Avi Assidon, MD

Gotta be honest. The @realDonaldTrump EO on healthcare and in particular, drug pricing could save hundreds of billions. Here is how: 1. Divorce formularies from PBMs. Require them to come from independent organizations with no economic incentive from the formulary Make them about wellness, not pay for play like a grocery store endcap. This ends rebates and allows for net pricing. It also allows for better care and wellness. 2. Require PBMs to provide ALL claims data to employers, states and manufacturers. The manufacturers need this to provide better results. It’s insane they don’t have this data to analyze and improve patient results. Plus they current pay 5 to 10 pct of the retail price to get that data so they can do just that. Make it so it’s required and they can save 10pct of RETAIL pricing , which they can use to lower pricing. This also stops the 340b double dipping problem. 3. Remove the specialty tier and the requirement to buy from any specified pharmacy. There is nothing special about specialty drugs. They call them special to jack up the price. And of course have them divest any that they do. 4. Require that all pharmacies get fully reimbursed for brand drugs and get rid of the Generic Cost Ratio which allows distributors to jack up pricing on generics with the threat of chargebacks and more.. We need independent pharmacies to thrive 5. Remove confidentiality clauses. They prevent companies from talking to manufacturers. It’s insane that your company can’t talk to a GLP1 manufacturer (as an example) to help you put together a wellness plan and get you a better price 6. Stop biosimilar substitution calls. PBMs know that they need to find new sources of margin. They do it by white labeling their own biosimilar versions. That’s fine. But because that’s where all the margin is, they will put a low cost biosim on the formulary, and when they get a script for the lower cost option, they will have someone call the prescribing doctor to switch to their more expensive version they make more money on. And because employers and manufacturers don’t get their data. They never know Put me in coach ! I’m here to help.