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EP439: Fixing the Generic Drug Pricing Problem, Where Patients Pay More When They Use Their Insurance, With Luke Slindee, PharmD
Jun 6, 2024
In this discussion, Luke Slindee, a pharmacy consultant, unravels the tangled web of generic drug pricing and its impact on patients. He reveals how Pharmacy Benefit Managers (PBMs) profit from inflated costs, often making patients pay more even when insured. They explore innovative solutions like removing unnecessary price structures and the benefits of direct payment tools. Luke also touches on the broader implications of these pricing challenges on pharmacies and the services they provide, all while advocating for a system that prioritizes patient affordability.
28:56
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Quick takeaways
- Pharmacy Benefit Managers (PBMs) manipulate drug pricing structures, causing patients to pay more out-of-pocket when using insurance than with cash or GoodRx.
- To address the generic drug pricing problem, solutions like removing usual and customary prices from PBM contracts and promoting Health Savings Accounts are proposed.
Deep dives
The Impact of PBMs on Generic Drug Pricing
Traditional pharmacy benefit managers (PBMs) profit significantly from generic drugs, often causing patients to pay more at the pharmacy than the reimbursement rate set by the PBM. This disparity leads to patients, especially those who have not met their deductible, paying less out-of-pocket when they purchase medications using GoodRx or cash rather than their insurance. In fact, statistics suggest that 79% of the time, patients save money by opting for a cash payment instead of utilizing their insurance. This phenomenon underscores the problematic dynamics within the pharmaceutical system, where PBMs profit by manipulating prices in their favor at the patient's expense.
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