RxClarity Group, LLC

BIG 3 PBM CEOS APPARENTLY MISLED CONGRESS TO HIDE PROFITS OVERSEAS   On Tuesday, executives from the “Big Three” pharmacy benefit managers (PBMs), CVS Health, Express Scripts, and OptumRx, testified in front of the Committee on Oversight and Accountability in a hearing aimed to examine the role of big PBMs in the prescription drug market. During the hearing, the executives needed to be reminded numerous times that they were under oath, as they continuously proffered prepared testimony that conflicted with countless independent reports, data points, and case studies on the nature of the big PBM, and their demonstrable impact raising the cost of medicines.     Specifically, the executives failed to answer repeated questions regarding the “offshoring” of American healthcare dollars to foreign-based so-called U.S. rebate aggregators or group purchasing organizations. (GPOs), which have become a profit-centers for PBMs based in well-known tax-havens.   Big PBM executives including CVS’s CEO repeatedly assured committee members that 100% of all manufacturer revenues are shared with employer clients or “passed” through, to help meet safe-harbor provisions under U.S. laws afforded to actual GPOs.     Lawmakers raised concerns about PBM’s GPO profits and the reach of U.S. laws on privacy, health regulations, and consumers protection in relation to these offshore accounts.   In the wake of the hearing, this morning, it was uncovered CVS Caremark, announced a breath-taking settlement to pay at least $45 million to the state of Illinois for rebates that were not passed through during a recent four-year period. At issue, according to media reports and settlement documents, was the relationship between the PBM and several related entities — particularly a so-called group purchasing organization — that allegedly obscured rebates paid by drug manufacturers but that should have been sent on to the state. This arrangement was noted in a contract that began in 2015 with the Illinois Department of Central Management Services.   In addition, the Federal Trade Commission determined, according to whistleblowers, “The intention of the G.P.O. is to create a fee structure that can be retained and not passed on to a client. A P.B.M. has to keep some level of income for them to grow and satisfy stockholders.”    “Based on what was answered and not answered today, it appears incredulous that big 3 PBMs share 100% of their rebates and fees with employers as opposed to lining their own pockets through offshore accounts,” stated Joe Shields, Founder and CEO of Transparency-Rx. Congress should pursue all available means to determine the truthfulness of these executives’ testimony and whether they lied under oath.”   Transparency-Rx applauds the House Oversight Committee attention to necessary reforms to the PBM market, delinking middleman profits from critical medicines, bringing transparency and relief to the American people and local employers through throughout the nation. 

CFOs are the ones typically involved in the negotiations of employer healthcare benefits. Inflation has hit employers hard with rising #Rx prices, and "no one is coming to save employers, said Marybeth Gray, an executive in health benefits consulting for Trion, a Marsh McLennan HR agency." This CFO Brew article focuses on how to do business with the Big Three in the #PBM industry... how to navigate their shady practices and get the most bang for the bucks spent. The best way in reality? Do business different and deal with transparency-forward PBMs. Don't play poker with employee health, show up to the table and do business fairly with patient-forward companies. https://lnkd.in/ePpXJupM

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Here's to strong Women: May we know them, May we be them, May we raise them. #womeninhealthcare #internationalwomensday #happywomensday