5 PBM Tricks in 1 Training Session

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AHealthcareZ - Healthcare Finance Explained

Күн бұрын

5 Pharmacy Benefit Manager (PBM) Tricks in 1 Training Session
Learn:
1) Hidden PBM Money Flow
2) Spread Pricing
3) Rebating
4) GPO Safe Harbor
5) Regulatory Capture

Пікірлер: 29

@themattgorman 5 күн бұрын

I just watched this (July 2024). I made a living in this space 25 years ago as a data analyst and then about 12 years ago as a business unit director of government programs. I am amazed by how little has changed. As I prepare for a phone screen interview to return to this work (hopefully, the interview goes well), I am verily enjoying several of your videos to re-familiarize myself with the mess of it all. THANK YOU!

@ahealthcarez 5 күн бұрын

Thank you for watching and for your comment.

@johnpetrosky406 Жыл бұрын

Very insightful. Thanks. Keep fighting the good fight.

@ahealthcarez Жыл бұрын

Thank you, John.

@rufussweeneymd Ай бұрын

I know I’m late to the party, but I am wondering how direct primary care doctors buy their medications. Are there wholesale companies that will do this? Wonderful as always, Dr. Bricker.

@ahealthcarez Ай бұрын

Direct primary care doctors can dispense medications only in certain states (e.g. Kansas). In other states, it’s against the law (e.g. Texas). There are large distributors such as McKesson.

@rufussweeneymd Ай бұрын

I’m in Utah, and they just changed the law to enable docs to do this. Thanks for your response!😊

@apark8787 Жыл бұрын

Data fees, portal fee, and the most ridiculous one I’ve seen is “compliance” fee

@ahealthcarez Жыл бұрын

Buckle and dime. Thank you for watching.

@ach3322 10 ай бұрын

Would love to see the questions and answers to the questions asked during the live session.

@ahealthcarez 10 ай бұрын

Thank you for watching and for your comment.

@toucheyang89 10 күн бұрын

What are your thoughts on the recent article the NYT published on PBMS/big 3?

@nechamia Жыл бұрын

Can you discuss what if any relevant legislature has been done to curb the shadowy dealings with PBMs? Any strategies for us docs in leveraging knowledge of this cabal to improve the ability to deliver care?

@ahealthcarez Жыл бұрын

Great question. You as your own practice as an employer should demand from your own insurance broker that you use a transparent PBM and not one of the big 3. You must be a self-funded employer to do this… so first step is to move to a self funded plan. Gotta lead by example. Thank you for watching.

@vincentkingsdale8334 6 ай бұрын

The pharma industry self regulated itself back in the mid 2000s. I wonder if they did that bc it would be hard to discern if the pharma companies were getting kickbacks from Medicare/Medicaid vs private health plans??

@ahealthcarez 6 ай бұрын

Thank you for sharing your thoughts.

@jeremyhuynh7106 Жыл бұрын

wow

@ahealthcarez Жыл бұрын

Thank you for watching and for your comment.

@liberoAquila 7 ай бұрын

How are drugs prices the VA and Military Health System pay so much lower? Do they source through PBMs or they have some direct sourcing process? We prescribed levabuterol quite often in the military, in a civilian hospital they looked at me like I was crazy.

@ahealthcarez 7 ай бұрын

Most likely direct. Thank you for watching.

@vincentkingsdale8334 6 ай бұрын

How would you simplify this overcomplicated mess we call the US healthcare system of you had a magic wand? For example, would you get rid of health insurance alltogether and go back to a true fee for service model? Thanks in advance

@ahealthcarez 6 ай бұрын

Good question. Steven Brill had some good suggestions at the end of his book ‘America’s Bitter Pill.’ 1) Hospitals and Insurance Carriers would be one and the same (I.e. Everything would look like Kaiser), 2) Price controls for drugs. Thank you for your question.

@vincentkingsdale8334 6 ай бұрын

The GPO should be under the umbrella of the AKS and should not be exempt from it

@ahealthcarez 6 ай бұрын

Agreed. Thank you for watching.

@Malachi_Knows 7 ай бұрын

What can primary care providers who practice in states that cannot dispense, do to disrupt this system? How do compound pharmacies disrupt this system?

@ahealthcarez 7 ай бұрын

Prescribe low-cost generics in a clinically appropriate manner as much as possible. Have patients use GoodRx for pricing instead of their insurance.

@vincentkingsdale8334 6 ай бұрын

I hate getting red pilled.....good to know, but what can be done about it? If there is no solution to help the patients, then knowing this is just torture.

@ahealthcarez 6 ай бұрын

If have insurance, must call around to different pharmacies to get pricing for your particular insurance. If doc prescribes brand, ask “Is there a generic medication that treats my condition?” Won’t always get yes, but often will.