Saw this first hand: drug was $100+ at my local pharmacy, but only $18 at CVS. The CVS PBM sells the drug much more cheaply to CVS than my local guy. Trouble is, when my doctor asks "which pharmacy should I send this prescription to?" there was no way to know the huge price diff at that time. The idea that we are educated consumers of medical goods and services is laughable.
I work in a pharmacy. Kroger and Walmart seem to be cheaper. Of course the price depends on your insurance. Some insurance don't work certain pharmacy chains
Pharmacist here: so much attention needs to be brought to how corrupt the insurance and PBM industry is. They nearly have 0 risk in their business and generate TONS of profit. Meanwhile, the healthcare workers (in this case pharmacists/pharmacies) are struggling to keep their jobs and businesses open even though they’re the ones who are actually helping patients.
Ex-software engineer here who worked for one of the largest health insurance providers in the country. It is a pure scam. If it was possible, everyone in my department would sit on their ass all day, collect your money, and cover nothing. That's the goal. Do nothing, get paid anyway. It'd be great but every time I went to the doctor, I thought "this scam is paying my paycheck". I had to get out
You're the pharmacist, start making a mockery of it Publicly. Write an article for the news paper, call your local news station and inform the people. This is the way to do it, people on the outside don't know, yall people on the inside know all to well. Don't you take an oath of ethics?
as they approach the counter, lined chips and chocolate treats...... they saddle up to the pill machine........ps.no drug has ever been tested for gut biome effects.... thanks for the help.
@@CraigChrist8239 Ex-Systems Analyst here who worked for the 3rd largest health insurance provider in the country. I can confirm. This is all true. I wore rose colored glasses for several years until my conscience made me leave. You should see what they do to the Provider claims. They don't pay. Your deductible and copays are all the Providers get. It's scary and probably criminal but everyone has to sign NDA's. Health Insurance companies are robbing us and killing us.
God bless this man (Ciaccia). He helped convince Ohio's greedy-ass senate to approve of making Medicaid servicers go through a single pharmacy benefits manager (pbm) of Medicaid's choosing. This gave Medicaid a huge level of say in what drugs are covered because up until then, each insurance company had their own pbm they would use, even with Medicaid consumers. Homeboy did the poor of Ohio a huge service.
Plus his research organization 46Brooklyn is fantastic, they do an outstanding job of explaining things for everyone to understand with their podcasts and compiling data to prove how full of shit these companies are
The healthcare companies are banding together and trying to get the supreme court on their side. I hope they lose. They have tried already to sue to overturn this.
It can even be Illegal for pharmacists to tell customers that they could save money by paying cash for a drug that would cost less than their health insurance copay with “gag clauses”
Oh I can do you one better/worse than that, in Minnesota if you are on Medicaid it is illegal for them to accept cash for a medicine not covered. (Technically illegal for the patient, too.) But just imagine, so if you have a medicine that could be afforded via a BS scheme like GoodRX or a Pharmacy specific discount, you can't.
@@smarty2456just let any liberal gun nut go with you to protect your rights or file a petition if you have sense. Nobody will leave you behind we just have to get moving. Good night and good lick
I'm Canadian, visited the US for 2 months for work related matter.. had to get a refill on my medications while there and a 1 month supply in the US cost me $570 (US)... meanwhile in Canada, where the specific drug I take is price-capped by our government because it is classified as a life-saving drug, only costs me $45 (US) for a 1 month supply. Similar results for my other drugs as well, on average the US charged between 4x to 9x as much per drug than what I paid back home. It is lunacy, I cannot fathom living in the US, I would lose a huge portion of my income just on medications I need for my various conditions.
I am from Canada, moved to the States decades ago. I'm still shocked at how poor the medical care is and yet how high our medical premiums are. My relatives in Canada have no idea and think I am exaggerating.
@@Acidfunkish Oh believe me, the second I hear any talk of privatization of healthcare by any politician, they automatically lose my vote. I would become financially crippled under privatized health care and it is anathema to the Canadian way of life as far as I'm concerned. Our health care is far from perfect and has plenty of problems, but having lived a bit in the US and 99% of my life in Canada, I would NEVER trade the Canadian healthcare system for the US system.... unless I was a millionaire and didn't have to worry about medical costs. That's all the US healthcare system is good for, rich people... it completely screws the middle and working class though.
@@HathurI live in AB. :( Our premier is privatizing everything peripheral to healthcare, and it *always* ends up becoming a huge burden. Lab work was privatized, and people were suddenly waiting weeks for results, and the backlog was growing. Hospital cleaning services were partially privatized, so they're no longer in-house and able to respond to requests within a reasonable amount of time. The general-use areas are never fully cleaned, anymore. Handles and railings are never sanitized. If an "accident" happens, a work order has to be put in, and the cleaning staff will get to it when they're scheduled next. IN HOSPITALS. Oh, and not quite to the same level of importance, but cafeteria services were also privatized. The food quality took a steep dive, and has never recovered. My mom used to eat her lunches at her hospital, twice per week, because they were healthy, tasty, and inexpensive. They're slop, now. Our premier also keeps coming up with stupid ideas like "health vouchers." Something like $300, annually, probably in order to get Albertans used to paying for healthcare services. Oh, and, mentioning my mom, again. They've not been allowed to order office supplies since January, and can't again until March, so they're supposed to organize office supply swaps between departments, to get the supplies they need. Problem is, everybody needs paper. Nobody has extra. But there's no way for doctors to opt out of receiving paper copies for everything medically-related, even if they solely use the online system, which has all of the same info. They're in such a rough spot, financially, that they can't afford paper and pens. But, Danielle Smith is choosing to go ahead with her plan to "restructure" healthcare in Alberta, dividing it into 4 separate entities: Acute Care, Continuing Care, Primary Care and Mental Health and Addictions. This is going to cost at least $85 million, apparently. Priorities. She is aggravating. I'm exhausted. 😕
As a physician I can verify this. The formulary is basically what you can prescribe and it varies even within insurance and changes yearly or more. Of course it has to do with money. It’s awful.
Oh, don't forget that a lot of clinics have an inhouse pre-auth department to decide if requests for drugs or procedures should be even sent to the health insurance companies for pre-auth. I had an issue with a medication I was on with another doctor and insurance that WAS paid for by Medicaid at the time. I changed doctors and companies that managed my Medicaid and the medication was refused. I asked my doctor two more times to resubmit the request with further info and it was denied again. Then I started digging, ended up talking to someone in the insurance department of the formulary that patients are NOT supposed to talk to, the # for physicians only. The super nice lady looked up the medication and was like, "Oh, yah we cover that medication with pre-auth, the doctor just needs to submit the request." ----this was after over at least 2 hours of phone calls and emails with my doctor and other people. I was livid. Didn't know about the inhouse preauth thing at the time and emailed my doctor asking what was happening.. thats when I found out about the inhouse preauth nonsense. But, it's not quite his fault.. hes over worked. NO clinic should do a pre-pre-auth in house. Just do a review to determine if other doctors feel it is medically necessary and then send the damn request to the insurance companies. .. and friggen be upfront to patients about the process needed to get pre-auths through. All my doctor did was tell me it was denied with no further info, no suggestions of what else to take or how to get them to cover it. I'm still seeing the same doctor but I watch him like a hawk.
I love how 15 seconds in I could immediately tell this was about PBMs. Did my Grand Rounds in pharmacy school on them, and I love nothing more than to seem them getting the spotlight they deserve for ruining the pharmacy world
As a brain tumor survivor who now has a rare terminal illness, let me give you one word of advice: DO NOT EVER GET F*CKING SICK IN AMERICA UNLESS YOURE RICH! OTHERWISE YOU WILL END UP BANKRUPT AND HOMELESS 🤬
A few years back, researching the cash price for a certain drug, one pharmacy wanted over $300, another was close to $800. Then I tried the Costco pharmacy who sold me the exact same prescription for $27. (Side note: you don’t have to be a Costco member to use their pharmacy. )
I switched from cvs/wallgreens to a local pharmacy (who's goal is to sell rx for the cost to get the drug + %30 for the pharmacy, they're very open about it), and my meds without insurance there is cheaper than my meds at the big names was with insurance.
😂😂😂 The US government has never been interested in helping the common man. Very few people in office give a rat’s a** about you and me. Too bad we are all exhausted by having to work 2 jobs each just to make ends meet to do anything about it. It’s almost like our sh*tty economy is that way for a reason, eh?
Great video!! A related topic - drug manufacturers offer "coupons" that reduce the cost to the consumer of many drugs (and these couponsare NOT based on financial need). These coupons cannot be used by anyone on Medicare. Many people struggle with the cost of medications when their only income is Social Security. The people who need the coupons most can't use them! That would seem to be worthy of a video...
Yes, you are correct. Before Turning 65 I could use coupons for two of my prescriptions, which cost me $20 per month. After being forced onto Mediscam, I could not use the coupons. I now pay $3200 per year. When trying to get a reason for this, my senator, Kevin Cramer, refuses to answer me.
I wish you had compared how formularies are used by other countries to control pharmacy costs. In the USA, there is a giant, bloated bureaucracy that generates profit at the patient's expense. Result: highest prices and worse health outcomes in the USA.
That's why things like healthcare and education should all be nationalized, just like police and fire departments. Profits should never be linked to these things. This country is all kinds of phucked.
@@shortstraw4 Oh my god are you silly. Learn from the others don't just repeat NONSENSE you swallowed whole from right-wing media. Government CAN be there to help you if you allow it and don't VETO it like morons. You literally souind like a parrot with the brains of a bird.
This is 'free' market capitalism, allowing legislative and regulatory capture by for-profit companies. Once companies make enough capital, they use some of that capital to finance polital campaigns. They then use more capital to lobby the pols they bought (not brought) into office. It could be argued that this system is simply bad government, but that would be putting the cart before the horse IMO. The problem is capitalism, for-profit healthcare, and legally incentivised greed. We would all hope for noble politicians who do the right thing for their constituents, but that's not the system we have promulgated (especially since the Citizen's United ruling by SCOTUS).
@@pierrechildress8875 Once legislative and regulatory capture happen, it isn't capitalism anymore. I have lived in Philippines and Kenya, and both of those countries have a fairly free market for health care. In the Philippines, I bought some antibiotics for about $5 for a bad blood infection after getting badly bit by some insects when traveling by cargo ship. Unfortunately, I was only able to take them for two days and was forced to toss them in trash during customs when I returned to America since I had no prescription. The infection came back with a vengeance. I tried to tough it out since you can't buy antibiotics over the counter in the USA, but eventually had to go to the hospital. The hospital bill was around $30,000 just to get some antibiotics. Yes, they ran other tests, but all I needed was the antibiotics. I am retired in Kenya now. Twice in the last decade, I have needed antibiotics. I just go to the pharmacy and buy them. There is a local dentist (very well educated) I like. He charges $10 for a tooth extraction. My wife got all her teeth cleaned for $25. She got an MRI after a bad accident for just $100. These medical/dental markets in Kenya and Philippines are almost pure capitalism. No doctors blocking your access to medication. This is what America needs.
Investigate the chemical plant near Paris County Kentucky. Residents have claimed that black mold started to grow in the area around the same time as the plant. Also, most residents didn’t want the chemical plant to be built in their district yet their politicians still approved.
Yes and the corporate often foreign owned pig farms spraying manure in the air in the Carolinas. Add the train chemical.spill and the outcome in Pennsylvania.
Drug companies are also to blame. They make record amounts of profit on US customers compared to other countries. If it were solely the PBMs' fault then prices for drugs would be higher here without a comparative increase in profits which isn't the case.
Drug companies are selling a product and their only interest is to make as much profit as possible for their shareholders. Insurance was supposed to be there to negotiate down prices for their customers and the government is supposed to protect us from price gouging and bribes that would cause us to pay more. But both of them are complicit in the corruption so everyone failed us.
The current FTC chair is actually trying to look into them, last year they managed to pass a vote to force them to submit documents for investigation. But it's the government so it's slow, plus their lawyers are trying to slow everything down as much as possible
You’re a fantastic communicator. Thank you for making these complex subjects easy to digest, so that lay-people can understand how and why they’re being screwed. It really is awful how corrupt the US economy is from the top down. Looking forward to more videos like this! Educate the people!
There’s a quote from a Pharma exec in a book from the Cochraine Institute, he said we’re just like the drug cartels, but legal. Apparently, insurance learned its lessons from them.
Express Scripts will change your Drs scripts, and when you complain,they say you're disposable. They hold you hostage by denying you access to your prosthetics for profit.
Please talk about copay accumulators and maximizers too! Another way insurance companies essentially get paid extra from pharm companies. Even in the few states that ban them, some have exceptions that still leave people paying thousands that the manufacturer already paid the insurance company for.
FYI I would also like to see you report on the Pharmaceutical Ads here in the US and in Australia only, not the rest of the world. This is also a major cost to us as consumers.
Investigation suggestion. 🔥 SSDI benefits application, approval, denial, appeals, timeliness, and decisions process. These are based on regulations designed to ensure most people are denied bc of the diseases covered list, outdated jobs in the economy list, and 5 year time limit that the SSA process makes extremely slow even if you're on a priority list. The fraud rate is under 1%, which is less than half the average rate for most crimes/allegations. ALJ hearings and appeals process including judges whose decisions are so inept that the US Attorney won't defend them. Lack of a fair reporting process for local SSA office federal employees who are known to be hostile to intentionally deny payments. I have receipts.
And then if you do get approved, you can’t earn more than $1500 a month and that’s BEFORE taxes are taken out. People who receive benefits are essentially forced to live their lives in poverty or they are stripped of their benefits and forced to pay back the last two years of benefits they received because they earned $50-$100 too much.
As bad as the insulin prices are, and they definitely are bad, it isn't even the most egregiously marked up product. A dose of Epinephrine costs $2 and is shelf stable for 3 years. Epi-Pens are sold for $700 and are sabotaged to only be shelf stable for 1 year. Pregabalin (Lyrica) costs about $15/mo at pharmacies that don't take insurance and $1400+/mo otherwise.
Thank you, More Perfect Union. I highly value your editorials (that might not be the best word). I feel like I need this information and there are very few alternatives where I can trust the source, so thank you.
They arent just hired by your insurance. Sometimes your insurance owns them. (See: anthems pbm. Sure they outsource the employees, but they own the pbm.)
I really appreciate you tackling drug pricing and pharmaceutical policy. I would love to see you guys tackle compounded drug coverage. Compounded medications are essential to many people who have allergies, have long COVID and Mast Cell Activation Disorder (a rapidly increasing disease) but most insurances and Medicare and Medicaid won't cover them even when medically critical. Many people who have these conditions are forced off public assistance because they must rely on charity to buy medication and it disqualifies them from services under "cash gifts". Too many go without because they can't afford compounded medications and the associated human and monetary costs are brutal.
I can’t tell you how many times I’ve been waiting on a prescription at my local pharmacy and I will hear someone say they can’t afford to get all of their medicine filled.. I go to the pharmacist and tell her I’m going to pay for that person’s medication but ask her to plz not tell them who it was because I don’t need any of that attention and I definitely don’t want to embarrass the customer or myself.. I just know how it is and if I can “pay it forward” I try to help as much as I can even if I don’t have much to give, it hurts me so much to see someone going without.. especially their medication 🥺
Interesting, valuable information. I live in Ohio, and my current pharmacy is CVS. Thank you for reporting, and thank you, Dave Yost. I am currently searching for another pharmacy. I am so glad this came across my views today it confirmed my suspicion.❤
It's great that you cover these issues, but I'd very much like more information available for how an individual might take action to help the situation on any given subject you cover. I often find myself thinking "Okay, now I know about this issue... what can I do about it?" and I'm sure I'm not the only one.
Frier Levitt published an expose document back in 2022 that details the many ways PBMs screw everything over, current legal precedents, and actions that can and are being taken to fix things. Just googling PBM expose should pull it up, it's an amazing read at around 80 pages full of resources and references. But in general a lot of states are waking up to what they've been up to and steadily cracking down, but mostly only affects state medicaid
Take responsibility for your own health. We take better care of our cars than we do our own bodies. Stop buying into their propaganda and using their system and crappy bioengineered petroleum based synthetic poison chemicals aka pharmaceuticals. 90% of all illness is related to diet.
My pharmacy filled my hubby's Eliquis for a year. Yesterday, I picked it up. They said this was the last time they could fill, or he could pay over 300.00 dollars out of pocket, or change his MEDICARE prescription plan and pay more that way. I told him, get a different scrip that is covered....funny to see this article next day...funny business by drug companies. Why am I not suprised?
Thank you 💫 I have walked away from my Nursing career partly due to scenarios such as this. Being a Case Manager & having to juggle around in the system to get patients what they were prescribed on the insurance formulary was rediculous. Some chose just not to take the med then were "labeled" noncompliant. The 3 month supply programs are wasteful and are guided as a convenience.
It has been fucked up for so long we are just starting to feel the side effects of it. The USA's healthcare systems were sold out to private interests in 1929 by Hoover and continued to be degraded by Roosevelt and 12+ other presidents after them.
Thanks for shining a light on this topic, but prescription drugs isn't even the half of it here in the US. Big companies have the same kind of wealth-slurping advantages in health insurance, dental insurance, worker's comp, probably mental health... overall leads to worse healthcare that costs more for average people. Gee, I sure wonder why average health and longevity is declining here. Couldn't possibly be the system prioritizing corporate "citizens" profits over pesky human citizens' rights and best interests...
Using pharmacies that don't accept insurance is one way to impact the PBM's. As a physician, I often refer people to Mark Cuban's CostPlus pharmacy. Many medications can be purchased from them without using insurance for less than the copay to a PBM like Express Scripts. The caveat is that they almost exclusively carry medications available as generics, so anything still under patents is not available.
Mail in rebates are a bit of scam themselves. The company "lowers" the price of an item by offering a mail in rebate, knowing that many people will never send it in. They can advertise the lower price, but put that it requires a rebate to get that price in small print.
From exorbitant medical bills to fraudulent practices, navigating the intricacies of the healthcare system can be overwhelming. Considering the complexity and potential financial pitfalls, having a finance advisor that knows much about healthcare becomes crucial to protect oneself and make informed decisions.
Absolutely. The rampant issues of overcharging, surprise billing, and deceptive practices in American healthcare necessitate a proactive approach. Engaging a finance advisor can provide insights into understanding medical bills, evaluating insurance options, and avoiding potential scams. It's about empowering individuals to navigate a system that often seems designed to exploit rather than support.
I have to rewatch this over and over to understand it. I seldom use prescription drugs, and I'm grateful for that. BUT I have many friends and family who do and this system is so confusing. The medical industrial complex, insurance industry, pharmaceuticals, food, and advertising all in bed together. This is so outrageous!
Another wrinkle in meds: the generic med I use is also made by the pharm company that makes the non-generic. So, if I can’t get the generic, I would be forced to buy the original which is many times the cost of the generic. So they can control the availability of the generic. Shouldn’t be allowed.
Per the pharmacist - They have drugs where the out of pocket price is actually cheaper that the copay amount. They are not allowed to tell the customer per their contract with the insurance company unless the customer asks first. The Copay amount actually ends up as a kickback to the insurance company.
This is why I never give the pharmacy my insurance information. We were completely uninsured for several years and during that time I learned that my husband's maintenance drugs were way cheaper as a cash pay patient versus paying the insurance drug co pay.
You do realize that the majority of physicians do not belong to the AMA, right? It is a completely voluntary organization, like joining your local Rotary Club, or the AARP.
@@TakenTook It's only 15%. Doesn't matter when the AMA Cartel controls and pays the lobbyists that write the laws. Congress doesn't write the laws they sponsor them. And who contributes to the politicians campaigns???
@@judylandry302 -- Drug / device manufacturers and health insurance companies, contribute far more to lobbying in total than the AMA. Look it up. Doctors are on the same side as the patients here. We want our patients to have lower drug prices, lower insurance premiums, better access to nutritious food, and other things that will keep them healthy.
@@judylandry302 -- Not sure why my reply keeps getting deleted, there's nothing offensive in it. Look up the numbers and you'll see that the AMA does very little lobbying compared to drug companies and insurance companies
There's an 80 page expose document published by Frier Levitt detailing the abuses of PBMs as well as what can be done about it. Highly recommend digging through it and hitting up your state legislature with it
Unfortunately, the propaganda machine worked so hard to make Americans believe that Canadians are dying all over the place, because we can't access the meds we need, or whatever. Most of the anti-single payer advertising was done in the late 90s and early 00s, but it is still believed, even now. The US is the richest country in the world. They could absolutely afford to provide healthcare for everyone. Instead, Cuba - suffering huge economic challenges due to a 60 year embargo - now has better healthcare outcomes than the nation attempting to stifle it. Embarrassing.
In the UK the British National Formulary indicates the maximum price the National Health Service will pay for a prescribed generic drug to pharmacies. For in-patent branded drugs there is the "Voluntary Scheme For Branded Medicines" which basically allows the National Institute For Clinical Excellence (NICE) to not allow the prescribing of an approved drug on cost grounds by the NHS. If the manufacturer lowers the price to a point that NICE accepts the NHS can prescribe it. Since the NHS pays for over 95% of prescribed drugs it's remarkable how quickly manufacturers comply. That's why Ozempic costs $90 a month in the UK and over $1,000 in the US.
I used to work for CVS/caremark. They tell their clients that the formulary is decided by a board of doctors for safety, efficacy and yes of course price, but they put emphasis on the first two. This company also loads up their employees with so much work that they don't get a day off for nearly 4 months in a row annually. At least in the dept I worked in which was to implement new clients.
@7:08 I was seeking the answer to this question for high dollar specialty medications. I’m currently being held hostage by a PBM and it’s exhausting and infuriating
Sure wish I was born in Canada, the worry and stress about health care in the US makes you sick. In the drug department ,in my case, I try to depend a lot on the old grannies remedies of old but, of course , I know there are some prescriptions people need. I feel doctors do over prescribe and don’t know much about what they are prescribing, doctors are bought and paid for today by for-profit local and foreign corporations.
Fantastic video! Great description that anyone can understand! It is past time to shed light on this parasitic and symbiotic drug distribution ecosystem. Thank you for sharing! I am joining the effort to help inform consumers also. It is going to take consumers, pharmacists, and hopefully employers and government entities. By the way, does 3AXIS do webinars, consultations or work with employers about what health insurance providers should consider when selecting insurance providers that include patient outcomes and formulary inclusion and prices.
I remember pharma reps coming in regularly to talk to our pharmacists to convince them to recommend their drugs or stock their drugs at our locations. I recall my boss being disgusted every time he’d see them who CB was a good sign.
Like a lot of modern problems in the world, Reagan is right there, like, at this moment it would be easier to just point out the problems where Reagan wasn't involved. Well, it would still be hard to find those cases.
This also kinda applies to the new call centers... If you had a problem years ago you could walk into your local business and handle it with a manager on site ..not anymore ...even a at Verizon TMobile etc you can't speak to a manager ... They totally cut off our ability to complain and get a resolve
8:44 this is the model that my heal care provider has had for 30+ years with very very limited special medication coverage, they only do generic unless there is literally no other option, then they’ll pay the astronomical price of the brand name. It works well & no one had to pay out of pocket for any medication until Anthem (Blue Cross Blue Shield) bought them out about 10 years ago, but even then they seem to have stopped at a maximum payment of $10/mo of medication & still have free medications.
PBMs became viable in the 60s when regulation of the pharma and health insurance industries made managing this area of healthcare far too complex for insurance companies, distributors and pharmacies. The main driver of the increase in healthcare costs is additional administration headcount(3300%) used to comply with all of the increasing federal, state and local regulations on healthcare. These increased costs are not only hurting individuals, but are also the main drive behind the consolidation that's occurring in the industry.
I'd be curious to see how vision care coverage works. Just bought a pair of glasses, cheap frames, because I'll probably never use, just like the last set (bought years ago). A $69 set of cheap frames, with progressive and all the fun films applied jacked the price to almost $500, and that was WITH insurance.
Saw this first hand: drug was $100+ at my local pharmacy, but only $18 at CVS. The CVS PBM sells the drug much more cheaply to CVS than my local guy. Trouble is, when my doctor asks "which pharmacy should I send this prescription to?" there was no way to know the huge price diff at that time. The idea that we are educated consumers of medical goods and services is laughable.
I always ask to have paper prescription
I work in a pharmacy. Kroger and Walmart seem to be cheaper. Of course the price depends on your insurance. Some insurance don't work certain pharmacy chains
You honestly should be. Doctors should think about looking for that as well. It seems a little dumb that that was the case ngl.
@@pierregravel-primeau702paper prescriptions are being phased out. This won’t be an option for much longer.
And it's always changing
Pharmacist here: so much attention needs to be brought to how corrupt the insurance and PBM industry is. They nearly have 0 risk in their business and generate TONS of profit. Meanwhile, the healthcare workers (in this case pharmacists/pharmacies) are struggling to keep their jobs and businesses open even though they’re the ones who are actually helping patients.
Ex-software engineer here who worked for one of the largest health insurance providers in the country.
It is a pure scam. If it was possible, everyone in my department would sit on their ass all day, collect your money, and cover nothing. That's the goal. Do nothing, get paid anyway.
It'd be great but every time I went to the doctor, I thought "this scam is paying my paycheck". I had to get out
You're the pharmacist, start making a mockery of it Publicly. Write an article for the news paper, call your local news station and inform the people.
This is the way to do it, people on the outside don't know, yall people on the inside know all to well. Don't you take an oath of ethics?
Software engineers have nothing to do with approving or denying claims. I did the same thing.
as they approach the counter, lined chips and chocolate treats...... they saddle up to the pill machine........ps.no drug has ever been tested for gut biome effects.... thanks for the help.
@@CraigChrist8239 Ex-Systems Analyst here who worked for the 3rd largest health insurance provider in the country. I can confirm. This is all true. I wore rose colored glasses for several years until my conscience made me leave. You should see what they do to the Provider claims. They don't pay. Your deductible and copays are all the Providers get. It's scary and probably criminal but everyone has to sign NDA's. Health Insurance companies are robbing us and killing us.
God bless this man (Ciaccia). He helped convince Ohio's greedy-ass senate to approve of making Medicaid servicers go through a single pharmacy benefits manager (pbm) of Medicaid's choosing.
This gave Medicaid a huge level of say in what drugs are covered because up until then, each insurance company had their own pbm they would use, even with Medicaid consumers.
Homeboy did the poor of Ohio a huge service.
Plus his research organization 46Brooklyn is fantastic, they do an outstanding job of explaining things for everyone to understand with their podcasts and compiling data to prove how full of shit these companies are
The healthcare companies are banding together and trying to get the supreme court on their side. I hope they lose. They have tried already to sue to overturn this.
Respect indeed
It can even be Illegal for pharmacists to tell customers that they could save money by paying cash for a drug that would cost less than their health insurance copay with “gag clauses”
This is so messed up. Pharmacists should be able to educate customers and be a part of the solution. Keep spreading the word.
The poors knowing ways to circumvent the systems that screw them for profit? That sounds like communism. @@mrjgilbert
Oh I can do you one better/worse than that, in Minnesota if you are on Medicaid it is illegal for them to accept cash for a medicine not covered. (Technically illegal for the patient, too.) But just imagine, so if you have a medicine that could be afforded via a BS scheme like GoodRX or a Pharmacy specific discount, you can't.
@@smarty2456just let any liberal gun nut go with you to protect your rights or file a petition if you have sense.
Nobody will leave you behind we just have to get moving.
Good night and good lick
😮
"At our other pharmacy, we have to charge higher prices because we have to do business with insurance companies."
That is one hell of a statement.
The same way a nursing home's client is the federal govt, not the patient.
I'm Canadian, visited the US for 2 months for work related matter.. had to get a refill on my medications while there and a 1 month supply in the US cost me $570 (US)... meanwhile in Canada, where the specific drug I take is price-capped by our government because it is classified as a life-saving drug, only costs me $45 (US) for a 1 month supply. Similar results for my other drugs as well, on average the US charged between 4x to 9x as much per drug than what I paid back home. It is lunacy, I cannot fathom living in the US, I would lose a huge portion of my income just on medications I need for my various conditions.
I am from Canada, moved to the States decades ago. I'm still shocked at how poor the medical care is and yet how high our medical premiums are. My relatives in Canada have no idea and think I am exaggerating.
Shhhh!!! Americans believe their health care system is the best.
Don't allow any of our premiers to try to slowly privatize healthcare. 😒
@@Acidfunkish Oh believe me, the second I hear any talk of privatization of healthcare by any politician, they automatically lose my vote. I would become financially crippled under privatized health care and it is anathema to the Canadian way of life as far as I'm concerned. Our health care is far from perfect and has plenty of problems, but having lived a bit in the US and 99% of my life in Canada, I would NEVER trade the Canadian healthcare system for the US system.... unless I was a millionaire and didn't have to worry about medical costs. That's all the US healthcare system is good for, rich people... it completely screws the middle and working class though.
@@HathurI live in AB. :( Our premier is privatizing everything peripheral to healthcare, and it *always* ends up becoming a huge burden. Lab work was privatized, and people were suddenly waiting weeks for results, and the backlog was growing. Hospital cleaning services were partially privatized, so they're no longer in-house and able to respond to requests within a reasonable amount of time. The general-use areas are never fully cleaned, anymore. Handles and railings are never sanitized. If an "accident" happens, a work order has to be put in, and the cleaning staff will get to it when they're scheduled next. IN HOSPITALS.
Oh, and not quite to the same level of importance, but cafeteria services were also privatized. The food quality took a steep dive, and has never recovered. My mom used to eat her lunches at her hospital, twice per week, because they were healthy, tasty, and inexpensive. They're slop, now.
Our premier also keeps coming up with stupid ideas like "health vouchers." Something like $300, annually, probably in order to get Albertans used to paying for healthcare services.
Oh, and, mentioning my mom, again. They've not been allowed to order office supplies since January, and can't again until March, so they're supposed to organize office supply swaps between departments, to get the supplies they need. Problem is, everybody needs paper. Nobody has extra. But there's no way for doctors to opt out of receiving paper copies for everything medically-related, even if they solely use the online system, which has all of the same info. They're in such a rough spot, financially, that they can't afford paper and pens.
But, Danielle Smith is choosing to go ahead with her plan to "restructure" healthcare in Alberta, dividing it into 4 separate entities: Acute Care, Continuing Care, Primary Care and Mental Health and Addictions. This is going to cost at least $85 million, apparently. Priorities.
She is aggravating. I'm exhausted. 😕
As a physician I can verify this. The formulary is basically what you can prescribe and it varies even within insurance and changes yearly or more. Of course it has to do with money. It’s awful.
I'm sure you didn't sign up for this when you went to medical school!
Oh, don't forget that a lot of clinics have an inhouse pre-auth department to decide if requests for drugs or procedures should be even sent to the health insurance companies for pre-auth.
I had an issue with a medication I was on with another doctor and insurance that WAS paid for by Medicaid at the time. I changed doctors and companies that managed my Medicaid and the medication was refused.
I asked my doctor two more times to resubmit the request with further info and it was denied again. Then I started digging, ended up talking to someone in the insurance department of the formulary that patients are NOT supposed to talk to, the # for physicians only. The super nice lady looked up the medication and was like, "Oh, yah we cover that medication with pre-auth, the doctor just needs to submit the request."
----this was after over at least 2 hours of phone calls and emails with my doctor and other people.
I was livid. Didn't know about the inhouse preauth thing at the time and emailed my doctor asking what was happening.. thats when I found out about the inhouse preauth nonsense.
But, it's not quite his fault.. hes over worked.
NO clinic should do a pre-pre-auth in house. Just do a review to determine if other doctors feel it is medically necessary and then send the damn request to the insurance companies. .. and friggen be upfront to patients about the process needed to get pre-auths through.
All my doctor did was tell me it was denied with no further info, no suggestions of what else to take or how to get them to cover it.
I'm still seeing the same doctor but I watch him like a hawk.
how about a nationwide doctors strike until health insurance is nationalized
@@ohiasdxfcghbljokasdjhnfvaw4ehr It would be a good thing. But it won’t happen until the older docs retire and maybe not even then. 😟
@@ohiasdxfcghbljokasdjhnfvaw4ehr,no way… no nationalized healthcare.
I love how 15 seconds in I could immediately tell this was about PBMs. Did my Grand Rounds in pharmacy school on them, and I love nothing more than to seem them getting the spotlight they deserve for ruining the pharmacy world
Rage on!
Is Grand Rounds like a dissertation?
@joshyoung1440 basically the pharmacy school equivalent, we give an hour long presentation about a topic affecting the pharmacy world like new drugs
Insurance in the U.S SUCKS. Pretty sucky ngl.
I think everyone can agree with that
It literally doesn't do anything. You pay into it with every paycheck then STILL have to pay 110% of your medical expenses at the end of the day...
As a brain tumor survivor who now has a rare terminal illness, let me give you one word of advice:
DO NOT EVER GET F*CKING SICK IN AMERICA UNLESS YOURE RICH! OTHERWISE YOU WILL END UP BANKRUPT AND HOMELESS 🤬
U ain't, kid....u ain't. 😢
The whole US medical system sucks. When even a very routine procedure (that costs
A few years back, researching the cash price for a certain drug, one pharmacy wanted over $300, another was close to $800. Then I tried the Costco pharmacy who sold me the exact same prescription for $27. (Side note: you don’t have to be a Costco member to use their pharmacy. )
I switched from cvs/wallgreens to a local pharmacy (who's goal is to sell rx for the cost to get the drug + %30 for the pharmacy, they're very open about it), and my meds without insurance there is cheaper than my meds at the big names was with insurance.
Our government is supposed to protect us from this predatory practices. @FDA
Captured by big pharma.
Instead, they rake in the $$$
Ftc
Our government is too focused on getting rich instead of looking out for the citizens
😂😂😂 The US government has never been interested in helping the common man. Very few people in office give a rat’s a** about you and me. Too bad we are all exhausted by having to work 2 jobs each just to make ends meet to do anything about it. It’s almost like our sh*tty economy is that way for a reason, eh?
Great video!!
A related topic - drug manufacturers offer "coupons" that reduce the cost to the consumer of many drugs (and these couponsare NOT based on financial need). These coupons cannot be used by anyone on Medicare. Many people struggle with the cost of medications when their only income is Social Security. The people who need the coupons most can't use them! That would seem to be worthy of a video...
Yes, you are correct. Before Turning 65 I could use coupons for two of my prescriptions, which cost me $20 per month. After being forced onto Mediscam, I could not use the coupons. I now pay $3200 per year. When trying to get a reason for this, my senator, Kevin Cramer, refuses to answer me.
I wish you had compared how formularies are used by other countries to control pharmacy costs. In the USA, there is a giant, bloated bureaucracy that generates profit at the patient's expense. Result: highest prices and worse health outcomes in the USA.
worse food too = well, let's not go there
I smell a congressional money making lobbyist policy.
That's why things like healthcare and education should all be nationalized, just like police and fire departments. Profits should never be linked to these things. This country is all kinds of phucked.
Or just deregulate. We can buy almost anything over the counter in Kenya and it cost about 95% less than in USA.
This problem is caused by government. More government isn't the solution here
@@shortstraw4 Oh my god are you silly. Learn from the others don't just repeat NONSENSE you swallowed whole from right-wing media. Government CAN be there to help you if you allow it and don't VETO it like morons. You literally souind like a parrot with the brains of a bird.
This is 'free' market capitalism, allowing legislative and regulatory capture by for-profit companies. Once companies make enough capital, they use some of that capital to finance polital campaigns. They then use more capital to lobby the pols they bought (not brought) into office. It could be argued that this system is simply bad government, but that would be putting the cart before the horse IMO. The problem is capitalism, for-profit healthcare, and legally incentivised greed. We would all hope for noble politicians who do the right thing for their constituents, but that's not the system we have promulgated (especially since the Citizen's United ruling by SCOTUS).
@@pierrechildress8875 Once legislative and regulatory capture happen, it isn't capitalism anymore. I have lived in Philippines and Kenya, and both of those countries have a fairly free market for health care. In the Philippines, I bought some antibiotics for about $5 for a bad blood infection after getting badly bit by some insects when traveling by cargo ship. Unfortunately, I was only able to take them for two days and was forced to toss them in trash during customs when I returned to America since I had no prescription.
The infection came back with a vengeance. I tried to tough it out since you can't buy antibiotics over the counter in the USA, but eventually had to go to the hospital. The hospital bill was around $30,000 just to get some antibiotics. Yes, they ran other tests, but all I needed was the antibiotics.
I am retired in Kenya now. Twice in the last decade, I have needed antibiotics. I just go to the pharmacy and buy them. There is a local dentist (very well educated) I like. He charges $10 for a tooth extraction. My wife got all her teeth cleaned for $25. She got an MRI after a bad accident for just $100.
These medical/dental markets in Kenya and Philippines are almost pure capitalism. No doctors blocking your access to medication. This is what America needs.
I’ve worked in pharmacies and it’s disgusting to see how cheap the medications are actually sold for directly from the manufacturers.
Investigate the chemical plant near Paris County Kentucky. Residents have claimed that black mold started to grow in the area around the same time as the plant. Also, most residents didn’t want the chemical plant to be built in their district yet their politicians still approved.
Yes and the corporate often foreign owned pig farms spraying manure in the air in the Carolinas. Add the train chemical.spill and the outcome in Pennsylvania.
Drug companies are also to blame. They make record amounts of profit on US customers compared to other countries. If it were solely the PBMs' fault then prices for drugs would be higher here without a comparative increase in profits which isn't the case.
Drug companies are selling a product and their only interest is to make as much profit as possible for their shareholders. Insurance was supposed to be there to negotiate down prices for their customers and the government is supposed to protect us from price gouging and bribes that would cause us to pay more. But both of them are complicit in the corruption so everyone failed us.
Nice to see an FTC out there doing something good for everyone
The current FTC chair is actually trying to look into them, last year they managed to pass a vote to force them to submit documents for investigation. But it's the government so it's slow, plus their lawyers are trying to slow everything down as much as possible
@@Taxmt And they are trying to get her fired...
You’re a fantastic communicator. Thank you for making these complex subjects easy to digest, so that lay-people can understand how and why they’re being screwed. It really is awful how corrupt the US economy is from the top down. Looking forward to more videos like this! Educate the people!
There’s a quote from a Pharma exec in a book from the Cochraine Institute, he said we’re just like the drug cartels, but legal. Apparently, insurance learned its lessons from them.
Unfortunately own the Cochraine institute has been corrupted
i'm so glad to live in france where the price of prescribed medicine is a choice the governement makes
Express Scripts will change your Drs scripts, and when you complain,they say you're disposable. They hold you hostage by denying you access to your prosthetics for profit.
You ARE disposable. Odd that more people don't realize what they are in this sick world.
Express Scripts is what VA uses, right?
Please talk about copay accumulators and maximizers too! Another way insurance companies essentially get paid extra from pharm companies. Even in the few states that ban them, some have exceptions that still leave people paying thousands that the manufacturer already paid the insurance company for.
Look up help co-pays act hr180…small non profits are trying to make something change
"Health care" in the USA is a corrupt racket.
FYI I would also like to see you report on the Pharmaceutical Ads here in the US and in Australia only, not the rest of the world. This is also a major cost to us as consumers.
Investigation suggestion. 🔥 SSDI benefits application, approval, denial, appeals, timeliness, and decisions process. These are based on regulations designed to ensure most people are denied bc of the diseases covered list, outdated jobs in the economy list, and 5 year time limit that the SSA process makes extremely slow even if you're on a priority list. The fraud rate is under 1%, which is less than half the average rate for most crimes/allegations. ALJ hearings and appeals process including judges whose decisions are so inept that the US Attorney won't defend them. Lack of a fair reporting process for local SSA office federal employees who are known to be hostile to intentionally deny payments. I have receipts.
And then if you do get approved, you can’t earn more than $1500 a month and that’s BEFORE taxes are taken out. People who receive benefits are essentially forced to live their lives in poverty or they are stripped of their benefits and forced to pay back the last two years of benefits they received because they earned $50-$100 too much.
@@TheProfessorTolkien$375 a week rly isn’t much to earn if ur wkg PT cuz ur DISABLED
If u can earn alot, why r u on disability?
As bad as the insulin prices are, and they definitely are bad, it isn't even the most egregiously marked up product.
A dose of Epinephrine costs $2 and is shelf stable for 3 years. Epi-Pens are sold for $700 and are sabotaged to only be shelf stable for 1 year.
Pregabalin (Lyrica) costs about $15/mo at pharmacies that don't take insurance and $1400+/mo otherwise.
Absolutely sickening!
Thank you for turning the music down. Love your work!
Yes👍maybe even consider no music like normal news stations do when reporting. Music often is quite annoying when trying to listen to these reports🤔☕️
Thank you, More Perfect Union. I highly value your editorials (that might not be the best word). I feel like I need this information and there are very few alternatives where I can trust the source, so thank you.
They arent just hired by your insurance. Sometimes your insurance owns them. (See: anthems pbm. Sure they outsource the employees, but they own the pbm.)
I really appreciate you tackling drug pricing and pharmaceutical policy. I would love to see you guys tackle compounded drug coverage. Compounded medications are essential to many people who have allergies, have long COVID and Mast Cell Activation Disorder (a rapidly increasing disease) but most insurances and Medicare and Medicaid won't cover them even when medically critical. Many people who have these conditions are forced off public assistance because they must rely on charity to buy medication and it disqualifies them from services under "cash gifts". Too many go without because they can't afford compounded medications and the associated human and monetary costs are brutal.
America is horribly depressing. 😔
Thank you for more disclosures on greed,greed,greed.
It sounds like those ''PBMs'' should be outlawed.
They should but the only people who can outlaw them are sitting in congress comfortably accepting their bribes to look the other way.
I can’t tell you how many times I’ve been waiting on a prescription at my local pharmacy and I will hear someone say they can’t afford to get all of their medicine filled..
I go to the pharmacist and tell her I’m going to pay for that person’s medication but ask her to plz not tell them who it was because I don’t need any of that attention and I definitely don’t want to embarrass the customer or myself.. I just know how it is and if I can “pay it forward” I try to help as much as I can even if I don’t have much to give, it hurts me so much to see someone going without.. especially their medication 🥺
This is the best video on the topic I've seen so far
Thank goodness for you and a "More Perfect Union"
Interesting, valuable information. I live in Ohio, and my current pharmacy is CVS. Thank you for reporting, and thank you, Dave Yost. I am currently searching for another pharmacy. I am so glad this came across my views today it confirmed my suspicion.❤
It's great that you cover these issues, but I'd very much like more information available for how an individual might take action to help the situation on any given subject you cover. I often find myself thinking "Okay, now I know about this issue... what can I do about it?" and I'm sure I'm not the only one.
I agree. What do we do? We must unite.
Frier Levitt published an expose document back in 2022 that details the many ways PBMs screw everything over, current legal precedents, and actions that can and are being taken to fix things. Just googling PBM expose should pull it up, it's an amazing read at around 80 pages full of resources and references. But in general a lot of states are waking up to what they've been up to and steadily cracking down, but mostly only affects state medicaid
Take responsibility for your own health. We take better care of our cars than we do our own bodies.
Stop buying into their propaganda and using their system and crappy bioengineered petroleum based synthetic poison chemicals aka pharmaceuticals.
90% of all illness is related to diet.
RUclips censored my response.
My pharmacy filled my hubby's Eliquis for a year. Yesterday, I picked it up. They said this was the last time they could fill, or he could pay over 300.00 dollars out of pocket, or change his MEDICARE prescription plan and pay more that way. I told him, get a different scrip that is covered....funny to see this article next day...funny business by drug companies. Why am I not suprised?
Thank you 💫 I have walked away from my Nursing career partly due to scenarios such as this. Being a Case Manager & having to juggle around in the system to get patients what they were prescribed on the insurance formulary was rediculous. Some chose just not to take the med then were "labeled" noncompliant. The 3 month supply programs are wasteful and are guided as a convenience.
This country has become so fucked up. It’s really sad.
It has been fucked up for so long we are just starting to feel the side effects of it. The USA's healthcare systems were sold out to private interests in 1929 by Hoover and continued to be degraded by Roosevelt and 12+ other presidents after them.
Thanks for shining a light on this topic, but prescription drugs isn't even the half of it here in the US. Big companies have the same kind of wealth-slurping advantages in health insurance, dental insurance, worker's comp, probably mental health... overall leads to worse healthcare that costs more for average people.
Gee, I sure wonder why average health and longevity is declining here. Couldn't possibly be the system prioritizing corporate "citizens" profits over pesky human citizens' rights and best interests...
Using pharmacies that don't accept insurance is one way to impact the PBM's. As a physician, I often refer people to Mark Cuban's CostPlus pharmacy. Many medications can be purchased from them without using insurance for less than the copay to a PBM like Express Scripts. The caveat is that they almost exclusively carry medications available as generics, so anything still under patents is not available.
Mail in rebates are a bit of scam themselves. The company "lowers" the price of an item by offering a mail in rebate, knowing that many people will never send it in. They can advertise the lower price, but put that it requires a rebate to get that price in small print.
Greedy, greedy greed greed greed!
Yes and most folks think of these billionnaire as very stable genius
That's the USA for you.
Greedy, Greed Greedy Greed
@@timothydana2726 Yep👍
we are living in a second gilded age
From exorbitant medical bills to fraudulent practices, navigating the intricacies of the healthcare system can be overwhelming. Considering the complexity and potential financial pitfalls, having a finance advisor that knows much about healthcare becomes crucial to protect oneself and make informed decisions.
Absolutely. The rampant issues of overcharging, surprise billing, and deceptive practices in American healthcare necessitate a proactive approach. Engaging a finance advisor can provide insights into understanding medical bills, evaluating insurance options, and avoiding potential scams. It's about empowering individuals to navigate a system that often seems designed to exploit rather than support.
Majority of American families can not afford financial advisors!!
5:25 best explanation
I have to rewatch this over and over to understand it. I seldom use prescription drugs, and I'm grateful for that. BUT I have many friends and family who do and this system is so confusing.
The medical industrial complex, insurance industry, pharmaceuticals, food, and advertising all in bed together. This is so outrageous!
Healthcare should NEVER be a privatized, for profit industry!
It always has been... Rockefeller Medicine in the US anyways
Good video! 🎉 another topic idea 💡 Same type of video but do it on Vision Benefits Managers. Vision insurance is crazy messed up.
Another solid public interest piece, MPU
Another wrinkle in meds: the generic med I use is also made by the pharm company that makes the non-generic. So, if I can’t get the generic, I would be forced to buy the original which is many times the cost of the generic. So they can control the availability of the generic. Shouldn’t be allowed.
Per the pharmacist - They have drugs where the out of pocket price is actually cheaper that the copay amount. They are not allowed to tell the customer per their contract with the insurance company unless the customer asks first. The Copay amount actually ends up as a kickback to the insurance company.
This is why I never give the pharmacy my insurance information. We were completely uninsured for several years and during that time I learned that my husband's maintenance drugs were way cheaper as a cash pay patient versus paying the insurance drug co pay.
Thank you for exposing this!
Our countries system has been rotted to the core.
Now cover American Medical Association monopoly
You do realize that the majority of physicians do not belong to the AMA, right? It is a completely voluntary organization, like joining your local Rotary Club, or the AARP.
@@TakenTook It's only 15%. Doesn't matter when the AMA Cartel controls and pays the lobbyists that write the laws. Congress doesn't write the laws they sponsor them. And who contributes to the politicians campaigns???
@@judylandry302 -- Drug / device manufacturers and health insurance companies, contribute far more to lobbying in total than the AMA. Look it up. Doctors are on the same side as the patients here. We want our patients to have lower drug prices, lower insurance premiums, better access to nutritious food, and other things that will keep them healthy.
@@judylandry302 -- Not sure why my reply keeps getting deleted, there's nothing offensive in it. Look up the numbers and you'll see that the AMA does very little lobbying compared to drug companies and insurance companies
Excellent description of the PBM fraud. THANKS
This is outrageous. I now better understand some recent denials from my insurance company.
Can we start at "citizens United"?. Everything else is just gravy.
That ruling is precisely where I lost faith in SCOTUS, and America in general :(
This medical system also has testing for diseases that don't work.
So … insurance is a mafia… gotcha!
"Pharmacy benefit managers" 😂 i love how you can the name of something and completely change people's perception.
This is why there was medical tourism of diabetics in Canada
Can you guys please put sources in the description or a pastebin? Some people want to look deeper into this stuff!
There's an 80 page expose document published by Frier Levitt detailing the abuses of PBMs as well as what can be done about it. Highly recommend digging through it and hitting up your state legislature with it
@@Taxmt Thanks! It would've been nice if they put it in the description though
@@dave_riots friendly reminder: you are sitting in front of the Google machine
Grateful I live in Canada. Our system may not be perfect but it’s so much better than US
I spent 20 years in Canada. Best healthcare, cost nothing, never a problem!
Unfortunately, the propaganda machine worked so hard to make Americans believe that Canadians are dying all over the place, because we can't access the meds we need, or whatever. Most of the anti-single payer advertising was done in the late 90s and early 00s, but it is still believed, even now.
The US is the richest country in the world. They could absolutely afford to provide healthcare for everyone. Instead, Cuba - suffering huge economic challenges due to a 60 year embargo - now has better healthcare outcomes than the nation attempting to stifle it. Embarrassing.
America is only industrialized nation without nationalized healthcare.
Nowadays they push offing self to save $ MAID
Greed destroys everything.
In the UK the British National Formulary indicates the maximum price the National Health Service will pay for a prescribed generic drug to pharmacies. For in-patent branded drugs there is the "Voluntary Scheme For Branded Medicines" which basically allows the National Institute For Clinical Excellence (NICE) to not allow the prescribing of an approved drug on cost grounds by the NHS. If the manufacturer lowers the price to a point that NICE accepts the NHS can prescribe it. Since the NHS pays for over 95% of prescribed drugs it's remarkable how quickly manufacturers comply. That's why Ozempic costs $90 a month in the UK and over $1,000 in the US.
This explains so many of my years-long arguments with my insurance companies.
This was really helpful. Great job!
Yes, and government contracts
racketeering, ive been saying it for years
I used to work for CVS/caremark. They tell their clients that the formulary is decided by a board of doctors for safety, efficacy and yes of course price, but they put emphasis on the first two. This company also loads up their employees with so much work that they don't get a day off for nearly 4 months in a row annually. At least in the dept I worked in which was to implement new clients.
This is just insane.
@7:08 I was seeking the answer to this question for high dollar specialty medications. I’m currently being held hostage by a PBM and it’s exhausting and infuriating
Good info.
Sure wish I was born in Canada, the worry and stress about health care in the US makes you sick. In the drug department ,in my case, I try to depend a lot on the old grannies remedies of old but, of course , I know there are some prescriptions people need. I feel doctors do over prescribe and don’t know much about what they are prescribing, doctors are bought and paid for today by for-profit local and foreign corporations.
I know that and also the doctors are getting a rebate or a kickback as I said.
Not legally they aren’t. 99% of medical providers just want to get through the day and prescribe the correct medication that is medically indicated.
Thank you!!!!!!
We need to vote blue to cut this stuff out and afterwards keep an eye on those we voted for. But right now, this is where we have to start.
Fantastic video! Great description that anyone can understand! It is past time to shed light on this parasitic and symbiotic drug distribution ecosystem. Thank you for sharing! I am joining the effort to help inform consumers also. It is going to take consumers, pharmacists, and hopefully employers and government entities. By the way, does 3AXIS do webinars, consultations or work with employers about what health insurance providers should consider when selecting insurance providers that include patient outcomes and formulary inclusion and prices.
Thanks for this important video!
Howdy hi hi,
Well put together video. Kudos and thanks for the enlightening content.
Dr. Glaucomflecken FTW.
I remember pharma reps coming in regularly to talk to our pharmacists to convince them to recommend their drugs or stock their drugs at our locations. I recall my boss being disgusted every time he’d see them who CB was a good sign.
Every day, I find more evidence that this civilization is too stupid to continue to exist.
Can you do a story about the job market and the presence of ghost jobs and scams all over job sites?
Like a lot of modern problems in the world, Reagan is right there, like, at this moment it would be easier to just point out the problems where Reagan wasn't involved. Well, it would still be hard to find those cases.
Ronald Reagan also taxed Social Security.
weird how so many problems in the USA start with the actor president, Reagan.
How many people would not need drugs if they took better care of their health?
This also kinda applies to the new call centers... If you had a problem years ago you could walk into your local business and handle it with a manager on site ..not anymore ...even a at Verizon TMobile etc you can't speak to a manager ... They totally cut off our ability to complain and get a resolve
Yup
Customers are too volatile in person
The staff in store doesn’t touch that mess
backdoor money laundering...
8:44 this is the model that my heal care provider has had for 30+ years with very very limited special medication coverage, they only do generic unless there is literally no other option, then they’ll pay the astronomical price of the brand name. It works well & no one had to pay out of pocket for any medication until Anthem (Blue Cross Blue Shield) bought them out about 10 years ago, but even then they seem to have stopped at a maximum payment of $10/mo of medication & still have free medications.
PBMs became viable in the 60s when regulation of the pharma and health insurance industries made managing this area of healthcare far too complex for insurance companies, distributors and pharmacies. The main driver of the increase in healthcare costs is additional administration headcount(3300%) used to comply with all of the increasing federal, state and local regulations on healthcare. These increased costs are not only hurting individuals, but are also the main drive behind the consolidation that's occurring in the industry.
Great video.
I'd be curious to see how vision care coverage works. Just bought a pair of glasses, cheap frames, because I'll probably never use, just like the last set (bought years ago).
A $69 set of cheap frames, with progressive and all the fun films applied jacked the price to almost $500, and that was WITH insurance.
I am always astounded by the amount of evil corporations do in order to increase "shareholder value"
Great video! Well done.