"The new price was chosen by looking at the prices of other specialty drugs and estimating how much insurers and employers would be willing to bear."
The honesty in this statement staggers me. The willingness and ignorance of the insurance plan sponsors (employers), who are usually self-insured, to pay whatever bill is presented to them is even more staggaring. From my most recent experience consulting with a major hospital group, the benefit coordinators have very little understanding of the way these PBM's work.
Our PBM quotes all the statistics of how specialty pharmaceutical costs are growing at outrageous rates, not ever hinting that they control some of that increase. We control those costs by bringing the pharmacy "in-house" and bypassing their specialty units. We can buy those products cheaper and pass the savings directly to the plan benefit. This concept really ticks off the PBM.
FYI. Medco is hiring at least 80 pharmacists to perform Medication Therapy Management (MTM), disease state specific intervention and medication review, by phone. If I were performing the MTM, my interventions would revolve around what is best for the patient. Think about the cost of 80 pharmacists. What criteria will their interventions be based on?
RPh
