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Message
re: UnitedHealth subsidiary sues Mississippi Board of Pharmacy
Posted on 1/9/25 at 7:31 am to iwantacooler
Posted on 1/9/25 at 7:31 am to iwantacooler
been going on for years, and getting worse. We finally decided to sell my wife's. In Arkansas, independents get about $6-8 over the cost of an rx, while the chains get $25-30 over the cost of a med according to the state and this was before COVID. There is no price bidding. They pay their own and other retail pharmacies more and profits filter back to the main company United Healthcare Group. Meanwhile, United Healthcare health says they're only making 6.1% profits, which is in line with a very good but not outstanding traditional profit margin for healthcare insurance.
As a self employed physician, I have not had a net raise from insurance in almost 20 years or more. Medicare is less than it was then and they have cut us every year for the last 5 years. Meanwhile the give more than adequate raised to Medicare advantage plans and hospital groups or large non physician owned corporate medicine conglomerates.
Our system is collapsing and it's all because of unfair business practices and gov't. We also took about half or less for our pharmacy than we could've gotten from Walgreens, but they would've shut it down.
As a self employed physician, I have not had a net raise from insurance in almost 20 years or more. Medicare is less than it was then and they have cut us every year for the last 5 years. Meanwhile the give more than adequate raised to Medicare advantage plans and hospital groups or large non physician owned corporate medicine conglomerates.
Our system is collapsing and it's all because of unfair business practices and gov't. We also took about half or less for our pharmacy than we could've gotten from Walgreens, but they would've shut it down.
1
Posted on 1/9/25 at 7:39 am to iwantacooler
We have the greatest healthcare delivery system in the world (although consolidation is eating away at that a bit)
But our healthcare payment system is corrupt, inefficient, anti-competitive, and for most people, there is a lack of reasonable choice.
You are tied to certain docs, hospitals, and pharmacies based on the decisions of your employer. This is an asinine way of doing things.
But our healthcare payment system is corrupt, inefficient, anti-competitive, and for most people, there is a lack of reasonable choice.
You are tied to certain docs, hospitals, and pharmacies based on the decisions of your employer. This is an asinine way of doing things.
Posted on 1/9/25 at 7:40 am to NOFOX
quote:
Am I missing something here? PBM's are Big Insurance, not Big Pharma.
Correct. And they are the biggest drivers of medicine costs. Instead of negotiating lower rates as they first said was their plan, they make their money by basically charging big pharma for shelf space. Obamacare made them even more powerful and with just a few left after consolidations, they essentially have a monopoly and there is 100% collusion between them. If a medicine is $1000, they may get $500 for not doing shite.
Insulin is a good example. When Lantus first came out it was about $200/month nationwide (maybe like $150-170 regionally here)
Pre PBM the drug company got about $150 of that, the wholesaler $25-30 and retail $20-25.
With PBM it shot up to $800. Pharma got $150 still, wholesalers went up to $75 due to cost of their inventory and retail (independents-not chain) got about $5-7 for a med that cost them $793. It's bullshite.
Posted on 1/9/25 at 7:47 am to SmackoverHawg
Did you sell before Arkansas passed the PBM rule requiring they pay all pharmacies acquisition cost + fair and reasonable profit?
LINK
It was temporary but recently made permanent. And the big PBMs are facing something like $1.5M in fines for underpaying.
I’m curious to see how it plays out in terms of better conditions and ultimately fewer independent closures.
LINK
It was temporary but recently made permanent. And the big PBMs are facing something like $1.5M in fines for underpaying.
I’m curious to see how it plays out in terms of better conditions and ultimately fewer independent closures.
Posted on 1/9/25 at 7:49 am to SmackoverHawg
quote:
Correct. And they are the biggest drivers of medicine costs. Instead of negotiating lower rates as they first said was their plan, they make their money by basically charging big pharma for shelf space. Obamacare made them even more powerful and with just a few left after consolidations, they essentially have a monopoly and there is 100% collusion between them. If a medicine is $1000, they may get $500 for not doing shite.
Insulin is a good example. When Lantus first came out it was about $200/month nationwide (maybe like $150-170 regionally here)
Pre PBM the drug company got about $150 of that, the wholesaler $25-30 and retail $20-25.
With PBM it shot up to $800. Pharma got $150 still, wholesalers went up to $75 due to cost of their inventory and retail (independents-not chain) got about $5-7 for a med that cost them $793. It's bullshite.
I wish regular people knew more about PBMs. They're these enormous entities that are hiding in plain sight, screwing us, and nobody knows about them.
Posted on 1/9/25 at 7:52 am to Queen
quote:
I’m curious to see how it plays out in terms of better conditions and ultimately fewer independent closures.
I’m told from a colleague that they are still being underpaid and trying to get some relief. The PBMs need to be fined big time, on a per claim basis, to prevent this from happening.
Posted on 1/9/25 at 8:29 am to GeauxtigersMs36
quote:
Support independent everything if you can. Grocery stores too.
I try.
But…
Our local pharmacy is open only 9-6 during the week and 9-1 on Saturdays
Our local grocery closes at 8 (7 on Sunday) and has trouble keeping things in stock. Additionally at times they have Walmart level checkout lines. And they are expensive.
Our local hardware store closed at 430 pm normally , closed many weekends,and randomly closes from time to time. If I can get there while open, they are amazing to work with.
Posted on 1/9/25 at 8:56 am to Queen
quote:
id you sell before Arkansas passed the PBM rule requiring they pay all pharmacies acquisition cost + fair and reasonable profit?
Yeah. My wife was tired of it and it really hasn't changed. Still doing it. She also lost her main relief pharmacist that she'd had for 20 years to breast ca. We're open to buying it back if it fails, but we don't need the money and I wanted a lump of cash to invest before Trump got back in. We also kept a large inventory that most couldn't for patient convenience. I've already replace her income by investing a portion of the money from the sale. It makes my life easier to have one in my parking lot, so I'm going to do whatever it takes to keep one there and viable. I do think now is a good time to be buying pharmacies if you can get a reasonable price and have plenty of cash flow and capital to sweat out the next few years. Also institute a vaccine program, which she didn't want to do.
Posted on 1/9/25 at 8:59 am to GetCocky11
quote:
I wish regular people knew more about PBMs. They're these enormous entities that are hiding in plain sight, screwing us, and nobody knows about them.
Privacy•Advertising•Contact•Terms
People don't give a shite because they don't get a bill from them. They think we're full of shite.
Posted on 1/9/25 at 9:00 am to dewster
quote:
Pharmacists at CVS and Walgreens
Healthcare Heroes
Posted on 1/9/25 at 9:18 am to iwantacooler
quote:
I’m told from a colleague that they are still being underpaid and trying to get some relief. The PBMs need to be fined big time, on a per claim basis, to prevent this from happening.
Arkansas is doing that now.
LINK
TBD how it plays out, of course, but if they commit the resources it should hopefully start to change the abhorrent practice of spread pricing. At least in Arkansas.
Some here may have followed the attempt at federal PBM regulation late last year, which went nowhere because it was tied to the failed budget bill for reasons. ??
Posted on 1/9/25 at 9:58 am to iwantacooler
quote:
Here is an example of a claim from United health earlier today. I was paid $65 below cost. My acquisition cost is $1,113 and I was paid $1,047.25 for a net of -$65.
Are you a pharmacist? Do you purchase your drugs directly from United/OptumRx or one of the big wholesalers, like Cardinal or McKesson?
The wholesalers are the true "invisible players" that nobody knows about.
Posted on 1/9/25 at 10:21 am to A12 Oxcart
I am, and understand that wholesalers could give some ground as well, but that does not excuse the fact that PBMs violate the law by paying their own pharmacies multiples more than what they pay independents, drive up prices by keeping higher priced brand name meds preferred (because they get a “rebate”/extortion fee) to keep on formulary and pocket those rebates instead of passing them along as originally intended. Wholesalers may be a part of the equation, but PBMs are magnitudes more problematic for overall healthcare costs.
Posted on 1/9/25 at 10:54 am to iwantacooler
I hate Walmart for one reason the self checkouts. I spend little more at the local grocery who has high school kids working the registers and stocking shelfs.
Posted on 1/9/25 at 2:46 pm to iwantacooler
quote:
I am, and understand that wholesalers could give some ground as well, but that does not excuse the fact that PBMs violate the law by paying their own pharmacies multiples more than what they pay independents, drive up prices by keeping higher priced brand name meds preferred (because they get a “rebate”/extortion fee) to keep on formulary and pocket those rebates instead of passing them along as originally intended. Wholesalers may be a part of the equation, but PBMs are magnitudes more problematic for overall healthcare costs.
What do you mean by "their own" pharmacies? The only PBM I'm aware of that owns pharmacies is CVS Caremark. Are you part of any other PBM's network?
Also, most contracts now mandate 100% pass-though of rebates to employers/plan sponsors. Keeping rebates is a thing of the past. However, they just keep finding new ways to hide money.
Posted on 1/9/25 at 3:47 pm to A12 Oxcart
Express scripts owns specialty and mail order pharmacies. CVS Caremark owns cvs and specialty and mail order pharmacies.
Optum owns specialty and mail order pharmacies.
Contracts may require 100% pass through of rebates(extortion fees), but state law requires independents and other non affiliates be paid the same as affiliate pharmacies are, and as you can see according to the audit that is not happening either.
Do you work for a pbm or would you happen to be a legislator or lobbyist?
Optum owns specialty and mail order pharmacies.
Contracts may require 100% pass through of rebates(extortion fees), but state law requires independents and other non affiliates be paid the same as affiliate pharmacies are, and as you can see according to the audit that is not happening either.
Do you work for a pbm or would you happen to be a legislator or lobbyist?
This post was edited on 1/9/25 at 3:54 pm
Posted on 1/9/25 at 3:57 pm to iwantacooler
quote:
Do you work for a pbm or would you happen to be a legislator?
No, LOL. I recently left a job in HR and had experience in dealing with PBMs and insurance companies from the employer side of things.
Posted on 1/9/25 at 10:01 pm to KamaCausey_LSU
quote:
Hope United Health gets fined massively.
With lead.
Posted on 1/9/25 at 10:22 pm to iwantacooler
All PBMs can frick right off!
Posted on 1/9/25 at 10:27 pm to auwaterfowler
quote:
All PBMs can frick right off!
They don't do shite. No value to the system. Just a way to generate more profit from the system by those not involved in care in any way. They do nothing but add enormous costs and zero benefit. They should be eliminated.
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