to their health, wellness, and the welfare of their families. While most consumers are familiar with the role that pharmacies and drug companies play in delivering these drugs, many people overlook the role of Pharmacy Benefit Managers (PBMs). By one estimate, 90% of individuals with prescription drug coverage receive benefits through a PBM, and PBMs handle approximately two-thirds of all prescriptions written in the United States.
PBMs serve as middlemen between drug manufacturers, pharmacies, health plan sponsors, and consumers. PBMs do everything from negotiating the prices health plan sponsors pay for drugs to setting the prices pharmacies are reimbursed for dispensing drugs. They also decide which specific drugs are eligible for reimbursement.
Some examples of PBMs are Express Scripts, Medco and CVS Caremark. Express Scripts and Medco, two of the nation’s largest PBMs, are seeking to merge and form the nation’s largest PBM. If this merger goes forward, the combined company will administer 1.14 billion prescriptions annually, and would handle 41% of all prescriptions administered by PBMs. The merged PBM would be nearly two times larger than its nearest competitor.
Express Scripts and Medco argue that this merger will benefit health plan sponsors, and ultimately consumers. They claim that the combined company’s scale will give it substantial buying power to drive down drug prices.
Some consumer advocates and competition experts fear this merger will diminish competition and cause drug prices to increase even more. They question whether the projected savings that the PBMs claim will be passed along to health plan sponsors and ultimately consumers. Community pharmacists - in small pharmacies and large chain drug stores alike - raise important concerns about whether they will be able to compete after the merger and continue to provide in-person services and consultations that many people have come to rely on.
As Chairman of the Senate Judiciary Antitrust Subcommittee, I convened a hearing Tuesday, to examine the effects of this merger on individuals and prescription drug prices. We heard from many witnesses, including two that represent Wisconsin businesses, and gained much insight into this proposed merger.
I will continue working to make sure the potential merger will not hurt consumers so that you are able to receive prescription drugs at a reasonable price ensuring that you and your family are able to afford the care you deserve.
Medicare is a form of national health care, look how that works: An office call is $200. Medicare pays $15. This explains why those without coverage are sent to collection. This is why those who have private insurance are charged so much more. The inflated prices are due to a loss of revenue from Medicare, Doctors have to make that up from the rest of us. Before jumping to conclusions about the wonders of NHC, look at the costs where it is offered. Compare tax rates. Denmark has great health care, but there is no way the people in the US would endure those tax rates. High taxes would kill more people than NHC would save!
“…the combined company will administer 1.14 billion prescriptions annually, and would handle 41% of all prescriptions administered by PBMs.” If these numbers are accurate, then that means that there are over 2,780,487,804 prescriptions annually filled by PBMs in this country for those with health care coverage. Another 308,943,089 prescriptions annually filled by non-PBMs in this country for those with health care coverage. And considering that of the 16.7% of the population that is uninsured, at least 8% are actually self-insured, that means another 268,646,164 annual prescriptions filled by self insured individuals in this country. That’s a grand total of 3,358,077,057+ prescriptions filled annually in this country. Divided by our 2010 census population figure of 312,735,814, that works out to be 10.73+ annual pharmaceutical drug prescriptions per every person in America! And considering that I personally haven’t had to use a prescription drug in the last 15 years, and under the assumption that there must be more people like me out there, that means that many people have more than 11+ pharmaceutical prescriptions yearly in this country! That’s incredible! Why is our society so medicated? Is this really necessary? I’m seriously in shock over this – aren’t you?
I'm not sure how Kohl defines 'prescription,' in the article. However, logic would dictate that in your example, you would have only two prescriptions counting towards those numbers, as the indefinite refills wouldn't actually count as 'new' prescriptions each time they are refilled, unless each refill is individually and expressly ordered by your doctor. But that's just a logical assumption on my part, premised upon a reasonable inference. In either case, it's still a remarkable number of prescription drugs. So much so that traces of prescription drug components are starting to show up in many municipalities water and sewage supplies.
Basically we have a system with doctors working on piece-work; not paid for being well trained, caring doctors, but paid for by an illogical system of pay-for-individual bits of services. I have no problem with doctors earning a good living, but the costs of the current US health system are unsustainable. And frankly, can you even fantasize that the private sector will get us out of this mess any time soon? So who does have the clout to push reforms and try to bring into being a rational system for taking care of the nation’s health care needs?
Look at the growth of dental care and the wealth of Dentists - it is all driven by insurance. Everyone (with insurance) now goes at least every 6 months to the dentist, has unnatural super bright white teeth, all types of expensive cosmetic treatments - and the reason for this growth is insurance money. It is a misallocation of Capital. A National. non-profit, single payer would be much more efficient. Euthanasia also needs to be allowed in terminal cases. There is ALWAYS a limited supply of money - so keeping a corpse alive at great expense denies others who need treatment and can be returned to productive lives. Before I get the hand-wringing comments about calling for Euthenasia - be honest with yourself and me - life boat ethics IS a part of everyday life - your discomforct with it does not mean it goes away - you just let others make those decisions for you.
As regards overtreatment in general, we as a society insist we look and feel like we're still in our 20s, 20 or more years beyond having left them and medical science is only too happy to assist us attempting to achieve that goal, at an enormous overall cost. I don't see that changing anymore than I see EOL decisions changing. Nobody, frankly wants insurance companies, the government or even doctors completely calling the shots. Once again, the two edged sword of technological advance.
Whenever it comes to EOL decisions, I'm constantly reminded of the closing scene from the film The Mist (2007). Essentially, the film teaches that you never know if/when an unexpected 'miracle' will happen. But, if you've already ‘pulled the plug’ on another, even if you've based your decision to do so on the very best information available to you, then it's obviously too late to be undone. And, you will be forced to live with that decision/act for the rest of your natural / un-natural life, which could be a devastating ordeal - especially if the facts that you used to form your decision/act happen to change after-the-fact, such as they did in The Mist. Could you honestly live with yourself knowing that you made the wrong call? I honestly don’t know if I could, and even then, I would never be the same again. I guess that’s why I’m against euthanizing pets/animals unless they have reached the end of their life expectancy. So, I guess I'm a ‘decide for yourself’ kind of guy, but hands off making a decision for other's lives.
I love your simple, direct, and unsympathetic responses! Kudos to you my friend! BTW - I loved your recent posts regarding 'Whitefish Bay!'
How about investigations of some religious-based, and purportedly "nonprofit" healthcare systems, and their avoidance of real estate and income tax payments via the religious tax loopholes?
Not bad ideas at all. However, I'm afraid that the entire system needs to be reformed all together to truly fix the problems we have with our health care system. And personally, I'm not against a government sponsored but private sector controlled universal solution, but it must done correctly. And Obamacare doesn’t even come close to doing it correctly! After all, even Lee Iacocca supported a universal health care system!
Did you catch the 60 Minutes episode re: medical tourism? State of the art hospitals in Tailand and India provide cutting edge medical care at a fraction of the cost of that in the U.S. Interesting point is that there are no for-profit, medical insurance companies in these countries.
Sorry, I missed that one! Funny, that the entire philosophical concepts behind insurance are heavily socialistic in nature, and yet, we managed to turn it into a for-profit capitalistic enterprise. I wonder if we'll start to see the rise of non-profit and/or cooperative insurance providers in the near future, which would actually be the best way to drive costs down and provide a level of competition to the for-profit companies unlike anything they’ve ever seen before! I’m actually surprised the big labor unions haven’t tried doing something like this yet, as opposed to entities like WEAC that primarily act to take advantage of anti-competitive contracts. Interesting none the less!
JRH hit the nail on the head. Too many times, including myself, the more you medicate the sicker the patient gets. Then you start medicating for a symptom that another medication caused. How many patients have died because of over-medication. Especially the elderly and cancer patients, who are in pain.
Indirectly the Republican Party supports death over health care ---- right here in Wisconsin, Walker is cutting back by millions health care for those in poverty without children -- just think about it -- he gets a double bang for the buck that is not spent --- the person who cannot get adequate health care will have a shorter life expectancy, and not only will Walker say spending money on that person's health care --- there will no longer be other expenses, such as Food Stamps, as dead people don't eat !
You are absolutely correct --- Sanger who founded Planned Parenthood was a racist and her main intent was to stem the flow of Black babies !! There is also something to be said of the rights of a woman, and many who support PP have no idea why it was started. At one time I thought this was an issue upon which politics could and should play a part --- but the idealogues on both sides will never let that happen. It is the conventional wisdom that all Dems are pro abortion, and all Reps are anti abortion --- but I have found that even among the politicians of each party, that does not hold true. Unfortunately the Red Meat Eaters of both parties keep those with an open mind close mouthed !