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8:35 Jun 07, 2025 63,600 5,339
@lorettaboesing
1371 words
Number one rule when contracting with PBMs is that you don't talk about the PBMs and their contracts. Whether provider, manufacturer, employer, or non-affiliated pharmacy, they prevent making public or discussing their pricing terms or any aspect of their contracts. And if you do, they're happy to sue you. Number two, magic names and specialty pharmacies. The PBMs have decided to take the drugs they can charge the most for and call them special. There's nothing special about most of these drugs. Many are generic small molecule drugs. Nor is there anything unique about the captive pharmacies they call special, and as we've heard, force their customers to buy from. We've had patients tell us that they have been charged 100 times more for specialty drugs like Imatinib or Droxodopa than what they or their employers would pay on cost plus drugs. Number three, rebates to employers. I genuinely believe that CEOs do not understand how their healthcare costs work, particularly as it applies to the rebates they receive from their PBMs. They tend to look at rebates as cash paid by the drug manufacturers. Nothing could be further from the truth. The reality is that the rebates are not paid for by the drug manufacturers. The rebates are paid for by these companies' sickest and oldest employees. These rebates could be used to reduce the employee deductibles or to actually pay for the cost of medicines. Instead, they keep deductibles higher, forcing sick and older employees to pay more out of pocket using after-tax dollars. And because of the pricing on specialty drugs, these deductible caps are likely to be reached all while the employee still faces out-of-pocket monthly co-pays for chronic illness medications. Rebates are a way that PBMs destroy and distort employer plans at the expense of their employees. Number four, rebates determine formularies. Rebates are also the reason big PBMs often restrict the medications they allow to be filled. They will often only reimburse for drugs that pay them significant rebates, excluding those that don't. Why leave out a Humira biosimilar like Usimri that is available in Cost Plus Drugs for a true price of $594, when you can charge an employer more than $8,000 per month for Humira? The reality is that formularies should not exist. Doctors should decide what patients need access to, not the PBMs. Number five, shitting on independent pharmacies. I couldn't find a better word. I mean, that is the appropriate word to describe the financial abuse that we've heard about from non-captive pharmacies. These pharmacies have zero leverage. So when the PBMs say they must pay a DIR fee that is calculated on a whim by the PBM, they must pay it. If they decide to audit a pharmacy, they can invent issues, knowing the pharmacy can't afford to fight it. I just talked to an independent pharmacist that is facing $200,000 in fines that is going to put them out of business. Another spoke publicly about how they were fined if a patient doesn't pick up their medications within 30 days. But it gets worse. These pharmacies buy their brand medications, as we've heard, from distributors for a set price. When a patient brings in a prescription covered by insurance, including Medicare Advantage, traditional Medicare, and employer plans, the PBM, which adjudicates that claim, will not fully reimburse the pharmacy for that claim. Literally, the pharmacy, after putting up cash for the inventory and taking sales risks, is expected to lose money on that script. What do you think we'd say about that on Shark Tank? It's gotten so bad that they are transferring brand scripts to the biggest chain, ending the long-term patient relationships, risking that patient's health, and losing front of the house sales as well. I can go on and on and on about the big three PBMs. They are everything that is wrong with this industry. Here's the crazy part. The reality is, there is a fix. Have the federal government states, as we've seen with Governor Beshear in Kentucky, have done, and self-insured employers, stop doing business with the big three PBMs. There is not a single thing that those big three PBMs do that is unique, or can't be replaced by Dr. Price's company, or any other independent, rebate-avoiding PBM. Not a single thing. It's insane when the people in this room, state and federal agencies and big companies, could switch out from those big PBMs and use their competitors, and change an entire industry in less than five years. Which brings us back to the original question, why is Cost Plus Drugs in business? It's simple as well. Everything that I just read you has killed the trust that this country has in our healthcare system. Nobody trusts anything about it beyond their own doctor. At Cost Plus Drugs, our product is trust. We believe that trust comes with transparency. Our Cost Plus Drugs business model is amazingly simple. We buy drugs, and we sell drugs. No rebates, no magic, no complications. We keep our business simple, which allows us to keep our pricing so low. Here's how it works. When you go to Cost Plus Drugs and put in the name of your medication that your doctor prescribed, if it's one of the 2,500 we carry, and our goal is to carry every single one that we're legally able to, it will come up and we will show you our actual cost, what we truly pay for it, our markup of 15%, and the pharmacy fill and shipping fee of $10. Or you can go and choose a pharmacy in our TeamCubanCard network for the same price, plus a fee that goes to the independent pharmacist, so you can pick it up at a nearby location. All of it is completely transparent for anyone to see at any time. In fact, we will be happy to send anyone here or anyone anywhere our complete price list, so you can see what our prices are. Try asking that to one of the big three PBMs. The biggest players do everything possible to hide and obfuscate everything they do. Simply by introducing transparency, real transparency, and working with government agencies and self-employed insurers to act in their own self-interest, and to do what is the best for the wellness of their employees and patients, we can bring back trust and make our system one that we can once again be proud of. Thank you. Let me just ask, it sounds incredibly compelling. There must be some friction, some barriers for people being able to move to this model. Can you talk a little bit about what impediments there might be? From a patient perspective, to start using it, or from someone in a similar business? Generally speaking, whether it be a state government or for individuals, why is it that not everybody has moved to this system? A couple reasons. We talk about regulatory capture, but there's also scale capture. The biggest three PBMs will make you think that they are so big, if you don't work with them, everything will collapse, like Dr. Price, and nothing could be further from the truth. That's one. Number two, if you try to move, like I tried to take my companies and just say, look, we want to add cost plus drugs. They said no, right? And then when we tried to move, as I think Governor Beshear said, when we asked for copies of claims, just so we can see and compare costs, they wouldn't give them to us. They do everything possible to stop you from moving. And three, in terms of adding, I mentioned we carry 2,500 medications, and we have a few brands, but we want to add more. Every single brand that we have talked to has told us that they were contacted almost immediately by the big three PBMs saying, if you move, there are going to be consequences. And so, you know, they're not dumb, right? They're big for a reason, and they do everything possible to retain that size. Alex, did you want to join? Oh, yeah. Well, first, it's an honor and a privilege to be here.

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