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The PBMs are who contracts with pharmacies over which insurance plans will be accepted. Basically pharmacies have to take the contracts as a whole and do the ma
by sct202 3y ago
The PBMs are who contracts with pharmacies over which insurance plans will be accepted. Basically pharmacies have to take the contracts as a whole and do the math over if they'll win or lose across the whole contract. Really only a few companies have the ability and leverage to negotiate somewhat fairly with the PBMs. On top of this, the major PBMs are now all owned by insurance companies so the difference between the PBM and insurance companies are kind of nebulous, and with this consolidation pushes the power more to the insurance company.
- twoodfin 3y agoUnder this logic how are PBM’s driving costs up? Seems like they’re there to reach the scale necessary to maximize downward pressure on costs.
- lotsofpulp 3y ago>The PBMs are who contracts with pharmacies over which insurance plans will be accepted. When the PBM is owned by the insurer in the first place, it is a moot point. The 5 biggest health insurers all have their own PBM.