| ▲ | cameldrv 4 days ago | |
I'd argue that the insurers are a big part of the problem, but not for the reason you state. Their profit is capped as a percentage of revenues by law (Obamacare). In order to get more profits, they have to increase costs, so it's the complete opposite of normal market forces. It's to their benefit that you have things like hospital monopolies that overcharge, because as long as all of the insurance companies are being overcharged equally, the insurance company makes more money with out of control costs. Now, insurance companies also play games with this law by having a common corporate parent own a PBM which the insurance company contracts with, and then the PBM receives various kickbacks from drug companies, which it doesn't pass on to the prices it charges the insurance company, thus getting larger than otherwise allowed profits for the corporate parent. | ||
| ▲ | toomuchtodo 4 days ago | parent [-] | |
I agree PBMs are also a problem, as my comment mentioned. Several states are working to aggressively regulate them, but until there is more progress in that regard, people who need medication through these systems will experience maximum extraction. Inside the Mafia of Pharma Pricing - https://www.thebignewsletter.com/p/inside-the-mafia-of-pharm... | https://news.ycombinator.com/item?id=40971553 - July 2024 > Today, as a result of these changes, PBMs are big. Really big. The parent insurance companies of the biggest PBMs top nearly $1 trillion in revenue annually, roughly 4% of the GDP of America. Just the top four equal 22% of national healthcare expenditures, up from 14% in 2016. And no other country has anything like the PBM industry. The revenue of American PBMs is larger than what France spends on its entire healthcare system [My note: !!!]. > In 2021, for instance, Kentucky got rid of its use of big PBMs in Medicaid, and saved $285 million out of $1.2 billion its program spent on prescription drugs. It even led to an attempt by the Trump administration to get rid of the ability of PBMs to engage in certain forms of secret rebating. Academics are now focused on the problem of vertical integration, and so is Congress. And there have been dozens of PBM-related hearings - the next one is on July 23 with the CEOs of the ExpressScript, OptumRX, and Caremark - and Congress is closer to passing PBM legislation than it has ever been. https://www.axios.com/2025/06/03/pbms-fight-state-regulation... https://www.axios.com/2025/01/14/pbms-marked-up-specialty-ge... https://www.ftc.gov/news-events/news/press-releases/2024/07/... https://www.ftc.gov/system/files/ftc_gov/pdf/PBM-6b-Second-I... https://nashp.org/state-tracker/state-pharmacy-benefit-manag... | ||