Pharmacy A,B,C,D, and E can't legally discount the copay (the copay is the same at all stores). So how is the PBM owned mail order pharmacy legally allowed to do this? And why should they be given this tremendous business advantage over the other pharmacies?
That's a nice discussion. It would have been nice to add that this vertical integration does NOT translate into savings for the end payor of the health benefit, the self-insured employer. That is because of spread pricing, MAC pricing games and NDC repackaging games that are played by PBMs and their wholly-owned mail order pharmacies. How is it that the PBM pays Pharmacy A, B, C and D $17 for 90 generic topamax and charges the employer $200 for the same drug when purchased via mail order?
Pharmacy A,B,C,D, and E can't legally discount the copay (the copay is the same at all stores). So how is the PBM owned mail order pharmacy legally allowed to do this? And why should they be given this tremendous business advantage over the other pharmacies?
HughG007 4 months ago
That's a nice discussion. It would have been nice to add that this vertical integration does NOT translate into savings for the end payor of the health benefit, the self-insured employer. That is because of spread pricing, MAC pricing games and NDC repackaging games that are played by PBMs and their wholly-owned mail order pharmacies. How is it that the PBM pays Pharmacy A, B, C and D $17 for 90 generic topamax and charges the employer $200 for the same drug when purchased via mail order?
bigdaddydocj 4 months ago