Shorter Weirddave: ‘If I have some valid points, you aren’t allowed to ask about whether I’ve got any support for my bullshit points.’
Whatever.
And if there’s one game I have repeatedly refused to play, it’s the ‘something at this link supports my argument, so why don’t you go find it, make my argument for me, and then rebut it’ game.
You’ve provided a link. If you were to provide a quote from it, or summarize its findings here, then I’d go to the link, verify that it says what you say it says, and then rebut.
If you’re too lazy to do the minimum, I have to conclude you don’t got game. Because a link supports argument; it doesn’t replace argument.
You’re the one who’s made an assertion. Having been challenged, you can drop it, or you can defend it. Right now, I don’t have to prove a thing.
I’m sorry but not too surprised that you don’t feel like defending your position with more than bluff and bombast RTF. I don’t usually think in terms like this online, but it looks like I “win” this one. When come back bring data.
Merijerk,
You asked me a question. I responded with a reply as to how I felt the article in question supported my position. Your response was “oh, you’re ignoring the facts”. I addressed the facts. Now it’s your turn.
I hate to remind you (ok, I’m actually enjoying it, but never mind that now), but I don’t even have a position to defend. You do, and I’m asking you to back it up.
My only ‘position’ is that I’m ready to rebut whenever you supply some evidence backing your lame-ass assertion.
Yes! It just wasn’t our government! But it was in one of the most expensive cities in the world – Paris. When I fell and injured damaged my eye, I was taken by government-owned ambulance to a public hospital emergency room. There was no one else waiting for assistance and a doctor saw me within about five minutes. I received a careful exam, a tetanus shot and was bandaged. Then I was released with instructions in English. I received one bill for all of these services. It was for about $30 American dollars and that included the ambulance. That was without using any insurance.
The country has made things horribly complicated and that in itself is costing money and resources.
Meanwhile, friends in Scandanavia do complain about the 40% taxes, but they certainly enjoy taking five weeks vacation every year. They are proud of not having masses of poor people. And they never have to worry about medical insurance. I just don’t hear people who live with socialized medicine complaining about their systems and wanting to revert to something like what Americans have.
We have socialized park systems, fire departments, police departments, highway departments health departments, and public works. Those are just off the top of my head. Those who would frighten you with the word “socialized” are just using a propaganda technique.
Some of each, most likely. The PBM will work with the insurance company and/or employer to develop the formulary, but usually from some limited menu of options. And the PBMs are really pushing high cost penalties for name-brands these days, because their margins are so much better overall with generics. Which is, in the end, ultimately because of how much the pharmaceutical companies are charging for their name-brand drugs … so there’s plenty of blame to spread around.
I know UHG has its own internal PBM, but they also outsource a lot of that business to Medco. The Blues do a lot of outsourcing too–I’m not sure if they handle any of their own prescription insurance at all.
MMO definitely outsources as well, and (at least today) they use other PBMs than just Express Scripts. (I’m not sure, in fact, that they use Express Scripts at all any more.)
Back to the OP–just to make it clear, the ‘discounts’ the government isn’t allowed to negotiate for Medicare aren’t the discounts for the patients–those are set by Medicare to whatever their statutory mandate and budget allow. It’s the portion that the taxpayers pay to the PBM, insurance company, or pharmaceutical company that’s not negotiable by Medicare. (I think the OP was clear on this, but some of the early responses seem fuzzy.) And those companies are making a metric ton of $$ from this. (Or mine is, anyway. I don’t really see the cash, I just get to see the incredible hassles that our executive management is willing to go through [and put me through] for the privilege of serving the Medicare members. Given what I know it’s costing us to meet the infinitely anally retentive federal requirements, the income side of that equation has got to be phenomenal, or we would have thrown up our hands long ago.)
I don’t know how much cheaper, if any, it would be for the government to cut out the middleman. (My company has a lot of experience negotiating with drug companies.) But the lack of transparency and accountability in the process of getting this program through the Congress makes me question whether the taxpayers are getting a good deal …
Interesting. They have contracts with at least one other PBM that I’m aware of. Unusual, most insurance companies end up with exclusive contracts, 'cause the PBMs give better rates for exclusive contracts, for some reason.
Yes, that’s quite possibly what it is. The big insurance company will try to sell their ‘total package’ to the direct insurer, but the direct insurer doesn’t have to buy it–they could contract the PBM & other services (dental, etc.) on their own.
True, PBMs have higher margin with generics, so they push them big time - but the co-pays are also much much lower, so the insured wins as well as the company and the PBM.
UHG outsources 99% to Medco, and the Blue, being basically independent now, outsource to Medoc, Express, Caremark, etc.
The one thing I like to point out when people complain about PBMs making tons of money (and if you haven’t figured it out yet, I work for a PBM), is that most large PBMs have very very small margins - sales/revenue is recorded by ‘drug spend’ so a large company in the Fortune 100 with $30B+ in revenue may be only pulling in $100-200M in actual bottom line net income. Every penny they can make by pushing generics and mail order helps the bottom line. Most PBMs break even or could lose money on every prescription filled at retail (your local CVC, Walgreens, etc.)
If the insurance company you choose has a contract with a PBM that goes along with it, then yes, the 2 are tied together. But, my point was that Express Scripts, in this situation, is not so much to blame for employees’ or your companies complaints - you could have gone with a different insurance company or a different PBM.
My overall point - if someone has an issue with thier prescription coverage (cost, service, etc) it is likely the contract with the employer, not the PBM demanding anything. If anyone is unhappy with thier coverage, complain to your employer, not the insurance company or PBM.
If you go with your medical insurance prescription coverage you will get whoever they contract with as thier PBM - which I believe is always exclusive.
But, an employer, state, etc. can always decline the medical insurers prescription service, and contract that seperately.
Thus,
MMO may use Express, but if your employer declines MMO’s prescription service they can use Medco, or Caremark, etc. - so you can still have MMO for medical and Medco for Rx’s.
You’re trying to make it sound as if the employer can always get a better deal for their employees, which is bullshit. As I said, we could switch insurance companies, but then we didn’t have the option of a $250 deductible.
The insurance companies are the ones with the power, here, not the employers–at least the employers like mine. We have 25 employees. We don’t have any bargaining power. The employers have an incredibly limited number of options, and everything they add simply drives up the cost–taking money out of the employee’s pocket in the form of deductibles or premiums.
