The “Big Three” PBMs just got exposed, and I’ve watched this happen from the inside.
Since joining Oration back in 2012 and then at VIVIO in 2016, I’ve known about how CVS/Caremark, UnitedHealth/Optum, and Cigna/Express Scripts operate.
The Hunterbrook investigation ( https://lnkd.in/gy_BgfNm ) confirms what industry insiders have long understood:
These companies created offshore shell subsidiaries (Zinc, Emisar, and Ascent) that exist almost entirely on paper. Ghost offices in Minnesota, Dublin, and Switzerland. Fewer than 150 employees total. Yet they extract BILLIONS in fees from drugmakers that never reach patients or health plans.
The scheme is elegant in its deception: Promise to pass through “100% of rebates”, then reclassify the money as “fees” routed through these shadow GPOs. As Mark Cuban put it: “They are covers for the Big Three to say in a contract that they pass through 100% of the rebates they get.”
I tried to fight this. So have other solutions in the market. But none of us made a dent big enough to change the broader market. Why?
Because customers keep buying from the Big Three. While at VIVIO, how many times did we hear from consultants that they had ‘100% rebate pass-through’ and so they didn’t need us? The sad part was, both they, and we, knew the truth. The employer listened to the deeply financially conflicted consultant nine times out of ten.
Then there were the PBMs themselves. One person I talked to a couple of weeks ago put it this way: “I have no illusions about who I work for.” Anonymous, for good reason.
Which is why this Hunterbrook investigation is so important, It sheds light on what everyone in the industry cannot talk about. The ‘wink and a nod’ is now public.
When your company chooses Optum, ESI, or Caremark for employee benefits, or picks a big insurer with a PBM subsidiary attached like a tapeworm, you’re not just accepting higher costs for your employees.
You’re feeding a system that drives up drug prices for ALL Americans.
This is why we launched Ten Ten Ten.
Our mission: Make the U.S. a top 10 nation in health outcomes while reducing healthcare spending from 18.5% to 10% of GDP within 10 years.
That won’t happen until we change WHAT the market buys.
If you’re an employer, benefits consultant, or anyone who touches healthcare purchasing decisions. You have more power than you realize.
👇 Sign the pledge www.tententrn.org and join us in demanding transparency, accountability, and a healthcare system that puts patients over profits.
#HealthcareReform #PBM #TenTenTen #HealthcareTransparency #PrescriptionDrugCosts
Originally published by Bhargav Raman, MD
Cofounder, Clinical Strategy and Analytics
https://www.linkedin.com/posts/universalistmd_bullshit-the-new-way-health-giants-hide-activity-7415399488896548866-tcel
