Drugs, Money and the Middleman

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A little more about that … Kaiser Health News infographic!


By Dr. David E. Marcinko MBA via Georgia Pharmacy Association


Recently, KHN ran an infographic from Kaiser Health News that gave a rough explanation of how the money flows in the sale of a brand-name drug.

After thinking about it a bit, Greg Reybold, Vice President of Public Policy & Association Counsel for the Georgia Pharmacy Association, noticed some fundamental flaws.

The infographic helps shed light on a process that lacks fundamental transparency,” he said, but it doesn’t reflect all of the practices engaged in by some PBMs.”

Furthermore, he added,

“There are times, unbeknownst to patients, when some PBMs charge patients copays that are significantly higher than the cost of the drugs themselves, or they steer patients to brand name drugs for which the PBM receives a rebate when there is a less costly generic available.”

He also noted the infographic:

“reflects that the pharmacy make a profit — when in fact there are many times pharmacies lose money on prescriptions they fill through low reimbursements, the imposition of different types of fees, and aggressive audits.”



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3 Responses

  1. Healthcare Triage: Orphan Drugs: An Introduction Video

    We at Healthcare Triage couldn’t be more excited about this month. We’re doing a whole month on orphan drugs, with the help of Nick Bagley. He wrote a lot about them, and we begged him to let us adapt his work into a series.


    This is the Introduction. Over the next few weeks, there will be three more. Enjoy!

    Aaron Carroll MD via Ann Miller RN MHA


  2. 90% of Employers Say Drug Prices Are Greatest Threat to Affordability

    The National Alliance of Healthcare Purchaser Coalitions recently conducted a survey of employers and private purchasers. Here are some key findings on the greatest threats to healthcare affordability:

    • 90% of employers say drug prices are the greatest threat to affordability of employer-provided coverage.
    • Nearly 3 in 4 (73%) say lack of transparency is a threat to affordability of employer-provided coverage.
    • 71% say hospital prices are a threat to affordability of employer-provided health coverage.
    • Nearly 3 in 5 (58%) say surprise medical bills are a threat to affordability of coverage.
    • 53% say overuse of low-value services/waste (53%) are the greatest threat to affordability of coverage.

    Source: National Alliance, September 29, 2020


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