Mark is 💯 correct when it comes to how fucked up our system is related to drug pricing and the 3 PBMs that control it all. We MUST reform our healthcare system and IMO, the very first step is ELIMINATING PBMs! For those that don’t know, PBMs sit between drug manufacturers, insurers, pharmacies, and patients, and they’ve grown so powerful that they control which drugs are covered, how much people pay, and what pharmacies get reimbursed. 3 PBMs control 80-90% of all prescriptions in America. These 3 PBMs negotiate rebates from drugmakers, but the savings don’t reach patients. We engage in spread pricing - where they charge insurers/employers one price and reimburse pharmacies at a lower one - keeping the difference for themselves. It’s a Mafia-like business model. PBMs also decide which drugs are “preferred,” sometimes pushing patients to more expensive medications because the rebates are higher. I have watched Independent pharmacies in MA get squeezed so hard they’re forced to close. Often times these independent pharmacies operate in underserved communities like Dorchester or Roxbury. I interviewed an owner of an independent pharmacy and he was literally getting reimbursed under his costs. He’s trying to survive (it’s been a family business for 50 years) but what business can survive if you routinely get reimbursed less than your costs? The 3 PBMs are doing this intentionally and it’s driving closures. Some of these independent community pharmacies deliver life-saving drugs to their customers because their customers don’t drive and it’s physically too much for them to try and catch public transportation and they certainly can’t afford to take an Uber. Here’s how we get rid of PBMs: 1. Ban spread pricing and require PBMs to pass 100% of rebates and discounts to patients or insurers. 2. Require transparency. Force PBMs to disclose what they negotiate and where the money flows. We should be able to compare the price of drugs the same way we compare prices for microwaves, refrigerators, cars watches or any other consumer product. 3. End rebate schemes and move toward fixed-fee payments for PBM services instead of percentage-based rebates. 4. Ban gag clauses so pharmacists can tell patients when cash pay is cheaper than insurance. 5. Federal regulations enacted treating PBMs like utilities and thus, subject to price oversight. 6. Facilitate competition. The 3 PBMs control 80-90% of all prescriptions. If we eliminate their stranglehold it will allow more competition like direct-to-consumer pharmacy models like @costplusdrugs that sell medications at transparent markups (cost + 15%). Competition drives prices down. Nothing is more American than facilitating that!(John E Deaton)