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A counterargument to the belief that out-of-pocket expenses originate with insurers or PBMs
In a fairly brutal exercise in finger-pointing earlier this year, Mylan Labs, caught up in the dispute over why its EpiPen product cost so much, tried to make the case that much of the drug’s cost was imposed by distributors and pharmacy benefit managers (PBMs), and that the out-of-pocket (OOP) copay was in the control of insurers and PBMs. That “campaign to deflect blame for high prices falls flat,” says the Pharmaceutical Care Management Assn., based on a just-released national survey.
The survey, performed by a national market research company, polled 1,000 registered voters (it was apparently taken at some recent point before the presidential election); 59% of whom had private health insurance and 32% who had Medicare or other government-subsidized insurance. In a series of prompted-answer questions, nearly three out of four respondents said that “drug prices are too high,” and over half (55%) blamed manufacturers directly. Health insurance companies were blamed by 14% of respondents; PBMs by 7%. (The federal government was blamed by 19%, but it’s not clear that that response points to consumers wanting government control of drug pricing.)
On the OOP question, 63% of respondents blame drug companies for higher costs; 24% blame insurers, and the rest “don’t know.” (One wonders what the response would have been if “PBMs” were one of the choices.)
“Consumers are well aware drug companies set drug prices and they know higher prices mean higher out-of-pocket costs. No one’s buying the drug companies’ campaign to shift blame to employers, unions, plans, or the PBMs that negotiate discounts on their behalf,” said PCMA president, Mark Merritt, in a statement.
For the record, in their 2015 annual reports, the top three PBMs, Express Scripts, CVS Health (which includes the CVS pharmacy chain) and United Health (part of which is the Optum PBM) reported cumulative revenue of $412 billion.