>>10220430 Who is the Middleman in Business? Look into POTUS remarks about the "middleman".

When the President was signing the EO on prescription cost cut, he specifically mentioned PBMs, Pharmacy Benefit Managers. All insurance companies use PBMs, along with many other industries.

==Five Biggest PBM companies

The five biggest PBMs operating in the United States are very large, covering more than 50 percent of patients with pharmacy benefits==

••The healthcare system is very complex, with many companies involved that go far beyond the doctor and pharmacist relationship. The PBM plays a pivotal role in getting you the drugs you need at a price you can afford and in using their vast resources to negotiate on behalf of insurers and customers

the many people involved are the middlemen and many layers in PBMs

https://www.thebalancesmb.com/largest-pharmacy-benefit-managers-2663840

This article a bullshit and a glow piece on PBMs, they keep the savings now,ever since the destructive ACA (fucking affordable care act-Obama should be hung for this horrendous, many hideous repercussions still happening, and corruption skyrocket in the medical and insurance fields), was initiated in 2010Yes I am an insurance broker. RX that cost $600 in 2008-9 (generic was $35, just a pain pill) in 2019-20 retail price at pharmacies is $1,700-1,800.

••The PBM market is dominated by three major players, who together handled about 76 percent of all prescription claims in 2018, according to Drug Channels Institute.

••A breakdown of PBM market share, by total equivalent prescription claims managed in 2018:

1. Caremark (CVS Health) / Aetna: 30 percent

2. Express Scripts: 23 percent

3. OptumRx (UnitedHealth): 23 percent

4. Humana Pharmacy Solutions: 7 percent

5. MedImpact Healthcare Systems: 6 percent

6. Prime Therapeutics: 6 percent

7. All other PBMs + cash pay: 4 percent

https://www.beckershospitalreview.com/pharmacy/top-pbms-by-market-share.html

February 2017

It is no secret that pharmacy benefit managers (PBMs) are not the most popular part of the health care neighborhood. The question is, does health care benefit from PBMs—by keeping drug price increases in check, or driving them down—or do they simply benefit themselves—by adding unnecessary administrative costs

••“PBMs are disliked by almost everybody,” said Norm Smith, president of Viewpoint Consulting, Inc, which surveys managed markets decision-makers for the pharmaceutical industry. “By manufacturers, because they get beat up no matter how they price a product; by physicians, because prior authorization causes unreimbursed time; by retail drug stores, because PBMs lower their dispensing fees; and by employers, because they feel the PBM is not transparent with net prices. It’s a tough way to go through life!”

••And it is looking as if things might get tougher. Consumers are demanding that the government take action on what they perceive as runaway prescription drug prices. Up until now, the focus has been primarily on pharmaceutical manufacturers, but many believe it is only a matter of time before the spotlight shines equally—or perhaps even more harshly—on PBMs.

••In January, CMS released a report showing paymentsPBMs receive in the form of rebates from manufacturers and concessions paid by pharmacies increased by 22% per year between 2010 and 2015, whereas Part D drug costs increased just 12% annuallyThe report shows that rebates/concessions reported to CMS hovered in the range of $26 to $28 billion annually in the early part of this decade, but escalated more recently, to $50 billion in 2015.

https://www.managedhealthcareconnect.com/article/how-pbms-impact-specialty-drug-market

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How Pharmacy Benefits Managers (PBMs) Use Spread Pricing To Make Money

POSTED ON OCTOBER 1, 2018 BY DISCOUNT DRUG NETWORKLEAVE A COMMENT

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Pharmacy Benefit Managers(PBMs) like Express Scripts and CVS use spread pricing to make money but are these PBMs nowspread pricing and pbms using this spread pricing to their advantage? Want to know more? Find out below:

What is ‘Spread Pricing’?

PBMs that practice spread pricing charge their sponsors/clients more for a prescription drug than what they actually pay to the pharmacies. This difference in the amount billed and the amount paid by the PBMs to the pharmacy is what makes up the revenue for them.

Question is, should there be such a huge difference in those amounts that they can make hundreds of thousands of dollars in profit? Let’s dig in deeper:

How Spread Pricing Works

Let me explain it to you with the help of an example:

Let’s say a pharmacy buys a prescription drug bottle for $5.

A patient comes and fills the prescription of that drug using their employer-provided insurance.

Now the PBM of that insurance company will pay $7 to the pharmacy to cover the cost for the pills, allowing the pharmacy to bank $2 as profit.

The PBM will then also bill the employer for the pills, $14 in this example.

The difference in what the PBM paid the pharmacy and what it billed the employer is the ‘spread’ which remains with the PBM.

This way the PBM ends up making a significant profit through spread pricing.

Generic Drugs and Spread Pricinghigh drug prices are making healthcare unaffordable

90% of all prescriptions dispensed in the U.S are generic drugs, and unfortunately, they are also the ones most affected with spread pricing. Generic pills are quite cheap when compared to their brand name versions, but because of the big spreads, their prices are now also increasing.

Spread Pricing Results in Higher Consumer Costs

Spread pricing is mostly understood by health planners and brokers. Employees and consumers paying health bills were mostly unaware of this practice until now.

Spread pricing has a significant impact on health plan costs. It is one of the main reasons why prescription drug prices are getting so expensive.

“In an analysis of pharmacy and middleman markups in Medicaid plans around the country, Bloomberg found big spreads on dozens of drugs, and evidence that the spreads are growing. For many widely used generic drugs, state insurance plans are collectively paying millions of dollars in fees to private companies.”

Clearly spread pricing results in higher consumer costs.

PBM Pricing Practices Have Generated Lawsuits

UnitedHealth Group’s PBM, OptumRx has been accused by four hundred independent pharmacies for manipulating its generic drug price lists to fill its pockets.

In July of 2017, West Virginia cut out PBMs, including Express Scripts and CVS, from its Medicaid managed-care program. According to a state spokeswoman, they expect to save $30 million a year by running the program themselves. Eliminating spreads and reducing administrative costs helped them save about 4 percent of the state Medicaid drug spending.

>>10220430 Who is the Middleman in Business? Look into POTUS remarks about the "middleman".

Moar on PBMs mentioned by POTUS when he signed the drug EO

Also in June 2018, Pennsylvania’s auditor general reviewed PBM practices in that state’s Medicaid program and cited a lack of oversight into how they determine prices.

Despite the criticism and public awareness, the PBMS are still not putting an end to this spread pricing practice. Although it has been a common practice in the PBM marketplace for years, the impact on costs and quality of care is now more significant.

“The PBMs have found they can do it and get away with it,” says Stephen Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. “The way that spread pricing is being done these days, generics don’t always save you money.

https://www.discountdrugnetwork.com/spread-pricing-pbms/

>>10220430 Who is the Middleman in Business? Look into POTUS remarks about the "middleman".

Understanding the hidden villain of Big Pharma: pharmacy benefit managers

By Jessica Wapner On 3/17/17

In the past few months, four bills have been introduced in Congress calling for transparency in prescription drug pricing. These bills—HR 1038, HR 1316, S.3308 and, earlier this week, one called C-THRU—largely concern pharmacy benefit managers (PBMs), a heretofore largely unrecognized component of the pharmaceutical industry.

••PBMs quietly became an integral part of the pharmaceutical supply chain—that is, the path a drug takes from the manufacturing facility to a bathroom medicine cabinet—following the passage of the Medicare Modernization Act in 2003. In recent years, PBMs have become a cause for alarm because, these bills allege, they drive up drug prices and interfere with patients' access to medications. In 2015, Express Scripts, the largest PBM-only company in the U.S., reported a profit of more than $660 million, from sales exceeding $25 billion.

But even as drug prices and access have become increasingly at the mercy of PBMs, how they operate has remained mostly hidden. Earlier this year, Community Oncology Alliance, an advocacy organization for community-based cancer care practices, commissioned a report exposing how PBMs work and the damage they are causing. Newsweek spoke with COA Executive Director Ted Okon about what many health care experts believe is Big Pharma's latest villain.

What are PBMs and how did they originate?

PBMs arose in the early 2000s, after the Medicare Modernization Act was passed into law in 2003. MMA included the creation of Medicare Part D, which handles benefits associated with prescription drugs. PBMs are companies that fulfilled a need created byPart D: a middleman between the insurer, including Medicare, and the pharmacy. The idea behind PBMs was that they could identify eligible patients, reduce the administrative burden on the benefits provider and negotiate drug prices with pharmaceutical manufacturers. Keeping this intermediary role in the private sector was supposed to help with all this.

I bet if you look up GWBush, families and all associates of GHWBush, you’ll find they started Or invested in PMBs before this law was passed

https://www.newsweek.com/big-pharma-villain-pbm-569980

>>10220430 Who is the Middleman in Business? Look into POTUS remarks about the "middleman".

=•Trump said PBMs Are Some of the middlemen, when signing the EO, now let’s look at the top CEOS and officers of CVS (which happened to purchase Aetna Insurance company two years ago. Aetna insurance started in 1853)==. Now consider looking at the pay of the leaders, multiply that by other PBMs out, but another I posted there were many other industries involved with PBMs. They have a MASSIVE reason for stopping Trump and the EO. There could be 100s of 1000s of companies and PBM middleman WW, that is why we won’t be seeing our a POTUS for a while. Pharma May have bigger profits than war.

https://www1.salary.com/CVS-HEALTH-CORP-Executive-Salaries.html

>>10222815>>10222899 >>10222921 >>10222948 >>10222956 >>10223025

Oh interesting I posted an article from Fidelity how Rice was dumping Netflix stocks yesterday, they denied it had to do with Biden. 2nd there is no way On this planet she only made $300,000 (I’ll check to confirm). From 2018 to now it’s grown at 400%, but why cash out a measly $300,000 gain. I’ll confirm but a friend owns Netflix from 2017 and has made $75,000 from 100 shares. I don’t know hiding money??

Is This Biden’s Running Mate? Susan Rice Dumps Netflix Stock

AUGUST 7, 2020

We’re nearing the most recent deadline the Biden campaign has set for a Vice Presidential pick, and there is speculation now that the choice has been made.

Susan Rice is an investor and director at Netflix, the top video streaming service in the U.S., and part of her deal with the company was stock options that she has now apparently decided to exercise. That tidbit broke yesterday. This comes via Allahpundit over at HotAir.

Alex Weprin

@alexweprin

Netflix director (and possible VP pick?) Susan Rice exercised her stock options in the streamer this week, and subsequently sold all the shares, netting her a gain of about $300,000

Not to read too much into the tea leaves here, but this appears to be the first time she has exercised her options since joining the Netflix board a couple years ago. Again, this was pursuant to a trading plan, so set before today.

This is by no means a surefire tell that Rice has the nod. However, a quick look at her Wikipedia page history shows that there’s been a lot of activity to clean it up. I’ve mentioned in the past how the open-source encyclopedia can be a big tell, though up until recently Kamala Harris’ page was being furiously edited by a single account, indicating someone out there thought she needed to be presented in the best possible light.

Rice’s Netflix divesting could be a sign she got the nod, but it could also be a sign she’s ready to move on to something else. What is curious though is the timing along with the clean-up of her Wikipedia page. It’s been more active than Harris’.

https://thespectator.info/2020/08/07/is-this-bidens-running-mate-susan-rice-dumps-netflix-stock/

https://sec.gov/Archives/edgar/data/1065280/000106528020000348/xslF345X03/edgardoc.xml…

7:18 PM · Aug 6, 2020

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