𝕀𝕞𝕡𝕠𝕤𝕤𝕚𝕓𝕝𝕪 𝔹𝕠𝕤𝕤𝕪

Part of the misunderstanding of drug pricing is the impact of pharmacy benefit managers. Prior to @costplusdrugs publishing our price list, there was not a benchmark to compare prices. They made sure that every contract was opaque and under an NDA For instance, Box, Tesla, Space X , and pretty much any self insured company can’t just come on @x and publish your PBM or insurance contract. As a result, the market is very inefficient for brand meds. Generics, which account for 90 pct of scripts on the USA are now efficient because of the price list we publish. In fact, generics are now cheaper here, than in most countries On branded meds, it’s a clusterfuck. I think Box now uses a pass through PBM so you can see your claims, and prices paid for meds. I know Tesla is working to do the same. Most CEOs have no idea they are getting ripped off. It goes like this. The PBMs have a subsidiary called a Rebate Aggregator. They buy their brand meds from the manufacturer at a significant discount. Say 80 pct. They then sell to their parent company, the PBM, at a lesser discount. Say 50 pct discount. The PBM then goes to the self insured, big companies and says they will pass on the entire rebate they get for each brand med, the full 50 pct But they don’t disclose that their subsidiary is keeping the 30 pct difference. That by definition inflates the price of brand meds. Enriching the PBMs But the bigger issue in terms of comparisons to other countries is that the manufacturers are only keeping 20 pct of the “retail price “. But it’s the full retail price that is usually (not always ) compared to the price other countries get. The true comparison should be the net price paid to the pharma manufacturers In most cases other countries will still pay less than the net price. But it’s not as dramatic as presented. As to what should we do? Transparency Every contract signed with anyone in the healthcare supply chain should be required to publish the entire contract. That will get us to an efficient market and IMO cut drug prices by at least 30 pct lower than today’s NET pricing because that will allow Box to compare their costs to Tesla, etc. The only reason you can’t is because the contracts both of you signed with your PBMs prevents it Go back to your PBMs and your Insurers ask them if you can publish your contracts. That’s how you change the game.