Pharmacy pricing and benefit design are fundamentally broken.
For proof, look at GoodRx’s 2020 financial results for its discount card business. The company accounted for an estimated $3.4 billion in U.S. prescription revenues—and earned nearly $500 million in fees from PBMs.
Incredibly, three out of four consumers who used GoodRx already had commercial, Medicare, or Medicaid insurance. This means that someone—the consumer, their employer, and/or the government—paid insurance premiums for a pharmacy benefit managed by a PBM. Yet it was still worthwhile for people to bypass their plan’s out-of-pocket costs and PBM network rates in favor of a different PBM’s rates. As I explain below, such arbitrage creates potent conflicts between PBMs and their plan sponsor clients.
Don’t blame GoodRx for this mess. I give it credit for helping consumers navigate a crazy system that incentivizes people to bypass their own insurance plans. But it’s hard not to dislike a system that enables these games. Read on and let me know what you think.
The unusual alliance between PBMs and discount card vendors is among the many topics that I’ll address in DCI’s upcoming live video webinar, Drug Channels Quarterly Update: Patients, Payers, and PBMs , on March 26, 2021, from 12:00 p.m. to 1:30 p.m. ET. CLICK HERE TO LEARN MORE AND SIGN UP.
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