Who’s In control of your Meds, You, the Pharmacy, Or the PBM’s?

Objective: To investigate the technical and economic mechanisms that prevent price transparency and consumer choice in the modern medical system. Specifically prescription drugs.The Reality (The "System" Problem)The reason you feel the system is "dishonest" is that the PBM's incentives have shifted.The Rebate Trap: PBMs often prefer expensive drugs over cheap ones because they take a percentage of the "rebate." If a drug costs $1,000 and the PBM gets a 20% rebate ($200), they make more money than if they suggested a $50 generic.The "Spread": As we discussed, they charge your Insurance $100 and pay the pharmacy $60, pocketing the $40.The Monopoly: Because the Big Three own the insurance companies, they can effectively force you to use the pharmacies they own (like CVS or Optum mail-order), which starves out the local independent pharmacies.