Side Effects May Include: The Hidden Costs of Prescription Drugs

We trust our insurance to protect us. But what if this system we rely on was never designed for us? I got introduced to a pharmacist. I called him up and I said, I think the PBM industry is broken and we can fix it. The Federal Trade Commission planning to sue the three largest pharmacy benefit managers over insulin and other drug prices. This law suit is expected to target those so called middlemen. People are dying because they can't afford their medication, and you all are part of the problem. The PBMs, the wholesalers, the actual pharmacies, all of these folks that touch the drug before they ever make it into the hands of a person. If you don't understand the PBM industry, that's understandable because it's meant to be opaque. But if you understand that the traditional PBM is in business to sell drugs to patients at a profit, that pretty much sums it up. Five prescriptions, dollars 29,000. As we can see here under GoodRx, the same drug is $35. Patients are paying more with insurance than without it. It was a $192. Breakthrough for the cash price and it was just $15. Unfortunately, everyone thinks that because they have insurance, they're always going to be getting the best deal. Life saving drugs are priced like luxury goods. You're almost never getting the best deal. We've seen drugs that have come to market at very low prices that couldn't even get on the formulary because there was not a revenue opportunity for the PBM. It's almost a pay to play. Whether it's a penny, nickel, or a million dollars, if you're conducting business in a way to earn a profit that your clients know nothing about, that's profiteering. That is a problem. That's unethical. Cigna, Anthem, United, Aetna, they all routinely deny employers access to their own claims data, and then they turn around and monetize it for themselves. What am I gonna do? I don't know that this drug actually sells in the pharmacy for $16 when they've charged me $1,800 for it. It was just so much like questioning a suspect. But it was easier to get a confession out of a bad guy than it was to get the truth out of a public vendor. Your employee just paid a thousand dollars for a med that should have cost them 500. If patients aren't winning, who is?