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What We're Reading: Investigating PBMs; A Guide to Medicare-for-All; Reality of Precision Medicine

AJMC Staff
Not only do pharmacy benefit managers profit thousands of percent using spread pricing, but the spreads are growing; support for Medicare for all is growing among Democrats in Congress, but it's still unclear how such a drastic chage would impact the complex American healthcare system; while precision medicine has great potential, it still has far more failures than successes, but that isn't usually discussed.

How PBMs Use Spread Pricing

Pharmacy benefit managers (PBMs) make part of their profit on spread pricing, in which companies mark up the difference between the amount they reimburse for a drug and what they charge clients. A new investigation from Bloomberg showed that not only do PBMs profit thousands of percent using this tactic, but the spreads are growing. Spread pricing is most common with generic drugs that cost pennies compared with brand-name drugs. While use of generic drugs has been promoted to control rising drug costs, spread pricing may be undercutting those expected savings, according to critics of the tactic.

 

Questions Remain for Medicare-for-All Idea

Senator Bernie Sanders, I-Vermont, does not stand alone—more Democrats are embracing his idea of Medicare for all. While the idea is gaining momentum among Democrats in Congress, as well as the general public, it’s unclear how such a drastic change would impact the complex American healthcare system. Politico pulled together a guide to Medicare for all that answered questions as simple as “what does it actually mean?” as well as more complex ones, such as “what happens to doctors?”

 

How Precise is Precision Medicine?

The future of healthcare is a system in which doctors can match patients with the best drug for them and their disease by targeting genetic mutations. While future potential is far from the reality of today, that isn’t always explained. An opinion piece in The New York Times explained that the number of people who can currently be helped with precision medicine is still very small, and successes remain rare. One study found that precision medicine failed to help 93% of 1000 patients treated, while 2 others reported failure to shrink tumors 92% and 95% of the time. Unfortunately, the failures are not always discussed or covered, which can paint a misleading picture of precision medicine.

Related Articles

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Federal Spending Rises, Total Health Expenditures Drop in Medicare for All Plan
Ohio Tells Medicaid PBMs That 2019 Will Be a Time for Transparent Contracts
 
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