Wed. Jun 23rd, 2021

Let’s give some props to DPC’s very own Molly Rutherford, MD, MPH, who wrote this great op-ed in her local media/paper. The article is called Kentuckians shouldn’t have middlemen raising the price of their healthcare and it really hits home. Here are some highlights:

  • Healthcare prices in the state have been on the rise for years. According to the latest available data, roughly $8,000 is spent annually on healthcare in Kentucky per capita—a figure that has doubled since 2000. The state’s spending metrics are on par with the U.S. average, which reveals it’s a systemic problem across the country.
  • A complex web of government regulations and middlemen are to blame.
  • Although well-intentioned, rules associated with the Affordable Care Act created an inefficient system that overly protects beneficiaries. For example, older women don’t need to be covered for maternity care. Likewise, a young healthy twenty-something doesn’t need a fully loaded plan with all the bells and whistles. At the very least, these groups shouldn’t be forced to pay for coverage they don’t need.
  • Meanwhile, injecting transparency into the supply chain of prescription drugs will help make medicine more affordable. Middlemen, known as Pharmacy Benefit Managers (PBMs), currently jack-up the price of drugs for Kentuckians at the pharmacy counter.
  • PBMs act as gatekeepers between drug companies and the patient market. In order to ensure their products make it to the patients, manufacturers are compelled to provide discounts and rebates alongside the drugs. But, unfortunately, the middlemen and insurance companies pocket the savings rather than passing it along to consumers at the point of sale. In 2018, PBMs collected $166 billion in discounts and rebates. You read that right—billion with a “B.”

It is nice to see DPC docs, like Dr. Rutherford, have the guts to go public and fight for their patients. And, yes, PBMs are 100% evil.

9450cookie-checkThe Middlemen in Healthcare

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