In this episode, we discuss the prices of drugs and how you can help reduce it for yourselves and us buying it.






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What you will learn

  • What is 21st Century Highway Robbery
  • How much is that drug….who knows
  • Why PBM’s must go!

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Michelle Sherman, president of MichRX pharmacist consulting services, and your host for the conscious pharmacist podcast. The conscious pharmacist podcast is one of the member podcasts of the pharmacy podcast network. Welcome to this week’s episode that have called 21st century highway robbery. How much is that drug? I have patients constantly asking how much is that drug? How much is that drug?

All of you out there are suffering from the same type of issue. How much is that drug? Well, it really depends who you ask, right? Is this drug pricing is like a moving target. It’s a number that people pull. How do they aid? Pull out of the sky? It just depends who you, who you talking to, who you are asking and what is this whole deal about drug pricing? Well as pharmacists know exactly what it is, what is it? The price of the drug you said we pay is not the price we’re getting reimbursed or paid for from insurance companies.

So we, where do we start? Well, first of all, let’s start with Congress. Let’s just go right to Washington and deal with Congress. They all these drug pricing bills coming out of the house coming out of the Senate because frankly, it doesn’t matter which side of the aisle you on, this drug pricing issue is not a Republican or a Democrat issue. It is a catastrophic issue, a public health issue. And one of a modern day highway robbery. Really because everybody’s getting robbed. Blind drug companies are getting robbed. Independent pharmacies are getting robbed in broad daylight like all day long, just by transmitting a prescription to a PBM and patients are literally dying. So where do we begin? Let’s, let’s, let’s just go to Congress. We have all these drug pricing, drug transparency bills add in, in the house, in the Senate. They don’t do any complicated maybe making headway one way or another.

But let’s face it, every member of Congress is bought and paid for by their sponsors, right? These loving groups are massive. Whether they coming from the oil industry, the pharmaceutical industry, lobby, lobby, lobby, lobby. Let’s just use an example and I’ll put a copy of the slide. This, this image in the resources that in 2015 CVS health spent 15 million, $290,000 on lobbying expenditures. Now really what could they have done with that money and 15 point $2 million on lobbying, you know, and all these members of Congress and state legislators and people that are supposed to be going to back for you and I and patients around the country are being bought and paid for by these massive lobbies. Why was it so high in 2015 well, for all your independent pharmacies out there, you know, you’ve seen what, what’s happened just over the last few years, from 2015 through through today, how our reimbursements have absolutely diminished into the negative abbess that we are paying for every prescription and then some that we dispense to our patients that we’re trying to take care of.

This is how this happened and that is why these PBMs, CVS Caremark, express scripts, Optum RX are these opaque behemoths committing highway robbery not only daily but all day long to independent pharmacies across the country. I mean some examples of let’s just talk about HIV meds from coast to coast, from California to New York, pharmacies are buying the drugs for the patients, dispensing the drugs to the patients and getting negative margins. Essentially paying for these some examples or I’m seeing California was unable to dispense a 30 day supply to the patient. They had to dispense a 90 day supply to the patient. The margin that the pharmacy brought was negative $740 negative $740 so essentially the patient was given their, the pharmacy was giving the patient three months supply of the HIV meds and they’re giving them a half a bottle of the medicine for free because the pharmacy was getting new reimbursed, negative $740 a pharmacy, New York, the same thing.

The patient didn’t want to utilize the mail order pharmacy because of stigma and confidentiality issues of the drug arriving through the mail on the patient’s doorstep. He went to his local HIV pharmacy who’s only too willing to take care of the patient. The pharmacy, the patient knows the pharmacist likes the pharmacist trust. The pharmacist feels comfortable at the pharmacy and has no issues with HIV sensitivity. Stigma with things like that. The pharmacy bills, the prescription, the copay is left over $2,000 the total that paid is $113 to the pharmacy. The pharmacist paid over $3,000 for the drug and its reimbursement is minus $183 now, how’s that that ride? How, how does business operate that way? With negative margins, it’s completely impossible and the egregious behavior is you ride at starts and stops with the PBMs. So when people ask you about drug pricing, you know it depends who you owe.

Their administration had required all these drug ads on TV to acquire the price of the drug on there. Now that’s a joke. What price? The price that the manufacturer might pop up on the screen is not anywhere near what the patients pay, what the pharmacist pay for the drug and most importantly what the pharmacy is getting reimbursed from the drugs. So it’s all ethereal made acting. I mean I could say the price of aspirin is $75,000 who’s to know when you, when patients are in the hospital and you look at the cost of the drugs and you see what the price is for an aspirin or Tylenol, that’s the drug price. It’s a joke. You can go to Costco and buy a whole bottle of Tylenol 500 Tylenol for next to nothing. It’s drug pricing. How much is the drug is an absolute joke and it’s a joke that’s crippling our healthcare system and patients are dying because of it.

So how do we pull this into check? Drug manufacturers also held hostage because in order to get their dry [inaudible] drug on a formulary, the PBMs are holding a gun, a literal gun to the head and making them pay ridiculous rebates. It’s like pay off money. People are being paid off in employee health plans have no idea what their drug costs so nobody knows what their drug costs. So it’s absolutely ridiculous and it starts and stops at the PBMs. It’s got nothing to do with drug manufacturers and it’s Sydney got nothing to do with independent pharmacies. It all has to do with the PBMs. So in order for us to reform drug pricing, to make drug pricing transparent, to make it standardized across the country, we need to eliminate PBMs. It’s as simple as that. But when you have a behemoth that’s spending $15 million on lobbying, how are you going to get the bought and paid for members of Congress to change the laws?

So pharmacists [inaudible] patients out, the people utilizing prescriptions. It’s up to us. We have to start a grocery to movement to eliminate PBMs. So that drug pricing is fair. Pharmacists get reimbursed adequately, at least it in a, in a positive way, or at least what they paid for the drug. I mean, that shouldn’t be hard to ask anybody to just get reimbursed what you pay for the drug. So we need to have a gross roots effort. We have to be conscious people on what’s going on and make changes. It’s all up to us. So this episode of 21st century highway robbery, you can all see the highway robbery and the cans being held to a head all day long. It’s coming from the PBMs. The way to change drug pricing is to eliminate the PBMs from this healthcare system. They should never be in the first place. They just making money hand over fist on the backs of drug manufacturers, on the backs of pharmacists and most importantly on the backs of patients who are literally dying every day. So you see what you can do. I challenge all of you listening to this podcast. What can you do to make a difference? Because it all comes down to each one of us. The difference comes down to what we can do. Be conscious and remember, be the change.