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What Determines Access To Expensive Medications? • Availability
Who Constructs the Formulary?
What Do PBMs do?
PBMs claim to save billions for our health care system Designing formularies based on "negotiated discounts"
Being on the Formulary Is Very Important
The Price Concession System (Rebate + Fees)
PBMs Claim They "SAVE" Billions Of Dollars Through Their Preferred Formularies (& Use of UM tools)
Co-insurance Based on List Price
How Often are Copay Cards used When There is a Lower Priced Generic? • An IQVIA analysis of claims data from 2013-2017
The Transparency Problem