Blame Pharmacy Benefit Managers (Not Pharma) For Driving The Gross to Net Drug Price Bubble

Summary: We start with a review of the history of the opaque pharmacy benefit manager (PBM) reseller business model. We present our prior estimates of the distribution of PBM gross profits over the past decade showing that they have become dependent today on retained rebates from specialty drugs. Next, we present numbers showing how PBMs …

The Problem with CVS’s “Guaranteed Net Cost” PBM Business Model

Summary: Consider this meta:  CVS opaquely is substituting one opaque source of gross profits — guaranteed net cost markup — for another opaque source — retained rebates. The pharmacy benefit manager (PBM) CVS Caremark has offered its self-insured corporate clients an alternative business model called “Guaranteed Net Cost”.  The pricing scheme features 100% pass-through of …

Pharmacy Benefit Manager Rx Drug Rebates – PBMs

A Position Auction Demonstration Project to Lower Reference + Biosimilar Rx Drug Prices in Medicare Part B (8/19)  Pharmacy Benefit Managers as Conflicted Countervailing Powers (01/07) Who is Best at Negotiating Pharmaceutical Rebates? (12/05) The Role of Pharmacy Benefit Managers in Formulary Design: Service Providers or Fiduciaries? Journal of Managed Care Pharmacy Vol. 10 No. …

The Pharmacy Benefit Manager (PBM) Business Model

CURRENT PAPERS: Quantifying a Pharmacy Benefit Manager (PBM) Fee-For-Service Business Model (03/19) The Problem with CVS’s “Guarantee Net Cost” PBM Business Model (12/18) Three Phases of the Pharmacy Benefit Manager Business Model (09/17) Will Amazon’s Online Pharmacy Display Therapeutic Equivalents (12/17) Blame PBMs (Not Pharma) For Driving Drug Price Inflation (09/17) Merck Data Discredits PBM-Sponsored Study of …

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