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Here is a boring story that it literally murdering you.
https://news.bloomberglaw.com/us-law-week/drug-middlemen-shift-arguments-to-escape-liability-state-laws/
It's about "pharmacy benefit managers," a phrase engineered to cause your eyes to glaze over.
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https://news.bloomberglaw.com/us-law-week/drug-middlemen-shift-arguments-to-escape-liability-state-laws/
It's about "pharmacy benefit managers," a phrase engineered to cause your eyes to glaze over.
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PBMs are middle-men your employer pays to manage your medication. They decide which drugs your doctor can prescribe for you and negotiate the price that they'll pay drug companies and retailers for your meds.
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But the largest PBMs are divisions of monopolistic insurers like CVS Health (CVS Caremark) Cigna (Express Scripts) and United Health (Optumrx). They have a conflict of interest, and a history of abusing patients by denying them med and/or charging vast co-pays to fill scrips.
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In theory, 1974's Employee Retirement Income Security Act requires PBMs to be "fiduciaries" - legally obliged to act in your best interest. In exchange, ERISA bans states from meddling in PBM business, in the name of keeping administrative costs low.
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Like many industrial regs, ERISA imposes a burden and offers a shield: act as a fiduciary and you escape a patchwork of 50 state-level regulations.
But like any monopolistic industry, PBMs have lots of money to spend to get right of the burden and keep the shield.
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But like any monopolistic industry, PBMs have lots of money to spend to get right of the burden and keep the shield.
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The largest PBMs have been busily fixing drug prices at sky-high rates and passing the costs on to employers and their employees. This is DEFINITELY not acting as a fiduciary!
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When the people who can no longer afford their meds bring class-action suits, the PBMs cite ERISA's ban on state regulation and walk away.
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Meanwhile, they argue that when they price-gouge on drugs, they're not engaged in the part of being a PBM that requires them to act as fiduciaries, and further, that almost nothing a PBM does is bound by fiduciary rules.
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I am fully aware of how boring this is: words like "fiduciary" and acronyms like "PBM" and "ERISA" are eye-glazers without parallel. But the upshot is this: tails they win, heads you lose. And what you lose is the medication that keeps you alive.
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