Express Scripts CEO on PBMs and rising costs of drugs

[@jonieisenberg2794]

Prices go up because PBM's take the overage and put it in their pockets.

[@justinfancher9208]

Here are some good questions to ask this guy the next time a major network interviews him: Is it true that some plans prefer the brand name over the generic? And why? Is it true that PBMs often pay a pharmacy below the cost of the drug, especially on 90 day brand names? Why is it that an estimated 10-25% of prescriptions get paid below cost plus $5? Ask them about DIR fees and why they need extra money for quality measures when nobody else gets paid extra for providing quality measures. This guy says he's a fan of transparency. Ask him why it's in their contracts that telling a patient what you get paid (or lack thereof) can cause the PBM to terminate their contract with your pharmacy. These guys are middle men who are "for profit" companies. They have leverage on every area of health care: doctors, hospitals, insurance companies, pharmacies, and drug manufacturers. They will always be the first to make a profit unless we can get some regulation on them. This CEO just said that prices increased at Express Scripts by 2.5% ... but he also said that it's a PBM's JOB is to decrease overall drug and healthcare costs for the patient. If their job is to lower cost, how come none have? Especially the #1 PBM out there.

[@jonieisenberg2794]

YES, IT IS TRUE THAT PBM'S PAY THE PHARMACY LESS THAN WHAT THE PHARMACY PAYS FOR THE DRUG. THEY DO NOTHING BUT PAD THEIR POCKETS,

[@vincentkingsdale8334]

Very good questions....are you a doc or work for a drig company? How did PBMs come about, and more importantly, how are they legal? Its like the mafia, taking their cut.

[@danthomas9321]

Because of PBM and specifically express script, local pharmacies have been dropped from military retiree Tricare (15,000 in total). Today I had to pay all my medication out of pocket. Because of my area, the best option for travel is not a CVS or Walgreens. These people are making it more difficult for veterans and killing family owned pharmacies. They are forcing veterans to use their mail pharmacy. I used controlled medication and live in the middle of nowhere which already has delays in mail and this is what they want me to hinge my medication delivery and life on for you to make a profit? Kind of seems like you’re screwing over veterans and small businesses.

[@jonieisenberg2794]

It sounds like you want to drive the independent pharmacies out of business. Our pharmacy is over 100 years old and going broke.

[@samfawaz9312]

Jonie Isenberg sorry to hear that. It’s heartbreaking to hear things like that. I also own a pharmacy and it’s almost scary to have another new client walk through our door because we don’t know if I’m gonna lose money or his plan will eventually send him off mail order I don’t know another industry that has the same challenges that pharmacies face Most merchants make more money selling cookies than pharmacies sell life saving meds There needs to be a minimum profit set that PBM may not pay below otherwise they are self regulatory companies with no oversight and that should be a big NO

[@carlosgarcia-jz3dq]

SPREAD PRICING, GAGE CLAUSES, STEERING, DIR FEES. thieves, cheaters, criminals. America wake up

[@Heavy_Distortion]

You've just heard the definition of a lie.

[@kam.26]

So PBMs are similar to the Group Purchasing Organizations (Premier, HealthTrust, Vizient, etc) for medical supplies. They aggregate the purchasing power and negotiate better prices than if a pharmacy tried on their own. They take a cut of the rebate and likely pass some back to the pharmacies. But no one NO ONE passes savings to the patients.

[@vincentkingsdale8334]

The PBMs are the problem. Why need a middle man to overcomplicate things??? This CEO of ExpressScripts is a scumbag, lying to their faces

[@davenpjp10]

They do not pass it onto pharmacies unless the PBM owns the pharmacy (cvs and Caremark or express scripts and their mail order). Independent pharmacies are paid below cost every day on a lot of medications. The top 3 insurance companies have PBMs and are fortune 15 companies in the US. They control 80% of market share. Express scripts is the one getting rich off you, not pharmacies

[@SuperTWIY]

I think they normally pass it to their clients, which normally is the insurance company. The insurer has a system to use it to reduce the costs for the patients, they normally do not pass it on to the patients directly. To give you a picture of how much an insurance company just keeps money for itself (profits) and how much it spends for the patients: Aetna had a medical benefit ratio of 95 % in 2024, which means that they couldn't even cover their whole costs, they lost money in this year. So are they keeping rebates for themselves and ripping of patients? Doesn't seem so.

[@medicostudy101]

His eyes look weird... as if he's hiding something or trying to give a blank stare

[@castello544]

20 years late but you're finally doing some reporting

[@jonieisenberg2794]

What about the drugstores that receive nothing for filling a script?

[@benangel9205]

True, reimbursement rates are at an all time low.

[@brookeepps1080]

“We get results”. No you don’t

[@bobdrake7611]

Express Scrips IMO, is the worst.

[@1brunohoffmann]

simple force pharma to lower the price and ship direct to pharmacies and customers get rid of all. keeps men period.

[@lesterburris1]

The clients have no idea how much money is going where - total lie

[@oliviat7054]

I can't sleep at night because have to get meds from express scripts. And can't afford it.

[@Windextheprettyblueliquid]

I can't believe the price of insulin now. Insulin prices have gone up and there is no generic.

[@shadow1591]

example, astrazeneca symlin pen 372.00 @ walgreens ~vs~ cvs 186.00. packaging, dosing, etc. appear the same with 1 major difference. drug package in fine print from cvs says "sharp mfg." made for astrazeneca. AstraZeneca is formulary Sharp is not.

[@lorettaboesing]

They should have never been able to do this. STOP the greed

[@stevee.4869]

Express Scripts is a racket too. I called to get prescription, I get oh you owe us $25 so we can't order yer prescription.

[@carlosgarcia-jz3dq]

All this guy is missing is a white cat on his lap

[@ernestogutierrez7929]

Positive interaction with Xpress Scripts. If bif pharma lowered the price it would eliminate the middleman, but they won't, so the theory is bulk pricing lowers the price.

[@noodlefarmer7]

This weasel is scared

[@OM-PeaceE]

Drug Cartel..

[@wfrog99]

Not only do they not cover my insulin they are supposed to cover, they actively interfere with me paying for it myself. They tell me I can go to the ER if i need insulin so bad.

[@steliohun]

Express scripts is awful avoid them at all costs if you can

[@Deberry59]

It just depends on the plan. There is a cost approved area, or "what the plan and esi agrees upon the maximum amount to be charged for an Rx" this negotiated amount is then paid for according to plan guidelines. The only problem is if there is a cost that the plan will not approve for because of esi attempt to get the lowest cost. This causes the person to feel like they are being forced into making a decision or having a decision made of their medication. Esi attempts to reduce the cost by offering the ability to have the medication delivered to the member directly, cutting cost approved at local rph. This causes again member to feel like they are being forced into a specific way of getting their meds. The lower cost impact is not something you see right away, so the member calls the agent, and yells in confusion about something they got a letter and threw away. Keep in mind this agent will take about 50-70 of these calls per day B2b with only "try to put yourself in the customers shoes" as a reminder and tool to prep for the onslaught of verbal abuse you are about to receive because all you can do is explain what's causing these changes, not like you did it directly, then eventually you can't take it, scream at the top of your lungs at some 67 year old lady, pass out, and now you went from being an agent, to a customer that works for the business, and has to pull extra hours for their new rx for anxiety and antidepressants. All part of the plan... (I'm speaking with a counselor I don't have suicidal thoughts anymore!)

[@OrlandoQuentin-f1y]

Thompson Sarah Lopez Brian Gonzalez Daniel

[@TheLipito86]

Express scripts is fantastically strange

[@HansenKay-q1h]

Davis Deborah Allen Angela Lee Daniel

[@karenreiter533]

There isn’t any supervision of generic drugs. Generic drugs could have little or nothing of the drug in them. It is beyond horrible to do this to people. Why do you want to force people to take a tablet that has no medicine in it??????????? Sure this CEO says it’s all someone else’s fault and not his company.

[@MartinKirk-y5v]

Garcia Donald Martin Deborah Martinez Cynthia

[@rphmansour2603]

I believe that this man is telling the truth. Actually, the negotiation tool, a huge number of patients will use the drug, that he mentioned in the interview is a very important tool that could be used when the negotiator set with drug makers.

[@pooploops]

You're a sheep. PBMs do not save you money lol

[@OleneHadden-v2p]

Johnson Donna Thompson Carol Garcia Eric

[@jonnash5196]

How do you know when they are lying ? When their lips are moving

[@chrislemaster2695]

I use Good RX gold

[@GsyshbagFsyuabag]

Taylor Brian Clark Donald Jackson Robert

[@kill7402]

This rat is going to run Walgreens into the ground.

[@SANDEEPBHATTARAI-vk7uk]

CEO is not making any sense!!!

[@utbigpapa]

You're not comprehending what he's saying

[@kdausu90]

Is her inner-lip not working?

[@newjerseylion4804]

This is why we need a single payer healthcare

[@kam.26]

Oh heck no!!! You think the government will do better than a company? Lol. They are even worse because they are all taking kickbacks from lobbyists.

[@vincentkingsdale8334]

Are you serious? It is bad enough as it is already. A single payer would be even worse, as there would be absolutely zero competition. One entity would dictate everything, and not to our benefit

[@davenpjp10]

80 percent of payment of drugs are controlled by the big 3, Optum, CVS Caremark, and express scripts. It’s already single payer except in terms of corporate welfare. These companies are opaque, not transparent. They have vertically integrated and are the riches companies in our country. They don’t care about you or any other patient, just the bottom line.