Ty Beringer

The answer to yesterday's poll: tripled. Access to affordable insulin is as important as food and water for those who need it. #InsulinAffordability

I hear your point on PBMs, but they’re not the only ones to blame here. Manufacturers could absolutely offer say GLP-1 drugs at $149/month directly to consumers—many have the margins to do so—but they don’t because they work hand-in-hand with PBMs to keep prices inflated. Take GLP-1 drugs like Ozempic. Novo Nordisk sets a U.S. list price around $1,000/month, while the same drug costs $150 in Canada. Even after PBM rebates, the net price in the U.S. is still 5-10x higher than overseas (Health Affairs, 2023). Manufacturers inflate list prices knowing PBMs will demand bigger rebates (often 30-40% of the list price), which PBMs then partially pocket while still charging plans based on the inflated price. A USC study showed for every $1 in rebates, list prices rise by $1.17 (USC Schaeffer Center, 2023). Manufacturers also guarantee PBMs sales volume for formulary placement, e.g., Humira kept 98% market share in 2023 despite biosimilars because PBMs listed them at the same high price (46brooklyn Research). This isn’t just PBMs acting alone; it’s a symbiotic deal where manufacturers set high list prices to maximize revenue, and PBMs profit from the spread. Your Cost Plus Drugs model proves manufacturers can sell at cost + 15%, but they choose not to because the current system with PBMs lets them rake in more. Transparency is key, as you say, but we need to call out manufacturers too. They’re not innocent victims here. They could bypass PBMs and offer fair prices directly, but they don’t because this collusion keeps profits high for both.