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.
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.
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?”
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.
What We’re Reading: RSV Vaccine Demand; Permanent Contraception; Drug Negotiation Impact
December 8th 2023The Biden administration recently met with manufacturers of respiratory syncytial virus (RSV) immunizations to encourage them to increase access to the vaccine; since the Dobbs v Jackson decision, many patients have been seeking more permanent reproductive health care solutions; a Mathematica analysis showed that Medicare prescription drug price negotiations could have cut seniors’ out-of-pocket costs by nearly a quarter had the program been in effect in 2021.
Read More
Oncology Onward: A Conversation With Thyme Care CEO and Cofounder Robin Shah
October 2nd 2023Robin Shah, CEO of Thyme Care, which he founded in 2020 with Bobby Green, MD, president and chief medical officer, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, to discuss his evolution as an entrepreneur in oncology care innovation and his goal of positively changing how patients experience the cancer system.
Listen
Data analysis showed that 40% of patients who filled a prescription for Wegovy in 2021 or 2022 were still taking it a year later; both Democrats and reproductive rights organizations are pressuring the Biden administration to ensure health insurers fully cover contraception; CMS implemented Medicare changes in March that limited access to blood tests that help transplant recipients ensure their organs remain healthy.
Read More
Oncology Onward: A Conversation With Dr Debra Patt of Texas Oncology
August 1st 2023Debra Patt, MD, PhD, MBA, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for episode 2 of our newest podcast, "Oncology Onward: Conversations With Innovators and Changemakers in Cancer Care."
Listen