Why are drug prices so random? Meet Mr. PBM
I filled a prescription recently, and the drugstore said they wanted more than 700 bucks… for an old-line generic drug. My insurance ended up knocking that down, but it was WEIRD. And it meant a big homework assignment for me.
Luckily, I got help. Both from some experts, and from the classic Christmas movie It’s a Wonderful Life (source of the pictures above and below, of course).
I mean, what I actually learned was not a hundred percent cheerful.
We get these unpredictable prices thanks to companies that — surprise! — make a big profit from driving prices up. (They’re called “pharmacy benefit managers” — PBM for short.)
Theoretically, they work for insurance companies and employers who pay the premiums, and they’re supposed to keep drug prices down.
Economist Geoffrey Joyce used to think they did OK at that, but he’s changed his mind.
One thing that turned him around:
They got sued in several states, saying, ‘Hey, you should be acting in the best interest of your clients.’ And they’ve won in court saying, ‘No, we have no obligation to do what’s best for our clients. We do what’s best for us.’
So, not all sunshine.
But: Feeling a little smarter about the whole thing? It’s a victory. Also kinda fun.
Hosted on Acast. See acast.com/privacy for more information.
More episodes from An Arm and a Leg
A ‘payday loan’ from a health care behemoth
When a New York doctor tweeted recently about “payday loans” for doctors from a branch of UnitedHealth Group — which operates the giant insurance …
Mental health ‘ghost networks’ — and a ghost-buster
For lots of people, trying to access mental health treatment — like a therapist or a psychiatrist —is nothing short of a horror story. You could even …
A $229,000 medical bill goes to court
Before her surgery, a hospital told Lisa French she would end up owing them $1,337. After insurance paid them — more than they’d expected — the …
A doctor’s love letter to ‘the People’s Hospital’
What if we had a decent, publicly-funded health system — available to everybody, with or without insurance? We’ve got one, says Dr. Ricardo Nuila. …
Lessons from “wrestling with a giant”
The ER visit was quick and uneventful. The bill was $1,300. Our listener decided to push back. He didn't win, but he learned a lot — and so did we.
…
The bill looked like BS. So she took it to small claims court.
“I sued a hospital in small claims court and lost — here’s what I learned.” That was the subject line for an email we got from listener Lauren Slemenda.
She wrote: “I feel like I won” — and …
How you can listen to this podcast
You can listen to episodes right here on the website, or if you prefer, in a podcast app. Listening in an app makes it easier to keep track of what you’ve already heard, listen without using your data plan and many other conveniences.