The Daily Rise: Tuesday, July 5

Pharmacy Benefits Manager Overcharged Patients: “No One Knows If They’re Getting Ripped Off”

A pharmacy benefits manager has been overcharging patients for prescription drugs, a lawsuit filed last month alleges.

According to the lawsuit, which is seeking class action status, “insured workers paid too much because Express Scripts charged “above competitive pricing levels” and Anthem, in effect, allowed those higher prices as part of a 10-year contract deal with the pharmacy management firm. Those actions, it alleges, violate the firms’ responsibilities under a 1974 federal benefits law called the Employee Retirement Income Security Act.”

“This action seeks to recover losses suffered by the plaintiffs … who overpaid and continue to overpay for the portions of the costs of prescription drugs … they are responsible for paying as plan participants,” the plaintiffs in the lawsuit, Burnett v. Express Scripts and Anthem, claim.

We’re pleased to see this lawsuit and hope that it will finally shed some light on the secretive practices of pharmacy benefits managers. Insurance companies and big companies (these big companies include many major pharmaceutical companies) outsource the administration of drug benefits to PBMs, which frequently save money by limiting patients’ access to life-saving treatments. Think of them as the middleman that does the dirty work with little regard for what is really best for the individual patient.

PBMs operate entirely in secret. Even PBM clients can’t access information. Susan Hayes, who works as an auditor of PBM contracts, told USA Today in February, that “auditors aren’t allowed to copy or take pictures of documents when they audit a PBM’s rebate contracts.

“It’s such a complicated web of intermediaries that stand between consumers and the prices they pay,” Erin Fuse Brown, an assistant professor of law at Georgia State University College of Law, recently told Kaiser Health News. “As a result, no one knows if they’re getting ripped off.”

White House 2016: Clinton’s End to the Moonshot?

Does a Hillary Clinton presidency mean the end to the cancer moonshot?

Dr. Robert Goldberg, vice president of the Center for Medicine in the Public Interest, says that Hillary’s health plan is likely to nullify Vice President’s Joe Biden’s efforts to eliminate bureaucratic barriers to innovation.

“Biden’s plan is to streamline decisions made by the FDA, NIH and other government agencies to both speed up drug approvals and give patients the freedom to obtain the combination of medicines that works best for them,” Goldberg writes in the New York Post. “He wants to increase tax incentives and patent protection for private companies to partner with and invest in government cancer research.”

“Clinton wants a vast new bureaucracy that would delay and limit such choices,” he says.

In addition to reversing Biden’s bureaucratic streamlining, patients should be concerned about Clinton’s support for Centers for Medicare and Medicaid Services radical experiment with reimbursements.

“Hence Clinton is outsourcing life-and-death decisions about cancer care to a panel of unaccountable bureaucrats and political cronies using one-size-fits-all criteria,” Goldberg argues.

But, Is The Donald Any Better?

Then again, the Donald isn’t much better for patients.

In an interview with Bloomberg, Ken Frazier, Merck’s chairman and CEO, said that, like Clinton, Donald Trump supports policies that will roll back innovation and reduce patient access to life-saving treatments. He says both candidates “are not good for innovation, not good for competition, and not good for patient access.”

“I think the debate about health care today is polarizing,” Frazier said. “I think it falsely pits all pharmaceutical companies against society, and the reality is, society needs these drugs.”

With both major presidential candidates supporting policies that could prove harmful to patients, patients need to make our voices heard.

You’ll receive updates about new resources, patient stories and insights, advocacy work, and alerts about patient-support events.