[jachriga]

PBMs finally being on the chopping block is 20+ years overdue, and the American public have consistently refused to accept that drug manufacturers aren't solely responsible for high drug prices. Having worked with the JDRF in the past, it's never been a secret that while the list price of insulin has been going up...the net revenue per unit has actually gone down (albeit only slightly). Total profit has been scaling upwards because of a massive push of type 2 patients towards insulin, increasing sales volume.

Knowingly pushing type 2 patients towards insulin when cheaper, better options for them might exist can 100% be blamed on the manufacturers; however, the oft-maligned list price increases have a lot to do with the mostly-secret negotiations between manufacturers, PBMs, and health plans (many of which share ownership with the PBMs). A big effect of those negotiations helps to artificially increase the amount of dollars spent on drugs (on paper) while also artificially decreasing the actual dollars spent, making it easier for health plans to hit the ACA 80/20 rule with elevated premiums.

All of this to say...none of these price negotiations or middlemen entities (I'm counting health plans as middlemen between patients and their drugs...) should be targeted by the FDA, as that's not their responsibility. The FDA should be focused on the clinical side only as much as possible. Much to my chagrin, some amount of credit for PBMs and drug rebates being part of the modern conversation goes to the Trump administration.

[howard941]

They may be hitting the 80/20 rule W/R/T PPACA premiums but the out of pocket for almost everything not negotiated by the executive branch is out of this world. Common generics have become crazy expensive. Don't even go to the on-patent meds: They're unaffordable for all but large employer plans and the policies covering Federal employees.

[jachriga]

They only hit the 80/20 because of the account-keeping shenanigans allowed by the PBM/manufacturer/plan negotiations. It would not surprise me if the rebate system were completely done away with and health plans had to spend the real amount compared to what they "spend" now, that premiums would go down and/or coverage would go up. I don't believe for a second that there are any such backroom negotiations involving a mostly-invisible 3rd party (the PBMs) that benefit patients in any way.