FUDiabetes

Anyone else had billing/order issues with CVS?

insurance
cvs

#21

It’s the fake price though… they pay that astronomical amount then receive a massive secret rebate. That’s what keeps driving prices up—- because they’re no longer even relevant to what the true amount being paid by the payor is.

Imagine a simple economy where I sell you something for $1000, and secretly give you $900 back… but then we tell the world that the price is $1000 instead of $100… and everyone agrees that the price is really $1000… what does that do to the market price for that product? The competition is no longer to drive the price down, its to drive the secret rebate up which leads to higher prices—- eg the next guy comes along and says “now I’ll sell this to you for $1500 (then whispers but give you a rebate of $1410) so that’s a better deal” but as far as the world is concerned the price is now $1500

If I could accomplish one thing in healthcare it would be to shed light on this nationwide…


#22

Thanks. I know how the process works. Just stating the “price” that I see on my Insurance website. It’s a simple explanation for these prices. One word summarizes everything you stated: Greed. In other 1st world countries, this corporate greed isn’t tolerated when it comes to healthcare and people’s lives.


#23

Would be extremely simple problem to solve, make rebates to anyone but the end user illegal


#24

I agree that’s one option.


#25

This is a key point.

Also, since PBM’s actually work for the insurance company, require that transactions between PBM’s and insurance companies are public record in the P&L’s of these corporations.

The problem is the secrecy of all of the sweetheart deals they work out between themselves.


#26

I’d be for the elimination of PBM’s altogether. They serve zero purpose imo other than driving up prices. Every middle man that can be cut out may result in lower prices.


#27

I think it’s a perfectly legitimate business decision to utilize an outside contractor for running programs that the insurance company would rather not handle themselves. Nobody should be telling a business how they should structure themselves.

The problem is that the PBM’s and insurance companies do not operate in a normal business/contactor relationship. They are allowed to make secret deals, and conceal them as trade secrets. This is ludicrous.

If an insurance company wants to utilize the services of a PBM, then they should pay the PBM as an independent contractor and have the transactions publicly available in their P&L.


#28

Imagine this parallel analogy. You have a small business. You hire a payrol processer to handle your employees paychecks. They come up with the brilliant secret idea to pay your employees 10x as much as their fair wage via direct deposit, but then remove 90% of their funds from their checking account later in a seperate transaction and transfer that difference to a seperate and secret account that’s protected as a trade secret. Sounds pretty ridiculous. The notion that these types of practices are tolerated in healthcare when they are so blatantly absurd in any other part of the economy is just flabbergasting…


#29

You just made the argument for me as to why they shouldn’t exist.


#30

Wrong.

I just made the argument for the reason that the business relationship between an insurance company and the contractor running their pharmacy benefits needs to be changed.

It is actually a fascistic concept that the government should decide on the structure of a private business. And we live in what’s supposed to be a free market capitalistic country.


#31

I agree with @docslotnick: since health care is highly regulated, it makes sense to regulate business practices, but I don’t think it makes sense to limit freedom of contract.