If I wrote what I think about the U.S. drug procurement “system,” the TMF computer would shut me down right away. Suffice it to say that it is opaque, expensive and a rip-off. Pharmacy benefit managers are a big part of the problem.
I have several prescriptions. Even though I have Medicare Part D coverage, I get paper prescriptions and carefully shop for the best price. I compare GoodRx and Blink Health as well as Amazon’s new prescription drug service. It’s amazing how much difference there is in pricing. Depending on the drug, I sometimes use my Part D coverage, sometimes not.
Now a major health insurer is doing the same. Can this be the beginning of the end for pharmacy benefit managers? The impact could be huge on the Macro economy as well as the stock prices of the PBMs.
Blue Shield of California says it aims to save millions on drug costs, and plans to drop CVS Caremark as pharmacy-benefit manager
Anna Wilde Mathews, The Wall Street Journal, Updated Aug. 17, 2023
A major health insurer says it will jettison the complicated system that Americans use to pay for drugs, and create something that aims to be better, with partners including Amazon.com AMZN -0.38%decrease; red down pointing triangle
and the entrepreneur Mark Cuban.
Caremark, the pharmacy-benefit manager it currently uses, which negotiates drug prices and wraps in other services such as a mail-order pharmacy.
Instead, Blue Shield, a nonprofit health plan with about 4.8 million members, will work with a selection of companies that each perform a designated function. Amazon will offer at-home drug delivery. Cuban said Mark Cuban Cost Plus Drug Company will provide access to low-cost medications, including through retail pharmacies. Another company, Abarca, will process drug claims.
Blue Shield said that, working with its partners, it aims to negotiate prices with pharmaceutical makers in a way that is different from the typical approach—with a simple net price structure that is supposed to eliminate rebates and hidden fees… [end quote]
Since this is new, it’s hard to say whether there will actually be cost savings for Blue Shield.
As for METARs, we can optimize our own situations.