J Anthony Ware retweetledi
Disagree. The problem starts because PBMs use their formulary leverage to threaten brands with lowering their formulary access if they don’t sell to distributors at WAC- (or equivalent)
That leaves the margin room for the PBMs rebates.
But there is no other good reason to sell to distributors at WAC-
Look at Eliquis at $600 WAC. -5 pct = 570.
Which means the distributor has to sell to pharmacies for $570 plus float
Which means pharmacies have to sell to uninsured patients, and patients in their deductible at $570 or more then beg PBMs to be fully reimbursed (unless they own the pharmacy )
If instead they sold to distributors at Net plus. They could sell to them at $300 because they aren’t paying the rebates and fees to the PBMs.
The distributors could sell to pharmacies at $335 and make more money , while the pharmacies could sell to uninsured and deductible phase patients for $345 and not worry about Pbm reimbursement and make money and the patient gets the same price we sell for
Get the PBMs out of the way or remove their formulary control and @costplusdrugs , distribution and others can take the job of negotiating
This is the only industry I have ever seen where the manufacturers are forced to sell at retail price
And how do I know they are forced ? Every brand ceo I have asked has told me the exact same thing
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