By Bill Rusteberg
I just attended a conference of health care revolutionaries whose goals are to redefine our broken health care delivery system by exposing industry secrets and offering common sense solutions.
A PBM established by a state association of independent pharmacists gave a presentation on how PBM’s earn their money through 34 distinct and separate schemes.
The audience was aghast to learn that a specialty drug for Hep.C. earned PBM’s a 45% commission (rebate) for one course of treatment, or about $45,000 per case!
Of course, many PBM’s tout pass through contracts with 100% of the “rebate” passed on to the plan sponsor. Not necessarily true according to this PBM “expert”! When you relabel a “rebate” as something else, or segment into more than two components and label as some incongruous administration fee/s, presto the 100% rebate return is now a 5% rebate return.
