THE PROBLEM

BIG PHARMA

The research and development of Pharma manufacturers is credited with many of the most important medical innovations in human history. From the discovery of penicillin to current day cancer treatment, we can thank the researchers funded by Big Pharma for saving millions of lives and improving quality of life.

Big Pharma is also great at serving market demand. In an instant gratification society, this can lead to profiteering. To serve demand, 80% of new drugs entering the market today provide relief of a symptom, rather than treating the root cause. You just need one hour of network television to understand the unbelievable advertising budget these companies spend on influencing your members.

With the proliferation of biologic injectables at annual cost exceeding $100,000 per year, plan sponsors (as ultimate payors) are facing the economic impact of this market demand.  Also realize, if you have an employee hooked on opiates, it’s likely a result of Big Pharma profiteering.

Big Pharma has also creatively “greased the wheels” with copay assistance programs to incent (and hook) patients into a lifelong relationship with chemical dependency.

The industry (combined) owns the largest lobbying effort for the creation and support of laws that protect their profits. That doesn’t help plan sponsors. If you’re waiting for government regulation of Big Pharma to cut your costs, good luck.

What we can do is educate our members and prohibit unnecessary scripts.

Plan sponsors have access to many free tools to influence the net cost of an Rx fill, but most just depend on a PBM (Pharmacy Benefit Manager) to do their bidding (in the form of a completely opaque formulary). See The Problem with PBMs to learn why this doesn’t work. 

LOXLEY SOLUTION: 

Custom Plan Docs, Custom Formularies, and leveraged patient assistance when deemed medically necessary.

BIG HOSPITALS

BIG INSURANCE

Rx BENEFT MANAGERS (PBMs)