For instance, imagine if you started a job under the agreement that you’d get paid $4,000 a month. But after six months, you get a notification that your account is overdrawn. When you check your account history, you see that a couple months ago, your job decreased your salary from $4,000 a month to $3,000 a month without telling you. When you confront your boss, he tells you, “Yeah, we decided that $4,000 was just too much.
“They have no line of sight on the calculations of how the PBM calculated what they get back,” Lang said. “So it’s completely nontransparent. They’re at the mercy of the PBM. And they have to just trust that the PBM is doing the right thing for them. Which, why would you?”PBMs, however, say the rules of their incentive programs are totally transparent — even those related to the most reviled clawbacks of all, called direct and indirect remuneration fees, or DIR for short.
The pharmacy services administrative organizations, the PSAOs, — the groups that represent independent pharmacies at the table with PBMs — and their own lack of transparency are the real problem, Lopes said. “Obviously, I’ve cut my salary,” Bill said. “I’ve had to cut staff, And that doesn’t feel great either, on a personal level.”
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Shameful
Another example of optumrx abusing ProcterGamble & Pharmacy for Trajenta 5 mg. Top is pharmacy adjudication screen. Bottom is patient EOB. Optum reports plan ProcterGamble paying $317.04, but you can see Optum reimbursed Pharmacy $286.23 = “spread” of $30.81. Understand?
I suggest pharmacies stop billing that insurance company.
Ultimately all independent pharmacies are going to close and we're only going to be left with the large chains, who happen to own the PBMs, like CVS. This is not a coincidence and bad for consumers.
When entity has total control over ANY INDUSTRY such as PBM’s do with respect to “Retail Pharmacy”-when u LITERALLY sit in on the drafting of legislation DIRECTLY affecting how the process proceeds bc u “brought ur way in” what else to expect? ZERO transparency-no oversight = $$$
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Source: Forbes - 🏆 394. / 53 Read more »
Source: Forbes - 🏆 394. / 53 Read more »
Source: Forbes - 🏆 394. / 53 Read more »
Source: Forbes - 🏆 394. / 53 Read more »