I just watched this (July 2024). I made a living in this space 25 years ago as a data analyst and then about 12 years ago as a business unit director of government programs. I am amazed by how little has changed. As I prepare for a phone screen interview to return to this work (hopefully, the interview goes well), I am verily enjoying several of your videos to re-familiarize myself with the mess of it all. THANK YOU!
The trick I'm getting faced with has to do with 90 day supplies. Cigna will ONLY fill my script for 90 days at a time with Accredo who they own, if I want to fill it at a local pharmacy they will only do it for 30 days. It's just a coercion tactic to use their own pharmacy so they can negotiate prices with... themselves?? I think the FTC needs to get involved and I really hope that California SB 966 will address this in some way. I hope the whole nation can get on board too and stop these PBMs from exploiting customers and being anti-competitive forces in their market. On top of that since it's an antiviral and adherence is known to increase with 90 day supplies, they are knowingly allowing viruses to spread when they should not. Beyond unethical.
I know I’m late to the party, but I am wondering how direct primary care doctors buy their medications. Are there wholesale companies that will do this? Wonderful as always, Dr. Bricker.
Direct primary care doctors can dispense medications only in certain states (e.g. Kansas). In other states, it’s against the law (e.g. Texas). There are large distributors such as McKesson.
The pharma industry self regulated itself back in the mid 2000s. I wonder if they did that bc it would be hard to discern if the pharma companies were getting kickbacks from Medicare/Medicaid vs private health plans??
Can you discuss what if any relevant legislature has been done to curb the shadowy dealings with PBMs? Any strategies for us docs in leveraging knowledge of this cabal to improve the ability to deliver care?
Great question. You as your own practice as an employer should demand from your own insurance broker that you use a transparent PBM and not one of the big 3. You must be a self-funded employer to do this… so first step is to move to a self funded plan. Gotta lead by example. Thank you for watching.
How are drugs prices the VA and Military Health System pay so much lower? Do they source through PBMs or they have some direct sourcing process? We prescribed levabuterol quite often in the military, in a civilian hospital they looked at me like I was crazy.
How would you simplify this overcomplicated mess we call the US healthcare system of you had a magic wand? For example, would you get rid of health insurance alltogether and go back to a true fee for service model? Thanks in advance
Good question. Steven Brill had some good suggestions at the end of his book ‘America’s Bitter Pill.’ 1) Hospitals and Insurance Carriers would be one and the same (I.e. Everything would look like Kaiser), 2) Price controls for drugs. Thank you for your question.
What can primary care providers who practice in states that cannot dispense, do to disrupt this system? How do compound pharmacies disrupt this system?
I hate getting red pilled.....good to know, but what can be done about it? If there is no solution to help the patients, then knowing this is just torture.
If have insurance, must call around to different pharmacies to get pricing for your particular insurance. If doc prescribes brand, ask “Is there a generic medication that treats my condition?” Won’t always get yes, but often will.
I just watched this (July 2024). I made a living in this space 25 years ago as a data analyst and then about 12 years ago as a business unit director of government programs. I am amazed by how little has changed. As I prepare for a phone screen interview to return to this work (hopefully, the interview goes well), I am verily enjoying several of your videos to re-familiarize myself with the mess of it all. THANK YOU!
Thank you for watching and for your comment.
The trick I'm getting faced with has to do with 90 day supplies. Cigna will ONLY fill my script for 90 days at a time with Accredo who they own, if I want to fill it at a local pharmacy they will only do it for 30 days. It's just a coercion tactic to use their own pharmacy so they can negotiate prices with... themselves?? I think the FTC needs to get involved and I really hope that California SB 966 will address this in some way. I hope the whole nation can get on board too and stop these PBMs from exploiting customers and being anti-competitive forces in their market.
On top of that since it's an antiviral and adherence is known to increase with 90 day supplies, they are knowingly allowing viruses to spread when they should not. Beyond unethical.
Thanks for sharing this ❤
Thank you for watching.
Very insightful. Thanks. Keep fighting the good fight.
Thank you, John.
I know I’m late to the party, but I am wondering how direct primary care doctors buy their medications. Are there wholesale companies that will do this?
Wonderful as always, Dr. Bricker.
Direct primary care doctors can dispense medications only in certain states (e.g. Kansas). In other states, it’s against the law (e.g. Texas). There are large distributors such as McKesson.
I’m in Utah, and they just changed the law to enable docs to do this. Thanks for your response!😊
Would love to see the questions and answers to the questions asked during the live session.
Thank you for watching and for your comment.
The pharma industry self regulated itself back in the mid 2000s. I wonder if they did that bc it would be hard to discern if the pharma companies were getting kickbacks from Medicare/Medicaid vs private health plans??
Thank you for sharing your thoughts.
Can you discuss what if any relevant legislature has been done to curb the shadowy dealings with PBMs? Any strategies for us docs in leveraging knowledge of this cabal to improve the ability to deliver care?
Great question. You as your own practice as an employer should demand from your own insurance broker that you use a transparent PBM and not one of the big 3.
You must be a self-funded employer to do this… so first step is to move to a self funded plan.
Gotta lead by example.
Thank you for watching.
Data fees, portal fee, and the most ridiculous one I’ve seen is “compliance” fee
Buckle and dime. Thank you for watching.
What are your thoughts on the recent article the NYT published on PBMS/big 3?
How are drugs prices the VA and Military Health System pay so much lower? Do they source through PBMs or they have some direct sourcing process? We prescribed levabuterol quite often in the military, in a civilian hospital they looked at me like I was crazy.
Most likely direct. Thank you for watching.
How would you simplify this overcomplicated mess we call the US healthcare system of you had a magic wand? For example, would you get rid of health insurance alltogether and go back to a true fee for service model? Thanks in advance
Good question. Steven Brill had some good suggestions at the end of his book ‘America’s Bitter Pill.’ 1) Hospitals and Insurance Carriers would be one and the same (I.e. Everything would look like Kaiser), 2) Price controls for drugs.
Thank you for your question.
The GPO should be under the umbrella of the AKS and should not be exempt from it
Agreed. Thank you for watching.
What can primary care providers who practice in states that cannot dispense, do to disrupt this system? How do compound pharmacies disrupt this system?
Prescribe low-cost generics in a clinically appropriate manner as much as possible. Have patients use GoodRx for pricing instead of their insurance.
wow
Thank you for watching and for your comment.
I hate getting red pilled.....good to know, but what can be done about it? If there is no solution to help the patients, then knowing this is just torture.
If have insurance, must call around to different pharmacies to get pricing for your particular insurance.
If doc prescribes brand, ask “Is there a generic medication that treats my condition?” Won’t always get yes, but often will.