Your PBM's drug rebates may pass through a shell company in Switzerland or Ireland before a dollar reaches your plan. It's called a rebate aggregator, or GPO. Your PBM owns it. It takes a cut before the "pass-through" even starts. How the structure works:

Mail-order steering: same drug, same dose. Filled at the retail pharmacy, one price. Filled at the PBM's own mail-order pharmacy, another. The PBM sets both, and writes the rules that nudge your members to the one it owns. Convenience with a markup attached.

A costly PR campaign run by PBM lobbyists in DC doesn't fix the massive conflict of interest stemming from vertical integration. As long as PBMs own specialty pharmacies, mail-order operations, and GPOs and manipulate the supply chain, they're running a legalized shell game at the expense of consumers and taxpayers.

When Pharmacy Benefit Managers say they're being unfairly blamed for driving up the cost of prescription drugs, they're indicting the Federal Trade Commission, Congress, @mcuban, the USC Shaeffer Institute, HUNDREDS of physicians, the NY Times and WSJ, just to name a few.

Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies. They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight. Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient. This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country

"Importantly, #pharmacies are not closing because PBMs found a cheaper option elsewhere. In many cases, the PBM-owned option is actually more expensive overall," TPA member and independent #pharmacy owner Crystal McEntire explained to Chair @LoisKolkhorst and the Texas Senate Health & Human Services Committee today. "Pharmacies are closing because the PBM pays itself more and the independent pharmacy less, making the average appear fair on paper." #PBMReform #txlege

Insurance companies’ ownership of pharmacies and hospitals is raising consumer costs, but economic competition can counter inflating expenses, according to bipartisan legislation from Sens. Josh Hawley, R-Missouri, and Elizabeth Warren, D-Massachusetts. “We need more competition. We need protections for patients. We need better and cheaper health care,” Hawley told The Lion in an exclusive interview Thursday. Hawley and Warren reintroduced The Patients Before Monopolies Act last week to counter the monopolized medical field, in step with their second bipartisan bill, The Break Up Big Medicine Act. The Patients Before Monopolies Act prohibits pharmacy benefit managers (PBMs), the middlemen between pharmacies and insurance companies, from owning pharmacies and hospitals, Hawley explained. “What’s happening is more and more of these insurance companies are buying up everything,” Hawley told The Lion. “They’re buying up the pharmacies. They’re buying up the doctor’s offices. They’re buying up the hospitals.” @HawleyMO Read full story: bit.ly/4vglY42

🚨 JUST IN: Trump anti-fraud AAG Collin McDonald says 450 MAJOR FRAUD incidents have been BUSTED in under 2 months JD Vance's task force is CRUSHING it 🔥 "The scope of this is larger than ever. We are now putting the necessary resources behind the fraud crisis that we're facing in the country. And we're off to a great start." "We're over 450 major fraud events at this point, just in the first 52 days of this fraud division. And we're just getting started."

New PBM “cost-plus” reimbursement models may carry significant financial and legal risks for pharmacies, including margin erosion, confidentiality concerns, and reimbursement penalties tied to acquisition cost guarantees. Read more about what pharmacies should carefully evaluate before signing new PBM reimbursement agreements. bit.ly/3Q3hHSp #PBM #PharmacyLaw #IndependentPharmacy #FrierLevitt

Question for our government @AFergusonFTC @MeadorFTC @DonaldJTrumpJr @SecKennedy @DrOzCMS @WaysandMeansGOP @WaysMeansCmte Question for @Aetna and their PBM CVS/Caremark, BOTH owned by @CVSHealth $CVS I filled an antibiotic cream for a burn for a @MedicareGov patient. You paid our Pharmacy $1.40 Total! Let me say that again. You paid $1.35 for the drug and $0.05 dispensing fee. A total of $1.40 For my license, malpractice insurance, software to bill insurance, label, the tube of cream, my liability, counseling, and record keeping Does that seem ethical? How much do you bill @CMSGov when this is dispensed from @cvspharmacy? @FrierLevitt @BergerMontague why is this legal?

Just did a price check online through Medicare.gov for #60 pregabalin (Lyrica) 75mg capsules utilizing the Part-D Plan @WellcarePlans Walmart price = $34.47 CVS price = $33.60 Walgreens price = $33.60 Kroger price = $33.60 Genoa Healthcare (subsidiary of United Healthcare) = $12.45 Any independent pharmacy = $4.80 Does anyone see the problem here? Is @WellcarePlans comfortable paying large chain pharmacies 7x more than an independent pharmacy for the same prescription medication? Apparently they are. So much for @ExpressScripts “negotiating” lower prices for Americans. How many unsuspecting people get screwed when their local “cheap” pharmacy option closes because $4.80 doesn’t cover their operating expenses, let alone the cost of the drug? Then their only options are Walgreens, Walmart, CVS where they get to pay over $30 for the same drug. Small pharmacies aren’t negotiating to be the cheapest option. If we accept the insurance contract, they TELL US what we get to charge the patient. Make it make sense! @DrOzCMS @DonaldJTrumpJr @realDonaldTrump @DrMakaryFDA @CMSGov