#usaproblems

For the past few years, it has become difficult to afford medicines in the United States. There have been many reports making headlines nowadays on how people are losing their life because they couldn’t afford proper health care. There are very few companies who compete in the drug market and they mostly spend their money on advertising instead of working towards a solution to reduce the prices. The people who can afford such highly-priced drugs are keeping their mouth shuts and people who cannot afford them are being silenced in this complicated system. Access to proper medical health care should be a right that every human being should be given.

A prescription for Humira is an injectable medication that treats a lot of common conditions like arthritis and psoriasis. Its one-month supply’s average cost is $7,037.81 making it the most expensive drug in the United States. Some people sell their life possessions just to afford the medications. Insulin is essential as it is a natural hormone that controls blood sugar levels in our body. An increase in blood sugar can cause vision loss, nausea, organ failure or a decrease of it can cause heart irregularities, mood swings, seizures and you can faint. These small vials used to be sold for $1 back in 1923 when it was first discovered so that it can be affordable and be available to the general public who needed it. But now that purpose seems to be lost somewhere.

When it comes to pointing fingers, people blame the pharmaceutical companies, who then blame the government regulations and insurance providers. But now slow changes are happening with third-party negotiators called the PBM.  

What does the third-party PBM do?

Many insurance companies enlist them, to fix discounts with drug manufactures so that the co-payment that patient gives out from their pocket is reduced.

The third party that was involved and is the Pharmacy Benefit Manager (PBM). According to the American Pharmacists Association, they are responsible for:

Developing and maintaining the formulary (List of Medications)

Contracting with Pharmacies

Negotiating discounts and rebates with drug manufacturers

Processing and paying drug claims.

The founder and CEO of RxParadigm Mesfin Tegenu stated that “For all intent and purposes, transparency and competitiveness do not exist in the prescription drug market because of an outdated drug rebate negotiation culture that allows a select few companies to see higher margins and, in turn, dominate the entire prescription drug ecosystem.”