BIP Fall 2024

Industry Innovation

How do you think the lack of transparency in the pharmacy system drives the cost up? Goodwin: So many PBMs are saying, ‘We’re transparent.’ OK, what does that mean? We’ve tried to say transparency means removing conflicts of interest, defining your commitments so that everyone that we work with can trust but verify what we are doing. That means we are only beholden to the people who pay us — the members and the clients. Removing those conflicts of interest, those misaligned incentives. Helping the end users understand what they’re getting, what they’re paying for, how much they’re paying, that type of transparency will help lower costs. When you know what you’re paying and how much you are paying, that’s when you can do better. Pfeiffer: A number of very good transparent PBMs are out there that you should be pursuing for your clients. Are they willing to show you literally everything they’re doing, every dollar that comes in and every dollar that comes back to them? Are they willing to do a one-year contract? Are they willing to skinny down the contract to something that’s rather simple? What’s the termination clause? Those PBMs exist today, but you need to seek it out. And if you don’t seek it out, somebody else is gonna seek it out for your client. How are you educating consumers? Brewton: What I do and what I empower agents to do is to educate beneficiaries and break

Why are drug prices so high? Four experts weigh in on the industry dynamics that are fueling costs.

Pharmaceutical costs have been skyrocketing, and understanding the main drivers behind this escalation is crucial to reversing the trend. Speaking in a panel discussion at NABIP’s Annual Convention, industry stakeholders addressed the factors driving pharmaceutical price increases and potential paths forward for greater transparency and affordability. Among the panelists were Amanda Brewton, owner of Medicare Answers Now, Ali Goodwin of TrueScripts, Bill Hepscher, founder of RxManage & Canadian Medstore, and Bob Pfeiffer with ScriptSourcing. What do you see as the No. 1 driver in escalating pharmaceutical costs? Hepscher: One of the reasons that we’re seeing costs go up so much is because we’re seeing massive advances in

pharmacology. We often want to throw the manufacturers under the bus; they’re charging way too much. I think the biggest thing that we need to look at is why, as Americans, are we paying $100,000 for a product, where in countries like Canada, England, Australia and New Zealand, those other countries are paying a third of that cost. The argument by the manufacturers has been, ‘But we need the money for research and development.’ My question is, when does the rest of the world start paying for that? Goodwin: The vertical integration that’s happening involves carriers owning PBMs, and it is becoming a monopoly. There’s no fair competition. When PE and VC money are pulling the strings, the entities that are supposed to be serving you are serving another master.

Ask PBMS: Are they willing to show you everything they’re doing, every dollar that comes in and every dollar that comes back to them?

Atlas Studio / iStock

12 bip magazine Fall 2024