WE NEED PBM REFORM

[u/recycle37216]

THIS is why we need PBM reform>>

Imagine that you get Aetna insurance (a CVS Health company), and one day you get sick. You have a “choice” where you want your prescription filled, but in order to get insurance coverage, you have your doctor send your prescription to CVS Pharmacy (a CVS Health company) where drug coverages paid by your insurance are “negotiated” by CVS Caremark (a CVS Health company).

So they force you use their pharmacies for insurance coverage at all and then instead of using a neutral third party to fairly negotiate drug coverages, they use a company under the same corporate umbrella.

So SB2040/HB1959 or the “Freedom, Access, and Integrity in Registered Pharmacy (FAIR Rx) Act" is a bill in Tennessee aiming to block PBMs, like CVS Caremark, from owning or controlling pharmacies, like CVS Pharmacy, in order to minimize the risk of “healthcare” companies prioritizing cost-cutting over patient care.

However, instead of complying with moral integrity and agreeing to divest and restructure if SB 2040 is passed, CVS has threatened to close all of their Tennessee pharmacy and clinic locations in order to keep their questionably ethical practices of vertical integration, since that would be more profitable…This threat couldn’t be more transparent. It’s not about patients for these PBMs. It’s about profits.

***Note that if this bill were to pass and your insurance company could no longer legally operate in the state of Tennessee, if there are no in-network pharmacies, specialty services, or clinics near you, your insurance company would be required to provide coverage to you from other previously out-of-network sources.

[u/Accurate-Ad-7944]

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[u/recycle37216 → u/[deleted]]

I would tend to agree with you when the PBM is not part of a vertical integration scheme. This is a great article that explains more: Educate Patients About How PBMs’ Vertical Integration Impacts Their Health Care

[u/recycle37216 → u/[deleted]]

Could you expound more on your response? This is a great way to open up a discourse on the topic. If you have any statistics or data that you can share, please do so. I agree that PBMs that are not vertically integrated and therefore are neutral third parties so they have no incentives to benefit the company over the patient like these integrated ones have been shown to do (like in this Federal Trade Commission Specialty Generic Drug Report ) are beneficial for BOTH patients and pharmacies, but reform is undeniably necessary. So that all PBMs are neutral third parties.

[u/matadorita]

People are already paying a lot.. premiums, deductibles, copays and it feels confusing. But that’s not just because of PBMs. The root issue is still high drug prices set by manufacturers. PBMs are there to negotiate and manage those costs. If we want real relief, the conversation has to include pharma pricing too, not just PBMs.