The hottest Pharmacy Benefits Substack posts right now

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More than half of every dollar spent by Medicare drug plans goes to private health insurers' pharmacy benefit managers and wholesalers

HEALTH CARE un-covered • 1318 implied HN points • 05 Jan 24
🏥 Health Politics Health Insurance Medicare Drug Pricing Pharmacy Benefits Healthcare Reform
  1. More than half of the money spent on Medicare drug plans goes to middlemen like pharmacy benefit managers (PBMs) and wholesalers, not to the actual drugs.
  2. These PBMs are making huge profits, taking over 40% of the funds while people often end up paying more for their medications.
  3. Lawmakers need to act on this issue because if they can reduce PBM profits, there could be funds to support important health programs for low-income Americans.

Strange bedfellows agree: PBM pricing reform cannot stop at Medicare, Medicaid

HEALTH CARE un-covered • 679 implied HN points • 24 Jan 24
🏥 Health Politics Healthcare Reform Pharmacy Benefits Bipartisan Politics Insurance Market
  1. Pharmacy benefit managers (PBMs) make a lot of money, often taking nearly half of all spending on drugs for Medicare and Medicaid. This needs to change so that more money goes directly to patients and their care.
  2. There is growing bipartisan support for reforming PBMs, but it’s important that these changes don’t only apply to Medicare and Medicaid. They should also include employer-based insurance plans, as many Americans still rely on them.
  3. Reforming PBMs could lower drug costs for both companies and their employees. It's a move that could save money for everyone and cut out unnecessary profits made by these middlemen.

UnitedHealth Group's 2022 Earnings are in, PBM Optum outperforms health insurance division

HEALTH CARE un-covered • 199 implied HN points • 13 Jan 23
🏥 Health Politics Healthcare policy Insurance Industry Pharmacy Benefits Profit Margins
  1. UnitedHealth Group's pharmacy benefit manager, Optum, is now making more profits than its health insurance division. This shows a big shift in how these companies are making money.
  2. Over the past decade, Optum has seen huge growth in both revenue and profits, while the health insurance side has not grown as fast. This tells us where the real money is for these companies now.
  3. Many major companies, like Cigna and CVS, are also finding their profits mainly from managing drug supplies instead of just selling health insurance. This shows a trend in the healthcare industry where drug supply roles are becoming more profitable.

Big insurer Cigna took in $44 billion in the first 3 months of 2022. 75% came from its drug business.

HEALTH CARE un-covered • 139 implied HN points • 06 May 22
💰 Finance Health Insurance Corporate Earnings Pharmacy Benefits Profit Margins Market Trends
  1. Cigna's huge revenue of $44 billion in just three months shows they are making a lot of money, mainly from their drug business. This means health insurers can earn a lot just from selling medications.
  2. Cigna's profits rose by 12% compared to last year, and they expect even more profits moving forward. This makes investors happy and boosts the company's stock value.
  3. Many Cigna customers face high deductibles and out-of-pocket costs, making it hard for them to afford care. This highlights a problem in the healthcare system where profits might come at the expense of customers' financial wellbeing.
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