How PBMs Make Money and Increase the Cost of Medication

How PBMs Make Money and Increase the Cost of Medication

  July 12, 2023    MDubPharmD

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Pharmacy benefit managers (PBMs) are middlemen in the prescription drug supply chain. They negotiate rebates with drug manufacturers, and they also manage prescription drug benefits for health plans and employers.

PBMs make money in a number of ways. They charge health plans and employers fees for their services. They also receive rebates from drug manufacturers, which are typically a percentage of the drug's list price.

In some cases, PBMs use their market power to negotiate rebates that are higher than the actual cost of the drug. This can lead to higher prices for patients and payers.

For example, the price of the EpiPen, a life-saving allergy medication, has increased dramatically in recent years. In 2007, the list price of an EpiPen was $57. Today, the list price is $608.

Part of the reason for the EpiPen's high price is the way that PBMs make money. PBMs have negotiated rebates with the drug manufacturer that are much higher than the actual cost of the drug. In some cases, the rebate has been as high as 90%.

This means that patients and payers are paying much more for the EpiPen than they need to. The money that they are paying for the EpiPen is going to the PBMs, not to the drug manufacturer.Opens in a new wind

PBMs have also been accused of using their market power to steer patients to more expensive drugs. This can happen when PBMs have financial ties to drug manufacturers. For example, PBMs may own shares in drug companies, or they may receive payments from drug companies for steering patients to their drugs.

When PBMs steer patients to more expensive drugs, it can drive up the cost of prescription drugs for everyone.

PBMs play an important role in the prescription drug supply chain. However, their business practices can sometimes lead to higher prices for patients and payers. There is a need for more transparency and accountability in the PBM industry.

In addition to the EpiPen, there are many other examples of how PBMs make money and increase the cost of medication. For example, PBMs have been accused of using their market power to negotiate lower reimbursement rates for generic drugs. This can lead to higher prices for patients who use generic drugs.

PBMs have also been accused of using their market power to deny coverage for certain drugs. This can make it difficult for patients to access the medications they need.

There is a growing movement to reform the PBM industry. Some people are calling for more transparency in the PBM industry, so that patients and payers can better understand how their money is being spent. Others are calling for more regulation of the PBM industry, so that PBMs are less likely to use their market power to drive up the cost of prescription drugs.

It is important to hold PBMs accountable for their business practices. By doing so, we can help to ensure that patients have access to the medications they need at a fair price.

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How To Effectively Treat and Prevent Constipation

How To Effectively Treat and Prevent Constipation

  May 09, 2023    MDubPharmD

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Constipation is a common gastrointestinal problem that affects millions of people worldwide. It is defined as having fewer than three bowel movements per week, and the stools are usually hard, dry, and difficult to pass. The causes of constipation can be varied, including a low-fiber diet, dehydration, lack of physical activity, medication, and certain medical conditions. While it may not be a life-threatening condition, constipation can be uncomfortable, and it can interfere with your daily activities. In this article, we will discuss how to treat and prevent constipation using over-the-counter remedies.

Treatment of constipation

There are several over-the-counter remedies for constipation that you can try before seeking medical attention. These remedies include fiber supplements, laxatives, stool softeners, and enemas.

1. Fiber supplements: Increasing your dietary fiber intake can help regulate your bowel movements and relieve constipation. You can increase your fiber intake by eating more fruits, vegetables, and whole grains. However, if you are not getting enough fiber from your diet, you can take fiber supplements like psyllium or methylcellulose. These supplements absorb water in the intestine, which makes the stool bulkier and easier to pass.

2. Laxatives: Laxatives are a common remedy for constipation. They work by stimulating the muscles in the intestines to move the stool through the colon. There are several types of laxatives, including osmotic laxatives, stimulant laxatives, and lubricant laxatives. Osmotic laxatives like magnesium citrate and lactulose work by drawing water into the intestines, which softens the stool and makes it easier to pass. Stimulant laxatives like senna and bisacodyl stimulate the muscles in the intestines to move the stool through the colon. Lubricant laxatives like mineral oil coat the stool and make it easier to pass.

3. Stool softeners: Stool softeners like docusate sodium work by increasing the amount of water in the stool, which makes it softer and easier to pass.

4. Enemas: Enemas are a last resort for treating constipation. They work by introducing a liquid into the rectum, which softens the stool and stimulates bowel movements.

Prevention of constipation

Preventing constipation is often easier than treating it. The following are some tips for preventing constipation:

1. Eat a high-fiber diet: Eating a diet rich in fiber can help prevent constipation. High-fiber foods include fruits, vegetables, whole grains, and legumes.

2. Drink plenty of water: Dehydration can contribute to constipation, so it's important to drink plenty of water throughout the day.

3. Exercise regularly: Regular physical activity can help keep your digestive system moving and prevent constipation.

4. Go to the bathroom when you feel the urge: Ignoring the urge to have a bowel movement can lead to constipation.

5. Avoid laxative abuse: Overusing laxatives can lead to dependence and can make constipation worse.

Least potent to most potent remedies for constipation

The following chart lists the least potent to the most potent remedies for constipation:

1. Fiber supplements
2. Stool softeners
3. Osmotic laxatives
4. Stimulant laxatives
5. Lubricant laxatives
6. Enemas

Conclusion

Constipation is a common problem that can be uncomfortable and interfere with your daily activities. Over-the-counter remedies like fiber supplements, laxatives, stool softeners, and enemas can be effective in treating constipation. However, prevention is often easier than treatment, so it's important to eat a high-fiber diet, drink plenty of water, exercise regularly, and go to the bathroom when you feel the urge.

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PBMs Increasing The Price of Epipen And Insulin

PBMs Increasing The Price of Epipen And Insulin

  April 24, 2023    MDubPharmD

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Pharmacy Benefit Managers and the High Cost of Epiens: An Overview

Pharmacy Benefit Managers (PBMs) are third-party administrators of prescription drug programs for health plans, insurance companies, and self-insured employers. PBMs negotiate drug prices with manufacturers and set reimbursement rates for pharmacies, and are therefore instrumental in determining the cost of prescription drugs. In recent years, the high cost of certain prescription drugs, including Epipens, has been linked to the practices of PBMs.

Epipens are devices used to administer epinephrine in cases of severe allergic reactions. The cost of Epipens has risen dramatically in recent years, from around $100 for a two-pack in 2009 to over $600 in 2016. This steep increase in cost has led to concerns about access to lifesaving medication for patients with severe allergies.

One factor contributing to the high cost of Epipens is the role of PBMs. PBMs negotiate prices with drug manufacturers and set reimbursement rates for pharmacies, and they have been accused of using their market power to drive up prices for medications like Epipens. PBMs may negotiate lower prices with drug manufacturers, but then charge higher prices to health plans or employers, effectively increasing the cost of medications for patients. Additionally, PBMs may favor certain medications over others based on factors such as rebates, which can lead to higher costs for patients.

In the case of Epipens, PBMs have been accused of favoring Mylan, the manufacturer of Epipens, over competitors. Mylan reportedly paid PBMs large rebates in exchange for preferential treatment in formularies, which are lists of medications that are covered by a particular health plan. This means that patients were more likely to be prescribed Epipens, even though there were other, less expensive alternatives available.

The high cost of Epipens is not an isolated issue, and PBMs have been linked to other cases of increased drug prices. For example, PBMs have been accused of contributing to the high cost of insulin, which is essential for the treatment of diabetes. Like Epipens, the cost of insulin has risen significantly in recent years, making it difficult for many patients to afford.

While PBMs play an important role in managing prescription drug programs, their practices have come under scrutiny in recent years. Critics argue that PBMs lack transparency and accountability, and that their practices contribute to the high cost of prescription drugs. Some have called for increased regulation of the PBM industry to ensure that patients have access to affordable medications.

In conclusion, the high cost of Epipens and other prescription drugs is a complex issue that involves many factors, including the role of PBMs. PBMs have been accused of contributing to the high cost of Epipens and other medications through practices such as preferential treatment for certain manufacturers and the use of rebates. As the debate over prescription drug costs continues, it is important to consider the role of PBMs in the pricing of medications and to advocate for greater transparency and accountability in the industry.

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Pharmacy Benefit Managers Increasing The Cost of Medication

Pharmacy Benefit Managers Increasing The Cost of Medication

  April 23, 2023    MDubPharmD

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 Pharmacy Benefit Managers Increasing the Cost of Medication: Understanding the Issue

Pharmacy Benefit Managers (PBMs) are companies that manage prescription drug programs for health plans, insurance companies, and self-insured employers. PBMs are responsible for negotiating prices with drug manufacturers, setting reimbursement rates for pharmacies, and creating formularies, which are lists of medications that are covered by a particular health plan. While PBMs were initially created to help reduce the cost of prescription drugs, some have argued that they are actually contributing to the rising cost of medication in the United States.

One of the ways that PBMs increase the cost of medication is by using a practice called "spread pricing". Spread pricing occurs when PBMs negotiate a lower price for a medication with a drug manufacturer, but then charge the health plan or employer a higher price for the same medication. The difference between the lower price negotiated with the manufacturer and the higher price charged to the health plan or employer is called the "spread". PBMs are not required to disclose the amount of the spread, which can be significant. This means that health plans and employers may be paying much more for medications than they need to, which can lead to higher premiums or cost-sharing for patients.

Another way that PBMs increase the cost of medication is through rebates. PBMs negotiate rebates with drug manufacturers, which are discounts off the list price of a medication. While these rebates can help reduce the overall cost of medications, they can also lead to higher prices for patients. This is because PBMs may encourage the use of medications that offer higher rebates, rather than medications that are more affordable or effective for patients. Additionally, PBMs may keep a portion of the rebate for themselves, rather than passing the full savings on to the health plan or employer.

PBMs have also been accused of creating and promoting formularies that favor higher-priced medications over lower-priced alternatives. This can lead to patients being prescribed more expensive medications, even when a lower-priced alternative is available and just as effective. PBMs may do this because they receive a percentage of the amount paid for each prescription, which means that they may have an incentive to promote higher-priced medications.

Overall, the issue of PBMs increasing the cost of medication is complex and multifaceted. While PBMs may have originally been created to help reduce the cost of prescription drugs, some argue that their practices are actually contributing to the rising cost of medication in the United States. If you are concerned about the cost of your medications, it's important to speak with your healthcare provider and insurance company to understand how PBMs are affecting your prescription drug coverage. Additionally, you may want to consider advocating for increased transparency and accountability in the PBM industry, so that patients can better understand how their prescription drug coverage is being managed.

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Way to Lose Weight and Keep it Off

Way to Lose Weight and Keep it Off

  April 19, 2023    MDubPharmD

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Losing weight can be a difficult and challenging process, but it is possible to achieve long-term weight loss success. In this article, we will discuss different diets, the mental approach, and how to sustain weight loss.

Different Diets

There are many different diets and weight loss programs available, each with their own approach and guidelines. Some popular diets include:

1. Low-carb diets: These diets restrict carbohydrates, such as bread, pasta, and sugar, and emphasize protein and healthy fats.

2. Mediterranean diet: This diet emphasizes whole, plant-based foods, healthy fats, and lean proteins, such as fish.

3. Intermittent fasting: This approach involves limiting food intake to specific periods of time, such as only eating during an 8-hour window each day.

4. Low-fat diets: These diets limit fat intake and emphasize lean proteins, fruits, and vegetables.

5. Plant-based diets: These diets focus on whole, plant-based foods, such as fruits, vegetables, nuts, and seeds.

The Mental Approach

Weight loss is not just about following a diet or exercise plan; it also requires a mental shift and a change in behavior. Some tips for adopting a healthy mental approach to weight loss include:

1. Setting realistic goals: It's important to set achievable goals and to focus on progress, not perfection.

2. Building healthy habits: Small, sustainable changes in behavior can lead to long-term weight loss success.

3. Finding support: Joining a weight loss group or working with a therapist can provide accountability and encouragement.

4. Practicing self-care: Prioritizing self-care, such as getting enough sleep and managing stress, can help support weight loss efforts.

Sustaining Weight Loss

Once weight loss goals are achieved, it's important to maintain the weight loss to prevent regain. Some tips for sustaining weight loss include:

1. Continuing healthy habits: Continue to eat a balanced diet and engage in regular exercise to maintain weight loss.

2. Monitoring progress: Regularly weighing oneself and tracking food intake and exercise can help maintain accountability.

3. Managing stress: Stress can lead to emotional eating and weight regain, so finding healthy ways to manage stress is important.

4. Building a support system: Maintaining a support system can provide encouragement and accountability.

In conclusion, achieving long-term weight loss success requires a combination of different diets, a healthy mental approach, and sustained efforts to maintain weight loss. By adopting healthy habits, managing stress, and finding support, it is possible to achieve and maintain a healthy weight for the long-term. 

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Overview and Treatment of a Heart Attack

Overview and Treatment of a Heart Attack

  April 19, 2023    MDubPharmD

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A heart attack, also known as myocardial infarction, is a serious medical emergency that occurs when the blood flow to the heart is blocked, causing damage to the heart muscle. In this article, we will discuss what a heart attack is, how to treat it, preventative measures prescribed to patients to prevent another heart attack from occurring, dangers of not seeking treatment, and non-pharmacologic ways to help prevent another heart attack from occurring.

What is a Heart Attack?

A heart attack occurs when the blood flow to the heart is blocked, usually by a blood clot. This can happen when the arteries that supply blood to the heart become narrowed and hardened by a buildup of cholesterol and other substances. When the blood flow to the heart is blocked, the heart muscle can become damaged or die, which can lead to serious complications or even death.

How to Treat a Heart Attack

A heart attack is a medical emergency, and immediate treatment is crucial. The following steps should be taken if someone is experiencing a heart attack:

1. Call for emergency medical assistance.

2. Administer aspirin, which can help prevent further blood clots.

3. Administer nitroglycerin, which can help improve blood flow to the heart.

4. Begin cardiopulmonary resuscitation (CPR) if the person stops breathing or their heart stops beating.

5. If necessary, perform defibrillation, which can help restore a normal heart rhythm.

Preventative Measures Prescribed to Patients to Prevent Another Heart Attack

After a heart attack, patients are typically prescribed a combination of medications and lifestyle changes to help prevent another heart attack from occurring. These may include:

1. Medications to reduce the risk of blood clots, such as aspirin, clopidogrel, or heparin.

2. Medications to lower blood pressure, such as beta-blockers or ACE inhibitors.

3. Medications to lower cholesterol, such as statins.

4. Lifestyle changes such as quitting smoking, eating a healthy diet, exercising regularly, and reducing stress.

Dangers of Not Seeking Treatment

Not seeking treatment for a heart attack can be extremely dangerous, and can lead to serious complications or even death. The longer the heart muscle is deprived of oxygen, the more damage can occur. In some cases, the damage can be irreversible, leading to heart failure, arrhythmias, or even sudden death.

Non-Pharmacologic Ways to Help Prevent Another Heart Attack

In addition to medication and lifestyle changes, there are several non-pharmacologic ways to help prevent another heart attack from occurring, including:

1. Quitting smoking: Smoking is a major risk factor for heart disease, and quitting smoking can significantly reduce the risk of another heart attack.

2. Eating a healthy diet: Eating a diet that is low in saturated fat, cholesterol, and salt can help reduce the risk of heart disease.

3. Exercising regularly: Regular exercise can help improve heart health and reduce the risk of heart disease.

4. Reducing stress: High levels of stress can increase the risk of heart disease, so finding ways to reduce stress, such as practicing relaxation techniques, can be beneficial.

In conclusion, a heart attack is a serious medical emergency that requires immediate treatment. Preventative measures, such as medication and lifestyle changes, are prescribed to patients to help prevent another heart attack from occurring. Not seeking treatment for a heart attack can be extremely dangerous, and can lead to serious complications or even death. Non-pharmacologic ways to help prevent another heart attack from occurring include quitting smoking, eating a healthy diet, exercising regularly, and reducing stress.

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