Great rambling Benjamin. I agree with everything you stated. It is time for Congress to act in conjunction with the president's EO on drug pricing. Patients, practitioners, and pharmacies have suffered long enough. Then they need to tackle our completely dysfunctional healthcare system.
Great intentions. Imossible to implement. Drug pricing in the US is market-based. Pharmaceuticals lobby the government and contribute large sums of money to both parties. This token gesture creates smoke and mirrors to make it look like he is doing something. He signs EOs with no plan of execution. He signs EOs with claims to do something about the flavor of the day, but never says how or follows up. Is the healthcare system dysfunctional? Yes. An EO, without an implementation plan, won't fix it.
I worked for CVS as a pharmacy tech. I watched people cry as they walked away without life-sustaining medication because they couldn't afford it. Diabetics need their insulin to live. Massachusetts has a law requiring pharmacies to fill with generics unless it says "dispense as written." EpiPens, even the generic brand, are hundreds of dollars. By statute, school-age children are required to have three. Pharmaceuticals claim they need to recoup funds for R&D. Nonsense. The most significant slice of the pie is marketing. R&D is a sliver.
I've had similar experiences. While the pricing of (especially brand) drugs by Pharma is insane, it's incredibly frustrating to tell someone "I'm sorry, but your insurance won't pay for your drug at my pharmacy, they require you to go to their pharmacy for coverage." That's a problem that I know the solution to, and the only downside to banning PBMs from owning pharmacies is that maybe CVS, UNH and CIG's stocks have a bad day. The downsides to unilaterally forcing price cuts to drug manufacturers are potentailly medication shortages and potentially reduced R&D. While you are absolutely right that the pricing of drugs is for the funding of R&D is more an excuse than a true statement, the existence of high drug prices does probably mean that investors are willing to put more money into early stage pharmas than they otherwise would. I think there are other and better ways to get at funding drug R&D than "sky high drug prices," but I do want to live in a world where we DO have more new drug products treating all of the diseases that are currently untreatable. And it's not just R&D or marketing, it's that the entire healthcare system, from Medicaid to safety net clinics is built on the edifice of sky high drug pricing through the MDRP and the 340b program. We have built a healthcare system where so much is built on the backs of the sickest patients and their employers paying full freight for drugs that everyone else in the system gets at a discount (sometimes even for $0.01).
One question: how much did the carbamazepine cost you, and how much were you reimbursed for the drug itself? To fully understand the problem we need to fully understand the transaction. Great article overall. I’m a physician x 40 years. I feel your pain.
Like Jim said, our total reimbursement was $0.35. Pharmacies don't get to bill separately for drugs and consultations surrounding the dispensing of drugs. Does it matter what the cost of the drug is when the total reimbursement was $0.05? Even if the drug was FREE, that's far below the cost to operate a professional pharmacy.
However, since you care, the payment for the drug was $0.25, and the payment for dispensing was $0.10 for the total payment of $0.35. The drug cost us $0.80.
As an independent pharmacist, I can answer this question. He (Jolley's Compounding Pharmacy) was reimbursed $0.35 for the drug itself. That is the entire reimbursement. THEN at the time of payment, a fee of $0.30 for the transaction was withheld from this $0.35. That is the reimbursement. It has been well established by studies that the cost to dispense including vials, electricity, personnel etc hovers between $11-12 ( I am in Oklahoma but I believe we are fairly close to the national average of cost to dispense) The PBM he mentioned does not include a dispense fee for service on most of their commercial plans
Great rambling Benjamin. I agree with everything you stated. It is time for Congress to act in conjunction with the president's EO on drug pricing. Patients, practitioners, and pharmacies have suffered long enough. Then they need to tackle our completely dysfunctional healthcare system.
Great intentions. Imossible to implement. Drug pricing in the US is market-based. Pharmaceuticals lobby the government and contribute large sums of money to both parties. This token gesture creates smoke and mirrors to make it look like he is doing something. He signs EOs with no plan of execution. He signs EOs with claims to do something about the flavor of the day, but never says how or follows up. Is the healthcare system dysfunctional? Yes. An EO, without an implementation plan, won't fix it.
I worked for CVS as a pharmacy tech. I watched people cry as they walked away without life-sustaining medication because they couldn't afford it. Diabetics need their insulin to live. Massachusetts has a law requiring pharmacies to fill with generics unless it says "dispense as written." EpiPens, even the generic brand, are hundreds of dollars. By statute, school-age children are required to have three. Pharmaceuticals claim they need to recoup funds for R&D. Nonsense. The most significant slice of the pie is marketing. R&D is a sliver.
I've had similar experiences. While the pricing of (especially brand) drugs by Pharma is insane, it's incredibly frustrating to tell someone "I'm sorry, but your insurance won't pay for your drug at my pharmacy, they require you to go to their pharmacy for coverage." That's a problem that I know the solution to, and the only downside to banning PBMs from owning pharmacies is that maybe CVS, UNH and CIG's stocks have a bad day. The downsides to unilaterally forcing price cuts to drug manufacturers are potentailly medication shortages and potentially reduced R&D. While you are absolutely right that the pricing of drugs is for the funding of R&D is more an excuse than a true statement, the existence of high drug prices does probably mean that investors are willing to put more money into early stage pharmas than they otherwise would. I think there are other and better ways to get at funding drug R&D than "sky high drug prices," but I do want to live in a world where we DO have more new drug products treating all of the diseases that are currently untreatable. And it's not just R&D or marketing, it's that the entire healthcare system, from Medicaid to safety net clinics is built on the edifice of sky high drug pricing through the MDRP and the 340b program. We have built a healthcare system where so much is built on the backs of the sickest patients and their employers paying full freight for drugs that everyone else in the system gets at a discount (sometimes even for $0.01).
One question: how much did the carbamazepine cost you, and how much were you reimbursed for the drug itself? To fully understand the problem we need to fully understand the transaction. Great article overall. I’m a physician x 40 years. I feel your pain.
Like Jim said, our total reimbursement was $0.35. Pharmacies don't get to bill separately for drugs and consultations surrounding the dispensing of drugs. Does it matter what the cost of the drug is when the total reimbursement was $0.05? Even if the drug was FREE, that's far below the cost to operate a professional pharmacy.
However, since you care, the payment for the drug was $0.25, and the payment for dispensing was $0.10 for the total payment of $0.35. The drug cost us $0.80.
As an independent pharmacist, I can answer this question. He (Jolley's Compounding Pharmacy) was reimbursed $0.35 for the drug itself. That is the entire reimbursement. THEN at the time of payment, a fee of $0.30 for the transaction was withheld from this $0.35. That is the reimbursement. It has been well established by studies that the cost to dispense including vials, electricity, personnel etc hovers between $11-12 ( I am in Oklahoma but I believe we are fairly close to the national average of cost to dispense) The PBM he mentioned does not include a dispense fee for service on most of their commercial plans